 Good afternoon, I guess it is, everyone. And thanks for joining us today. I'm Adrian Dix. I'm V.C.'s Minister of Health. And I wanted to acknowledge that we're on the territory of the Musqueam of the Squamish of the Slava-tooth First Nations. And we're honored to be here on their lands. And of course, I'm grateful to have you with us today. Joining me and all of whom will be speaking in this presentation, which is a substantial one, are my colleague and the Honourable Ann King, Minister of Advanced Education and Skills Training, Jamie Wigston, the President of the British Columbia Pharmacy Association, and Dermot Kelleher, Dean of the UBC Faculty of Medicine. I think that's a better title than Minister of Health. That's a good title. There you go. It's good to see you, Dermot. It's great to have all of you here today. Today, we're talking about, of course, and what we're going to cover are a number of key issues with respect to the healthcare workforce. And my colleague, Minister Kang, and I have been working diligently on this question, not just over the last number of months, but over the last number of years. We are announcing today, B.C.'s and presenting today, B.C.'s Health Human Resources Strategy, which is a five-year strategy for a diverse, accessible and sustainable healthcare workforce and system. Its goal is to deliver the care for patients and its centerpiece, the care for patients, the patients in our province deserve. We are going to be announcing some key actions today and in the Health Human Resources Plan are 70 total actions across a range of priorities and we're going to speak to that through this presentation. And then, Minister Kang is going to make some specific announcements, as will I, that are actions that are taking place today and announcing today. Obviously, over the last number of years, we've invested significantly in healthcare to provide better care for patients, a billion dollars to address long-standing challenges facing our healthcare workforce since 2017. In that period, since I've been Minister of Health, and I think we know this because we count our workforce and we ask our workforce to do a great deal through two public health emergencies. We've added net 38,000 new workers to the provincial health system. We've added more than 1,000 people to primary care networks, urgent and primary care centers to support our primary care system. In that period, the number of family doctors in BC has increased by more than 600. 7,000 staff have been added since September of 2020 through the long-term care systems, notably in the HCAP program. We've hired back 4,000 housekeeping and food service workers through the repatriation of contracts, and we've expanded nursing seats and physician residency spaces and healthcare assistance spaces and allied health spaces throughout our healthcare system. In 2022, for example, and dealing with the urgent focus required to deal with the growing demands of our system, we've added new bursaries and recruitment supports and broken-through barriers for hiring internationally educated nurses and healthcare assistance pursuing practical nursing. We've changed the provincial nominee program to prioritize healthcare workers. 602 new nursing seats have been added across the province, and those are part of our Health Human Resources plan. We've invested, of course, recently $118 million to support family doctors. We've added 150 paramedic positions and, of course, considerably more. But all of us know the challenge, and I get this quite a bit. People understand that we've added 38,000 healthcare workers, but they say it's not enough, and it isn't. Demand over the next decade will grow, and there is significant demand now. We're in the midst of two public health emergencies, and that's significant, and our healthcare system is in the midst of that population, and the inadequacy of where we were before these changes were brought in. BC, as people will know, was 10th in Canada in registered nurses, which would be good if there were 100 provinces, but there were only 10. When I became Minister of Health, we had gone through a generation of treating healthcare assistance poorly in our system and assigning them laws that were profoundly unfair. We've had both the COVID-19 pandemic and the toxic drug supply, the overdose public health emergency, the aging population, and significant challenges, not just for patients, but for healthcare workers in our system, from stress and burnout to high staff turnover and retirements. This is not just a BC problem. The World Health Organization forecasts a global shortage of 15 million health workers across health systems by 2030, 15 million. Other jurisdictions, as you know, across the world and in Canada are facing significant challenges now. Some of the challenges we're facing and indeed worse, we expect by 2032 demand for healthcare services to increase by 14% in BC on top of what we must deliver now, and that doesn't include the very significant new programs that we're adding to the issues of mental health and addiction. Our healthcare workers and our patients are both facing some of the strains and pressures of all of this that's going on, and we acknowledge, and I acknowledge, the strain and pressures healthcare workers have been working under over the past three years. We intend to work together with every aspect of the healthcare system and with patients to develop solutions that will make a career in healthcare a more sustainable model. This includes, as all of you know, and it's going on now, the ongoing talks with doctors of BC on creating a new compensation model, for example, for family practice doctors, which brings us to our strategy, the stronger BC for everyone strategy, BC's health human resources strategy putting people first. The strategy lays out 70 total actions under four central pillars, retain, redesign, the strategy is a key approach in delivering comprehensive and quality public healthcare services to people now and in the future. Retain, that's fostering healthy, safe and inspired workplaces by supporting workplace health and wellness, embedding reconciliation, diversity and inclusion in cultural safety, and by better supporting workers in high needs areas. We need to not just recruit healthcare workers, we need to ensure that healthcare workplaces provide healthy workplaces for people to work. We need to redesign our system and we've seen some of these actions already and you're going to hear about two of them today involving ambulance paramedics and first responders on the one hand and pharmacists on the other hand, making changes to systems and practice to improve the quantity and efficiency of care ensuring that all of our healthcare workers can work to their scope of practice and work fully to their scope of practice and support them in doing that and work more effectively as teams in our system. We need to recruit more healthcare workers of course and that means attracting people to new and existing vacancies, reduce barriers for internationally educated workers, you've seen some of that already and improve practice readiness through supportive on loading. That means when people come that we have systems in place to ensure that their work here is successful and training, we need to strengthen employer supported training models so that people can ladder up that people who