Estimates Debate: Ministry of Health

MLA Sonia Furstenau


S. Furstenau: I'm delighted to be here, marveling at the energy and depth of knowledge of our Health Minister and just want to say how much I appreciated the way he worked with us throughout the lockdown period with COVID-19 and how much I appreciate his willingness to just keep us apprised of things, answer all of our questions and really be a shining example of really excellent governance through this very difficult time. I just want to start by really appreciating and acknowledging the minister for that.

Then I'm going to jump right into the questions here. We'll start with COVID and long-term care homes, which clearly was one of the biggest challenges that this province faced and that the minister and Dr. Henry faced. It brought to attention very much across the country the issue of for-profit care homes.

Data from Ontario has shown that there were significantly higher death rates in for-profit long-term care homes from COVID-19 than there were in not-for-profit care homes and municipally run. I'm not sure how that data is in B.C. Maybe the minister can speak to that.

Also, to break down some questions here, could the minister just start with telling us how many for-profit, how many not-for-profit and how many public care homes are in operation in British Columbia, and could he explain quickly the difference in operational and administrative structure between these systems?

Hon. A. Dix: With respect to and how many public care homes are in operation in British Columbia? Could he explain, quickly, the difference in operational and administrative structure between these systems?

Hon. A. Dix: With respect to COVID-19 and the for-profit, non-profit question, it should be said that there have been quite a few outbreaks in B.C., and 110 people have died in long-term-care outbreaks in B.C. But I don't think the number of outbreaks represents a sufficient analysis of whether one form of health care is better than another or leaves people more susceptible.

In fact, the largest number of outbreaks amongst the category of outbreaks is in private, not-for-profit facilities. That's because, in those facilities, an outbreak generally occurred because COVID was brought into the facility.

I'll just give you an example. Holy Family, which we talked about with members yesterday, in southeast Vancouver is Providence Health Care. It has a very high staffing ratio. It's in the HEABC agreement. It was basically a single-site provider before the agreement. It's known for the quality of its care and the care of the people who care, its spiritual care, its other supports, its social activities. Yet, they have this striking outbreak, as they did at Langley Lodge, which is a not-for-profit; as they did at Royal Arch Masonic, which is a not-for-profit; as they did in Haro Park, which is a not-for-profit; as they did at Lynn Valley Lodge, which is a for-profit provider.

So I don't know if there's sufficient information to draw conclusions from that, except that in all the cases, people have worked in an unbelievably dedicated way under the most difficult imaginable conditions to do their best in those conditions. The health authority has been there for them.

We've tried not to pit or suggest one group as opposed to another, because I think the evidence shows that if circumstances had been different and COVID had come into a health authority–owned and –operated workplace, for example, as it did in some cases, had come in, in a serious way, the fact that conditions might have been good wouldn't have changed the fact that COVID-19 is a relentless enemy. It has a real impact on people in long-term care, and 22 percent of whom tested positive passed away, which tells you the vulnerability of people in the sector.

I guess, just to generally speak to that subject, that's the evidence — that the largest number of cases and deaths in B.C. was at not-for-profit facilities. But I want to say to everyone who might hear that statement that they should not draw conclusions from that, that there's not enough evidence to draw conclusions from that. It just happened to be the case because four out of the largest five outbreaks were in not-for-profit facilities, and that obviously changes the number. Should there be — we hope not — another outbreak, that would change the numbers again significantly, and more so than one institution should….

With respect to long-term care, there are 113 health authority–owned and –operated care homes in B.C.; 110 private, for-profit; 88 private, not-for profit that serve the public system; and 59 private, which are private care homes that don't have private beds. In assisted living, there are eight health authority–owned assisted living; 56 private, for-profit; 73 private, not-for-profit; and 77 private, for a total of 370 care homes in the first category and 214 assisted living in the second category.

S. Furstenau: I guess this is more of a philosophical question for the minister and maybe one that is beyond budget estimates, but we have a publicly funded health care system in British Columbia that has been recognized for its excellent delivery of care to people and patients around the province, and we are very proud in Canada to have a publicly funded health care system.