are working in the healthcare system can aspire to new jobs and new responsibilities in that system and of course expand education seats which we've already done as you know, recently announced that BCIT for allied health professionals for nurses and we're going to make some announcements Mr. Kang is going to make some announcements with respect to doctors today. So those are the four key elements of the human resource strategy retained and you'll see with it 17 total actions focusing on issues from workplace safety to supporting workplace health and wellness. On redesign 18 total actions, you're going to see a couple of those examples of those today, optimizing scopes of practice and expanding opportunities for workers to support one another and build out team-based care. Recruit 16 total actions to attract new workers in particular to rural and remote communities and remove barriers for internationally trained healthcare workers and add training seats for example to the health career access program and we'll train 19 total actions including the exciting one that Mr. Kang is going to announce in a few minutes. In addition to all of those actions with respect to supporting our healthcare system in the coming years and now immediately providing more supports for patients, we have to continue our task at addressing systematic and anti-indigenous racism in our healthcare system. That means the full implementation of the in-plane site report, the independent review of BC Healthcare led by Mary Ellen Terpal LeFond but it also means ensuring at every level from leadership, every level of our healthcare system, we're able to provide and promote opportunities for indigenous people to lead our healthcare system and in the future and that is an important priority throughout our actions. And so with that presenting that report and I encourage people it is up on our website now to review those 70 actions and many of those actions are starting the implementation process and I can go through those perhaps in the question and answer. Working through with either health professional colleges or with health professions or in some cases working through as part of collective bargaining those 70 actions are significant and they're the actions we need to take to continue to build on the progress we've made in many areas. When I became Minister of Health 90% of care homes did not meet our own minimum staffing standards and we've changed that by adding healthcare workers and by working through that and we've done that in many areas throughout the system. Those are significant changes in the tens of thousands in that area and we needed that and we surely needed that when the pandemic hit particularly long-term care. So to speak about one of the actions on the side of training is my exceptional colleague the Honourable Ann Kang the Minister of Advanced Education leader in building out training opportunities in BC particularly for young people and her focus on healthcare of course is in remarkable support to everybody working in the healthcare system. So over to you for the big announcement. You can go this way. Thank you so much Minister Dix and I'm joined together with an amazing team here with me today. I'd like to begin by recognizing that I'm on the traditional territory of the Coast Salish Nations the Squamish, Musqueam and Sliwa Tooth. Our healthcare system and healthcare systems across the country across the world are facing challenges right now. Our government is continuing to build up and as well strengthen our healthcare workforce. Since 2017 our government has made significant expansions in healthcare training sectors and we invested in as Minister Dix has referenced to new nursing seats across British Columbia. We've also more than doubled nurse practice nurse seats hundreds of additional healthcare assistance seats as well, new residency positions to help train more doctors and new training opportunities outside of the lower mainland so people can get the training close to home. Over the past year we stepped up even further. We invested in allied health seats expansion opening doors for internationally educated nurses and offering bursaries for allied health students and bursaries for healthcare assistance interested in becoming licensed practical nurses. But people in BC are facing acute challenges right now. That is why Minister Dix and I are taking action to train and educate a new generation of physicians to support families now and into the future. We are excited to announce that British Columbians will benefit from the up to 128 new seats added to UBC's Faculty of Medicine. These seats are for both the undergraduate MD program and the graduate residency program. This is an expansion across all program sites in Vancouver Fraser, Northern, Southern and Island medical programs. So what does this mean? Our doctors graduating from the program and that is very good news for people in every corner of British Columbia. The 40 new undergraduate seats and 40 family medicine residency positions will be phased over two years beginning fall of 2023. The remaining 48 residency positions will then be phased in to accommodate the expanded undergraduate program. UBC tells us this expansion maximizes the existing capacity and this training expansion is just one part of the work we are doing. It complements other more immediate work that Minister Dix is doing to recruit and retain physicians. We're making the investment needed to significantly increase the number of doctors we're training and this means new doctors joining is incredibly sorry this will mean new doctors joining and incredibly working long-term career becoming our healthcare heroes and we're not stopping there. We're also focused on work underway with Simon Fraser University to open a second medical school in Surrey to complement the UBC medical school. The province has provided 1.5 million dollars to Simon Fraser University to support planning and development of the business case and to share that a project board has been established to oversee this work. We continue to have an all hands on deck approach to put British Columbians first improve health services and create a better BC for everyone. Through our stronger BC economic plan we're positioning BC to be future ready and what does future ready mean? It means we are taking actions and training opportunities for people to work in high demand and rewarding careers. We know that preparing a new generation of doctors is crucial to a strong healthcare system that continues to serve British Columbians. By investing in medical students we get people the care they need when they need it where they need it at home in their communities. Together we're building a stronger BC with resilient communities. Thank you so much for joining us today and now I would like to invite Dr. Dermot Galeher, Dean of UBC Faculty of Medicine to share his news with us. Hello everyone and thank you very much Minister Cairng for that warm introduction. Before I begin I'd like to also respectfully acknowledge that we're gathered here today on the traditional ancestral and unceded territory of the Musqueam, Squamish and Slavitude peoples. This is a wonderful day and it's an honor and an exciting occasion to be here today as we celebrate the significant government investments in the expansion of medical education and training at UBC in both the MD undergraduate and postgraduate medical residency programs. Ultimately this investment means graduating more doctors for BC and not only will this benefit students, families and communities it also means greater access and opportunities for more medical students including indigenous medical students and resident doctors to learn and train in the communities where they live including in regional, remote and rural settings all across the province. And this is really important because we know from our experience that where students train they are more likely to put down roots and stay to practice in the same BC communities. In fact, UBC medical students tell us with great enthusiasm and with starry eyes that these experiences are unparalleled providing them with outstanding training opportunities where they learn about unique healthcare needs of diverse communities and populations. It's truly extraordinary to see the enthusiasm of these students and when it comes to family medicine UBC is one of the top medical schools in the country with the largest single family medicine residency program and every year this program is filled. UBC resident doctors train and enhance the delivery of care in hospitals and healthcare settings in the north, in the interior in Vancouver Island in Vancouver and in the Fraser Valley and the success of these distributed programs across the province is a testament to the extraordinary work and dedication of the thousands of UBC clinical faculty who play a key role every day in training and inspiring just remember those starry-eyed students inspiring the next generation of doctors while simultaneously delivering exceptional clinical care for their patients. None of this would be possible without our partners including the government of BC, the University of Victoria the University of Northern British Columbia UBCO and all of the health partners across the province all of our health authority partners. So today's announcement is a substantial investment in the future of medical education across BC. It builds and complements the recent expansion of UBC health professional programs such as physical therapy occupational therapy and nursing as referred to by Minister Kang and beyond in the allies health professions that are fundamental to creating quality team-based care which is why UBC is pleased to play a significant role in the government of BC's broader strategy towards increasing the supply of doctors and health professionals for the benefit of patients and families and also for students and resident doctors and aspiring students for our programs and so on behalf of UBC I'd like to sincerely thank Minister Dix and Minister Kang and indeed the fantastic teams in their ministries for leadership and support for this expansion. Thank you all very much indeed. Thank you very much Dr. Killer thank you Minister Kang and we're going to now speak this is of course extraordinary news and one of the best parts of it from our perspective is the strong links that the University of British Columbia and the BC healthcare system have overwhelmingly graduates of UBC work in British Columbia over 90% so when we talk about expanding spaces at UBC what that means for patients in BC is more doctors more care more supports we have right now we are expanding our program in Canada and we are expanding it and with that and with BC as a destination location for people to want to come to witness the extraordinary migration into BC that's occurred even in this time of pandemic we're going to be building a stronger healthcare system in the future and I think you only have to spend time with resident doctors to know their commitment to UBC's commitment to supporting BC's healthcare system it is a profound partnership and as we build out other partnerships it shows our ongoing commitment to UBC as we develop and we talked about this a second medical school at SFU the fundamental role that UBC plays and its expansion today is a recognition of that fundamental role and we are very, very proud of the work that we do together I want to speak about other changes that are on that are on the redesign side of our health human resources plan and in particular expanding the scope of practice of pharmacists which is pretty exciting news I think today and we'll provide support for our healthcare system as you know our family doctors in BC we've recently provided significant funding and are working through a fundamental redesign of the way that we pay doctors and provide care and more care for patients and working closely with them part of that is to assist and has been to assist with fundamental challenges of overhead that they are facing also we need to provide support to ensure that we provide maximum care for patients and part of that is using our 6,500 registered pharmacists in BC to assist in this effort so today we're announcing two significant changes first beginning October 14th, 2022 pharmacists will be allowed to administer and renew a wider range of medications particularly for that set of patients who currently does not have access to a family doctor and I'll be describing that in some detail and then beginning towards the beginning of 2023 pharmacists will be able to be working through and we'll be working through this for the appropriate approvals with the college and so on will be able to issue prescriptions for less acute ailments such as allergies, indigestion, urinary tract infections and acne as well as and very importantly contraceptions so this aligns with the federal directions set up by Health Canada and other provincial jurisdictions and allows us to provide better care for patients using the exceptional skills of BC pharmacists so just to put it in context many prescriptions for chronic conditions are written to avoid for refills throughout a year but if not filled in the year the prescription expires at the end of 12 months and they've seen that this is sometimes a challenge for some patients so the first announcement today we're announcing pharmacists will be able to refill existing valid prescriptions for up to 24 months in those circumstances where people have trouble accessing a family doctor this allows greater access to medication for patients who unexpectedly may run out of their annual refills for people who have lost their primary care providers pharmacists will have an expanded ability to renew a prescription for patients with chronic conditions who have been stabilized on their medications we expect that pharmacists will therefore be able to support a majority of patients who do not have access to a family doctor due to retirements that are unable to access primary care for prescriptions renewed in those situations where a pharmacist is concerned about renewing a prescription for a patient a pharmacist will be able to seek advice on behalf of the patient from a prescriber which may result in a referral and note that we will have through the Ministry of Health medical staff on staff to support the system now already pharmacists play a crucial role in renewing prescriptions in our system 200,000 prescriptions last year but this expands on that and then in 2023 further changes as I noted to address and allow pharmacists to expand for minor ailments and for contraceptions and so all of this I think is a positive expansion in the access to care for patients in