Given that care for seniors is also health care, in many, many cases, what is the minister's view and vision for long-term care for seniors into the future, particularly as we're seeing a demographic shift underway in our country? As we're going to see more and more people needing longer-term care as they age, does it make sense to the minister to have, on the one hand, a publicly funded health care system demographic shift underway in our country, as we're going to see more and more people needing longer-term care as they age?

Does it make sense to the minister to have, on one hand, a publicly funded health care system but to have a seniors care system that has a merger of all of these things that does include for-profit care, with the implications that that may or may not have for COVID but that does have some implications around how we see long-term care for seniors as part of a wider health care system?

Hon. A. Dix: Thanks to the member for her question. I think we do have to deal with the situation that's in front of us. I talked about the number of facilities. Roughly 9,000 of the 29,000 publicly funded long-term-care beds are health authority owned and operated at present, and roughly 20,000 are not-for-profit or for-profit private facilities of some sort that are funded in their public beds — these are all public beds — under per-diem arrangements.

The member and I had an exchange in question period where we discussed the reforms that we'll be bringing and the process to review those and the work we're going to be doing with the providers over the next number of months to bring a little more stability, standardization and clarity with those contracts, which, of course, makes it easier to ensure and maintain standards.

My approach is the one that the member will know. Clearly care standards were dramatically low in B.C. when I became Minister of Health. They just were. They were dramatically below the standard the government had set, which was in 2008. They said the standard should be 3.36 per-resident a day. It had gone down in the subsequent years. There was an Ombudsperson's report, in which that was the primary recommendation two years later, and it had still not succeeded to the point that 85 percent of the care homes in B.C. didn't meet the provincial standards when I became Minister of Health.

So what have we done? We've dramatically increased standards. This reflects some the challenges, because the places where they had the lowest-funded care hours tended to be private and not-for-profit and 75 of them, for example, were under 2.9.

My approach and my belief is that if they're publicly funded beds, they all have to meet and come close to the provincial standard for care hours. That's what we've done. We have this system. It's very challenging to transform it. I'll just speak briefly about that again in a second. So if they're all publicly funded beds and if, for many people in many communities, they only have a choice of one facility, which might be private for-profit or not-for-profit or public, they should expect a certain standardization in care hours per home. So that's what we've done, and that's important.

Secondly, I believe that the system of subcontracting and the system that had denied worker's rights that was founded in Bills 29 and 94 was wrong for B.C. So we got rid of that, and we restored labour rights to workers. That was a powerful and emotional thing. I know the member had met with members of the HEU and BCGEU and others and understands its importance — to re-engage workers in that system. I think that was fundamentally important.

Thirdly was not to forget that we could spend all of our money in long-term care. We can spend all of it. But it's 30,000 of a much larger subset of a much larger set of seniors who want to, for the most part, stay at home. So we have to invest in home care and home support. We've done two sets of things — significantly increased home care hours and dramatically increased adult day programs for seniors living at home, those hours, in a transformative way, in order to improve resources in the community.

On the south Island and in Metro Vancouver, we brought those services back in to the public health authority and under the direct direction, not by contract, at the public health authority after contracts ended on March 31, 2020, and slightly earlier here with Beacon Services in the south Island, at the end of 2019. So that's a key priority.

The fourth, I think, is that our capital stock, the actual long-term care homes on the public side, are much more likely to be multi-bedrooms. I think only some 24 percent of them on the public side are multi-bedrooms.

We've got a capital deficit problem. We haven't been investing in the capitol of health authority owned and operated. So while you'd like to build new ones, we have an enormous capital job to address those, and we have to increase the number of beds, because there are more seniors in lots of communities in long-term care.

My view is to work public side are multi-bedrooms.

We've got a capital deficit problem. We haven't been investing in the capital of health authority owned and operated. So while you'd like to build new ones, we have an enormous capital job to address those, and we have to increase the number of beds because there are more seniors in lots of communities in long-term care. My view is to work with all the players in long-term care and not to take an ideological view but a pragmatic view about increasing the options for seniors.