BC it's not focused on barriers it's focused on team-based care on healthcare professionals working to the full extent of their scope of practice and working together to see that patients get the care that they need and it's my honor to introduce the President of the BC Pharmacy Association Jamie Wixman to speak more about these changes Jamie Thank you so much Minister Dix I'm so excited to be here for a couple of very fantastic announcements as he said my name is Jamie Wixman I'm the President of the BC Pharmacy Association and I'm a practicing pharmacist and newest minister I want to first start by thanking Minister Dix for his leadership and timely response to what is a growing healthcare crisis in primary care for British Columbians on behalf of the thousands of community pharmacists across the province we know these decisions are vitally important to patients anxious about running out of their needed medication before being able to find a prescriber in my practice in newest minister I often hear from patients who are trying to access primary care to renew prescriptions being able to help these individuals continue their treatment so they won't go without a mist dose is so crucial to their care this is especially important for individuals dealing with mental health and substance use disorders who need access to their medication today's announcements also help patients in areas that may have community pharmacies but a medical clinic or a prescriber might be hours away as a pharmacist we work collaboratively with primary care physicians in rural areas and we often hear the challenges that they face enabling pharmacists who have the expertise training and training to prescribe for minor elements like the minister said the GPI's contraception means we can fully support patients and that they have access to getting these urgent medications that they need in a timely matter we are excited to begin our work with the ministry and the college of pharmacists so by spring 2023 British Columbians can access their pharmacists when they need specific medications we welcome the opportunity to work collaboratively with our primary care physician colleagues to support all BC patients thank you so much Minister Dex can we say what pharmacy you work on? West End Medicine Center there you go we are not doing that thank you for being here today and thank you for all of the work that pharmacists have done not long ago pharmacists only did a minority of flu immunizations and last year they did the overwhelming majority of those immunizations in the time of pandemic until in the first stages of the COVID-19 pandemic pharmacists were not providing those immunizations now they are providing majority of those immunizations so the scope and the contribution of BC pharmacists and community pharmacists in particular but all BC pharmacists to our public health response to the COVID-19 public health emergency in our current circumstances has simply been exceptional I want to note a third change with respect to a third change today it's a change with respect to scope of practice for first responders and paramedics one that we spoke about last summer in our response to some of the challenges facing the ambulance services at that point to say that new regulations are now in place to enable paramedics and first responders to provide a broader range of services to better care for patients during emergencies paramedics for example will soon be able to provide more care to patients during transport such as pain management and first responders will see their scope of practice expanded as well this is allowing people to provide the care that's required when it's required and we worked in close cooperation with training institutions of BC emergency health services the ambulance paramedics the BC association of professional firefighters the fire chiefs association of BC the emergency medical assistance licensing board in particular and first responder agencies on these regulations these are changes that have been waiting for both paramedics and first responders such as firefighters for a long time and we're confident that the scope expansion will provide better health outcomes for patients who need emergency health services and we are also required of course to ensure the paramedics and first responders have the training and support they need to do more for the people who rely on their care this is again an element of redesign that's critical to our healthcare system I just say finally before we take questions that the actions announced there are just a few highlights of our strategy to create a strong healthcare system that puts people first because if there's one thing we know for sure it's that there would be no healthcare system without the people who show up for it to work every day the more than 200,000 to take care of British Columbians from the delivery rooms to the long-term care homes healthcare workers touch the lives of every British Columbian every person deserves exemplary care when they need it and together we need to build a healthcare system build on our successes of the past build on our response to the current public health emergencies to ensure that we have a system in the future with new challenges before us that will provide the care that patients can count on and that they deserve and that they need the improvements we are making today and over the next five years will make a difference and prepare us for the future need and demands of people in BC and as we work hard to pave the way for where we will continue to listen to people their voices matter the extraordinary people who work in our healthcare system and all patients of BC and all residents of BC who every single one have a stake in that system when you need healthcare nothing is more important in healthcare and I want to thank all of the people working in healthcare and all of the people who support healthcare in BC all of the residents of BC who have done so much to support us during this public health emergency 92% who received their first two doses of immunization and a considerable sacrifice people take over the past two and a half years in the COVID-19 pandemic to keep one another safe we have I believe profound and important support for public healthcare it has never been more important for patients and for the people that work for it and we are putting in place today and continuing the effort to ensure that we have the health human resources the people necessary to provide the care for everyone when and where they need it thank you very much and I look forward to taking your questions Thank you for joining us as a reminder to the reporters on the phone please press star one to enter the queue you're limited to one question and one follow up please also remember to take your phone off mute as you are not audible until your name is called our first question is from Justine Hunter Globe and Mail, Justine go ahead Here is a question for Dr. Kelleher I'm just trying to get a sense of when these new doctors might actually get into the system and practicing medicine with these new seats and can you just clarify are we talking about 128 additional doctors I'm just a bit confused with the resident's graduate undergraduate so if you could just clarify that Thank you very much for that question we are going to admit the first tranche of new doctors in the 23 in 2023 and the 40 new doctors will be admitted between 23 and 24 the additional positions are actually postgraduate medical education positions up to 40 over the next two years and then that will be further followed by the additional positions which are necessary to support our additional tranche of 40 new students so that comes up to 48 because we typically allow 1.2 for each undergraduate medical education position so the first tranche of students will be starting in 2023 the second tranche will be starting in 2024 four years later they will graduate but the initial tranche of residency positions precedes that and comes into action over the next couple of years Justine do you have a follow up I do thanks I want to speak about the pharmacist changes I'm just wondering do we have any idea how many patients might be able to take advantage of these changes so how much pressure are we taking off the primary healthcare system with this change I think a significant number of patients will be able to take advantage of both sets of these changes the changes that are putting place in October are dealing with our current situation and particularly focused on those people who have for example had their family doctor retired and need to get prescriptions renewed so I think that is a smaller number of people and then a larger number of people benefit from the changes in 2023 which expand essentially the scope of practice or pharmacists to prescribe and that's important in a number of areas and I think both of those changes will be by definition more substantial and both assist in easing the load of family transitions but also expand opportunity for patients to get the care they need and I think it demonstrates the value of pharmacists working especially as part of the overall healthcare team in providing more care for patients we have thousands of pharmacists at how many locations around BC about 1300 locations around BC this is obviously an addition to that system one that will be supported by the system will follow the direction of course healthcare colleges and we'll see people continuing to work strongly in teams but the changes this fall will be a smaller number but significant, particularly significant for those patients in those circumstances and then the ones next year are more fundamental system changes that will be working through the normal process our next question is from Richard Zussman, Global News Richard, go ahead I'm trying to get a sense of how much some of these things may save the system in cost how much it may cost overall and is there any consideration being given to cutting down on administrative costs when it comes to health authorities in terms of the duplication of a number of positions that exist within each of the health authorities First of all, as you can see as you know where we've added when we're talking about adding healthcare workers that's been nurses an 18% increase in that bargaining association that's been in facilities so acute care a 26% increase in that bargaining association that's been ambulance paramedics a 28% increase in the people in that bargaining association that's ambulance paramedics and dispatchers so the increase we've seen has been in providing direct care for people and of course to do that I think we have in BC in terms of administration certainly in the administration the insurance side of the system vastly more efficient system than say the American model or other models administrative efficiency led through the Ministry of Health and we have 6 health authorities and if you've ever looked at the situation in a community for example such as Toronto which has multiple boards and others that's a relatively efficient system others have gone to one health authority we don't think that's the best path so we're looking at administrative savings all the time in the system and one of the key parts of our discussions with the doctors of BC will be easing the burden on family physicians often when one adds rules for often very good reasons those add none of time and a lot of people who are qualified family doctors are spending on administration so to the extent that through technology and through the reduction of administrative demands we can reduce that we're going to do that everywhere but the idea I know that some people promote the idea that there's been an increase in administration this is not the case there's been an increase in care and a dramatic increase in the demand for care particularly as a result of two public health and a dramatically more people in BC are the compared to everywhere else really the excellent economy here means that many people come here more than 100,000 in 2021 alone they require care our aging population requires care the increasing demands on our healthcare system particularly the additions we've made in support for mental health and addictions require more health professionals so we've been adding that at every level more nurses, more doctors more health sciences professionals more paramedics, more healthcare workers that's where the additions have been that's where the increase in the size of the system has been it's been in direct care for patients and our workers in spite of all those efforts especially after two and a half years of COVID and six years of the overdose public health emergency of course extremely strained and are working flat out all the time so we need to provide them more support and more health Richard do you have a follow up you mentioned minister near the beginning a change for data services coming for doctors in the province can you give us an update on how close we are here and how quickly do you expect to be able to unveil the way that that structure will change so we took a couple of immediate actions as we were working through these discussions with the doctors of BC because this is a fundamental change in our primary care system that we're working through with them and so by interim as you know we provided $118 million to support doctors with overhead and other demands to ensure the stability of medical practices through this period of discussions as we undertake together this reform of the system and we also because we didn't want to lose a year of residence while these discussions were going on made a significant offer for new to practice doctors in BC and that process is going through as well so those are two steps we took the negotiations are going very well it involves the most senior people in my ministry Deputy Minister Steve Brown Assistant Deputy Minister Mark Armitage HABC and others on our side and the doctors of BC and I would say they've been involved in dozens and dozens and dozens of hours of discussion as we work together to build a compensation system that works for doctors yes builds out team-based care yes provides opportunities to younger doctors as alternatives to fee-for-service in particular and for others yes but is focused every day on the needs of patients in BC which are significant and we hear we hear from them every day about their anticipation of the need for change and we want to deliver for them Our next question is from Amy Smart Amy go ahead You're increasing training for paramedics so they can do more but it doesn't come with increased compensation we've heard repeatedly from paramedics that a lot of their burnout is linked to low or a lack of compensation what's your message for those people today Well first of all we just need to put I think the paramedic issue into context in 2017 when I became Minister of Health about 3 in 10 paramedics were permanent in the paramedic system BCHS 3 out of 10 that system was out of date and at risk of collapse and in fact those very on-call positions where we are seeing significant problems today so together with ambulance paramedics we work to change the system in a time of growing demand on that system so we've gone from about 30% who are permanent employees to well over 50% now which is a substantial change and had we not done that had we left the system in place which was barely a 20th century system you know I hesitate to describe the 19th century but certainly barely a 20th century system we would we would be in a much much more serious situation than we face in some communities today so that is a fundamental reform that's occurred so the size of the bargaining unit has increased dramatically as we've hired more paramedics and dispatchers there are still challenges in the system particularly for people who are carrying a pager in that system and many of the challenges that we face continue to be faced there so we do look at those but we do require it's absolutely essential to require when you expand some of the scope of practice training we negotiated really it was the first time it had been done in a long time a collective agreement in 2018 to implement these changes together and of course we'll be starting soon negotiating collective agreement and that's where issues of pay and benefits are generally dealt with but we're also working with them all the time to make changes to improve access in the system particularly in rural and remote communities what we've seen because we've added permanent staff in lots of communities we see stability on the first car we see continuing instability on the system as it was and continues to be in some places and so we're working together with them also on some steps to deal with those problems right now but if you're talking about pay and benefits those are naturally negotiated and that negotiation is taking place across the healthcare system now with different groups in that healthcare system Amy do you have a follow up I just had a clarification question on the pharmacist area you mentioned the renewal prescriptions for people who've lost their family doctors due to retirement there's a lot of people who've never had a family doctor but might have chronic illnesses and things like that how do they fit into this plan do they have to go to clinics or can pharmacists help them out well some of that happens now but when we're talking about prescription renewals right and that's what that measure is talking about by definition you received an original prescription and it's being renewed right and what the fat challenge lots of people are facing are twofold there's a challenge for people who've moved here from other provinces there's just an even problem so they're not on the rolls here there's a challenge for people whose family doctors I'm getting a phone call from somewhere but it's a challenge for some people who have lost their family doctors and in those circumstances this allows them to get prescription renewals and to extend the period of prescription renewal so people with chronic illnesses such as myself I obviously have the prescription for insulin which I have is a continuing issue but also for other issues that that ability is there for them so this isn't a resolution for every problem in the healthcare system in addition of course we're making the change for 2023 on minor ailments and on contraceptions to expand the scope of practice of pharmacists so both those changes are coming into place our next question is from David Nadalini City News Hello, good afternoon my question is for Minister Adrian Dix but I'm also open to hearing from the Dean of UBC's Faculty of Medicine in order to address systemic racism in the healthcare sector I wanted to ask how does this strategy plan to support indigenous healthcare students through this strategy? Well I'll invite Dr. Keller-Herb because he's given a lot of thought to speak about that in a moment we had introduced to deal with the issues of anti-indigenous racism we sought the advice of Mary Ellen Terpel who found it an outstanding report we're in the midst of implementing that report at every level it seems to me a number of things have to change one of the proudest things about our response to the pandemic is the full integration at every meeting of our leadership of the First Nations Health Authority in that process and the distribution to diverse areas of this problem of vaccines demonstrated the effectiveness of that work together but as a practical matter we have to dramatically expand at every level the role of indigenous people in our healthcare system to in fact change the balance of power in that system requires doctors, nurses health sciences professionals, paramedics healthcare workers and so we have to create more opportunities for that and implement all of our commitments under the in-plane site report by Mary Ellen Terpel LeFont all those elements of the system are in place for healthcare workers yes, and Dr. Keller will talk about that with respect to the UBC Medical School but also for patients as you'll remember from that report at a major hospital in BC of indigenous women for 11 times I believe it was 11 or 12 times more likely to leave against doctors advice which shows us that the extent to which racism profoundly, profoundly injures and distorts life but it also profoundly distorts people's health and so we are committed to those changes, they're fundamental in our health human resources plan and I know they're fundamental to the work that's happening at UBC and I'll invite Dr. Helen Keller here to speak to her Thank you very much for that question at UBC we have a large indigenous medical student admission program that's situated over 120 students to date we've also expanded that process to encompass all of our other health disciplines with an increasing number of indigenous students particularly marked I would say in midwifery I think so the points that Minister Dix has made are really critical it's not just enough to bring in more students but it's really important that we change the culture around education and around the healthcare processes and in our faculty we have an ongoing process of cultural change which is specifically directed at eliminating racism throughout our faculty we've taken on board the recommendations of the Mary Ellen Turpole Fund report and we've implemented a new program called UBC 2324 which is intended to deliver cultural humility training to all of our students and our faculty and these are really really important steps for us because as we go forward I think this expansion in the training program actually allows us to think about how we can expand the number of indigenous students and the proportion of indigenous students and indeed we've also added to our indigenous admissions program a black medical student admission program as well with support from the ministry so this is fundamental to us. You cannot have great healthcare if a part of the community is marginalized discriminated against and effectively not treated to the maximum capacity and as Dr Nadine Caron who heads the centre of excellence of indigenous health at UBC often says cultural safety saves lives it's not just an abstract concept it saves lives and we have to inculcate that in all of our students across all health disciplines we're actively working on it and it's a very important subject for us. Thank you. David do you have a follow up? No follow, thank you. Our next question is from Mira Bains CBC. Go ahead Mira. Thank you. This question is for Jamie and it's about pharmacists on training. In terms of expanding the scope of practice I'm wondering whether pharmacists will need more training and whether there's an extra cost to that and will there be extra fees that pharmacists will have to pay for it? Thank you for my first question. No pharmacists will not need any additional training. We are already very well trained in everything that Minister Dix has brought up and if anything even more so than that but we've had pharmacists like myself I graduated roughly about 10 years ago and at that point we were really really fighting to be able to do more and then and we were trained to a much higher level than we were able to provide and I've talked to many other pharmacists who have said the same about even 20-30 years ago so we've been trained to do much more than what we've been able to do for a long time and that's why this is such an exciting time for pharmacists that we are finally able to work to a much higher level of our knowledge than we have been able to before. Mary do you have a follow-up? Yes and this is for Minister Dix and I'm hoping for an answer in French as well at yesterday's press conference on COVID and flu through winter you mentioned that 1,300 patients in BC hospitals at present could be moved into community care and we spoke to the HEU and the BC nurses union yesterday and they expressed concern and some confusion about that point. The nurses said they weren't consulted and both unions said there would not be enough staff in community care nursing to care for that many patients. Please explain more about what the removal of patients from hospitals could look like and how this will all work with concerns about healthcare staffing. I think it's not a question of removal it's a question of moving people in the case of those who require long-term care to an appropriate level of care. So we've taken some steps for example in Burnaby at the New Vista care home and they built a new care home there and the health authorities are able to access that care home so we have new spaces and in the long-term we're going to use that spaces to reduce a number of multi-bed rooms but in the immediate term we use some of those spaces to take people from hospitals who should be in long-term care and get them in long-term care equally and we're working and we'll be working with care providers with people to ensure that our care homes that are currently have fewer than the capacity of people in them, of residents in them that will be able to work to that capacity so that we can in fact decant and so we've done this at various points through the pandemic for example at Ponderosa and Kamloops there's also other beds that we may be able to purchase that are currently private beds that are creating essentially more public beds in the system so all of these things are the actions that we're going to take in addition we have to provide additional supports in the community to support that and that's what we're working to do that's why when people talk about consultation that's why we're laying out this plan some months in advance of having to deal with these issues so that we can prepare and at least move some of the people to the appropriate level of care so that we create more space in our hospitals and that's the plan to do that. The idea is to ensure that we have that our hospitals if there is a significant spike in either the flu or in COVID-19 through the November, December, January February period are able to take that and take advantage of that equally and you've seen this before when we had for example the significant increases in say April 2021 or the significant increases in January of 2022 with the arrival of the Omicron variant of concern we took other actions the reason you defer for example, non-original scheduled surgeries at those times was effectively to create space so that your hospitals capacity didn't overwhelm the staff there there are extraordinary challenges right now in the healthcare system but what this is about is ensuring that we use all elements of the system to support our acute care system in a difficult period in December and January so what we laid out yesterday was our planning for that the possible demand for that and some of the actions that we're going to take to support our healthcare professionals and our healthcare workers to get through it we will now move to in the room Traraj, CTV Hi Kevin, in the room it's been a while I just had a question just in regards to the increased scope of work for paramedics and you somewhat acknowledged it before but just in regards to I've covered several stories now of patients waiting over an hour for an ambulance to arrive you mentioned the increased scope but the head of the ambulance workers union had mentioned that employee retention is a major challenge turnover is high as many as 30% of staff are off due to non-physical injuries related to overwork stress so my question is how do you address those significant staffing issues I know you mentioned that there has been an improvement but to those people that are waiting more than an hour for an ambulance to arrive how do you address those staffing issues we named a couple of them we started with a system that was unfit for the 21st century a system that was largely 70% casual and we're fundamentally changing that with the ambulance paramedics of BC it's why the budget in a very short period of time went from 424 million to 559 million to seek those improvements in service in last year in the last calendar year we put in place new air ambulance responses we needed that and we had to transfer all of those patients from ICU in the north down to Metro Vancouver all worked on for ambulance paramedics we have in the bargaining unit about 27% more paramedics and so that tells you because we count those how many more there are but there are some challenges one the system that was based on casual workers isn't working that well and hasn't been for a long time so we've got to continue to address that two we have to train more paramedics and that's clear three it seems to me we're facing a massive increase in demand not in all cases but in our most serious cases so they define paramedic cases by color so the most serious ones are purple and red those are immediate responses life and danger circumstances of those has increased two and a half some of the challenges facing people's health in a pandemic and the impact as well of the overdose public health emergency so we have to continue to train more we see that in the health human resources plan we have to transform the system we're doing that with our ambulance paramedics and we have to work through some of these problems and there are different kinds of problems in different places in urban areas there are significant challenges of response and the pressure and the type of workload in rural areas we're having challenges in some many communities with the second car which tends to be a casual car and getting people to fill that position and that puts you under pressure because when one car is on a call and there's a second call if you're in a community that gets one call a day well that might be four calls in one day and no calls the next day so the second car is important and we're working through with our ambulance paramedics to address some of those problems we're obviously addressing some of these issues as well in terms of in terms of our work with the union and finally there's the issue of people booked off sick which is very high higher in this bargaining sector than in anywhere else partly that is the quality and the pressures of this work which is considerable right now and that's particularly true in the overdose public health emergency so we have to take steps to help our paramedics get back to work sooner if that works for them but also more importantly to recover from the challenges that they chase so we're taking all of these actions it is other than mental health addictions we have increased spending more and the BCEHS on the ambulance system than anywhere else we're transforming the system we're hiring more paramedics but clearly the demand is on the system by patients who need immediate care is growing and we have to continue to meet that and that's why you're seeing all of this investment and all this action including in this meeting's budget where we added significant number of new funding for ambulance paramedics but we've got to meet that demand on a lot of calls if you were getting a lot of calls where people were not needing an ambulance but needing medical care and they were calling you could respond to that and we do we've also doubled the number of 811 calls we take every day so that increase in demand has been felt in the system where the real challenge in the system is an increase in what I call purple and red calls and the only way to meet that test is to have more ambulance paramedics working and that means retention that means recruitment that means training those are the elements of this plan and that means ensuring the system responds and redesigning the system so that people can practice expanding what ambulance paramedics can do expanding what first responders can do so we can provide better care for people Kevin do you have a follow up just a quick follow up this is in regards to internationally trained healthcare professionals spoke about how you want to streamline that process to get people practicing in this province any idea on what that'll look like or any specifics well we did we had some specifics in April for nurses we had a nine million dollar program because we have our multiple systems of essentially accreditation for international nurses so we provided a very significant changes both to streamline that situation for nurses which are significant the college of nurses are very much part of and to provide essentially support nine million dollars in support in bursaries so that the fees were not an impediment for people practicing those were significant changes and we're going to do more to assist internationally educated nurses to come and work in BC sooner that's critical similar circumstances and similar work is being done with the college of physicians and surgeons on doctors and the expansion for example of residency positions always assist us in that as well generally both those that are trained in British Columbia, those that are trained in Canada and in North America and those that are trained around the world we also have a process in place for allied health workers as well to do some of the same things so systematically we've got to reduce those barriers and we are and to support workers when they arrive because sometimes when workers arrive and then go to where we need them they don't have sufficient supports when they get there so there's a retention issue and we want to continue to take action on that finally there's a practice ready assessment program in BC and we'll be not just rural and rural communities where the focus has been up to now but other communities which are facing shortages of doctors our last question is from Walden at Paul Radio Canada thank you hello two questions for you let's start with the first today we're announcing more places in medicine when will these future doctors be able to serve the population so the Colombians I would like to know in the long term what is the plan of the province at what time will we be able to have medicine families for all the Colombians well first of all it's a announcement today and of course very important because we have 40 places of course but also postgraduate places for the second element of training so it will add medicines and it will start from 2020 because we need medicine now but also there's a big increase in the population in the next years and our population of medicine and there are for example 400 families who are more than 70 years old so we need to replace them and then add them to the system and so this change with the creation of a new school of medicine in the Colombian we will have a big effect in the next 4 years to do this we haven't done this for a few years and the consequences are seen today so we do this in the medium which are important I think we need to also work to assure especially for the medicine families who work as medicine families in the community so we took actions in June to see the results for people who are training here to work in the community in the health system because there are a lot of options but we want more medicine families in the community so we have several actions but in this plan there are 70 actions which will contribute all the and the necessity for people in the British Columbia and I think it's an important plan I invite everyone to read it and I think it demonstrates our determination because it's not a plan it's actions that are important there are 70 here and I think it will make a big difference I will go with the following question concerning the accrued powers of the French nation it's a measure that already exists in other provinces for a long time so why did it take so long here in the British Columbia to put in place this measure that seems quite simple so why did it take so long what was blocking it and what motivated it to put in place this measure is it an admission that we were leading to a wall listen I will not talk about the liberal period and only about ours I think it's an important action we have increased the responsibility of pharmacists for two years especially in the matter of vaccination of an extraordinary measure I think we did the last year 1,200,000 it was 400,000 years ago for the grid and of course the actions of the pharmacists regarding Covid-19 so it was important I think we are behind some provinces in this area we are in front of provinces in several other areas but we saw what happened especially in Alberta and we will do it and we will act by supporting the teams we made a great contribution to the medicine family because it was important to do it we have to share the work so that they can help their patients in the system and I think we will continue to do it so it's too late it's too early anyway it's today thank you thank you and that's all the time we have for today thank you everyone