The final thing is the care itself. This is hard to say in these times, because these times are about safety and about not having many visitors and having visitation policies. But we've got to find ways to make life better for people who live in long-term care — not just keep them safer, which takes a lot of effort and a lot of money, but to make life better. That's our commitment to do that and really for the system to not be about a race to the bottom on wages and competition between care homes, but that the competition should be about the quality of care and seeing that it rise.

I believe, underlying all that we've done — single site and the changes we've made and the investments we've made — is that, which is respecting people who work in long-term care and ensuring everybody has standards. That's the philosophy that I've tried to put in place in my time as Minister of Health.

S. Furstenau: I appreciate the depth and the detail of the minister's answers on this. I'm going to ask one more question on this and then get to a bit more of a specific piece.

With public funds going to care homes, as the minister points out, they're publicly-funded beds in all manner of long-term care homes. One of the challenges that he's identified and has also been identified by the seniors advocate is the oversight of how those funds are being spent. Are the standards being met? Are the care hours being delivered in the way that they need to be?

I guess my question is if the minister could provide some insight into the mechanisms for government oversight for the spending of all public funds that go to any of the care homes to ensure that the direct care hours, the total staff wages and the funds are going to where they should be going to. What capacity does the government have, in cases where that's found not to be the case, to address that issue?

Hon. A. Dix: I think there are two sets of issues. I'll just briefly touch on the first, which is ensuring that standards are high. That's the work of medical health officers. That's the work of health authority boards of directors, supported by us.

The member will know, because she lives on and represents Vancouver Island, that we've had three care homes that have been brought under the administration of Island Health in our time. That's about ensuring the standard of care. It's not the financial question she's raising; it's the standard of care. That part is independent of the other. In other words, the medical health officer's job is not to address the financial stuff, because there would be some internal conflict in that. So we have different people doing different things, but it's really important.

Unfortunately, only six times in history has that provision ever been used, and four of them involved retirement concepts in B.C. right here and right now at this moment. That's unfortunate, and we're working with that company and others to ensure that standards are raised. So there's that set of things.

In terms of the issues raised by the seniors advocate in her report, I think we talked about this in question period. I understand the concerns of the member. I think that what would be useful for everyone is to move towards more consistency amongst health authorities, which makes it easier, in fact, to deal with these contractual arrangements. So that's what we intend to do.

I think, in general, our care providers do a very good job, but I think there could be more clarity and more consistency. We're providing more consistency now in the care hours that we provide and that we fund and providing more consistency in the contracts. We'll be working with the sector on this question. That will be useful in terms of allowing us to ensure that people get the care that they need, which is established, on the one hand, by medical health officers and, obviously, on the other hand, by health authorities who are delivering those services.

S. Furstenau: On a specific and COVID-related issue, recently there was a change allowing some visitation to long-term care homes. Could the minister answer two questions for me? One is: what are the specific parameters for visitation to long-term care homes right now? Secondly, what related issue. Recently there was a change allowing some visitation to long-term-care homes. Could the minister answer two questions for me? One is: what are the specific parameters for visitation to long-term-care homes right now? Secondly, what can be done if a care home isn't abiding by those parameters — specifically, if they're not allowing the level of visitation that is identified in the provincial parameters — and how to get consistency across all long-term-care homes on that issue?

Hon. A. Dix: The policy changed on June 30. Prior to that, there were visits allowed, for example, in circumstances of palliative care. The member will also know that we made changes — she made representations on this question, as did others — around people with disabilities and their ability to make visits and have their advocates join them for visits, both in long-term care and acute care. That's what an essential visit is. I use the term "essential" with a capital E, because we are defining what essential visits are. That's laid out in provincial health and administrative health policy that the care homes have to follow and the acute care sector has to follow.

The changes we made on June 30 were to allow, essentially, one designated visitor per resident per care home. We added to that resources to see that enforced. We asked every care home in the province to provide safety plans. I had the number in my head earlier, but a majority of care homes now, about 75 percent of them, have followed safety plans of assisted living. Long-term-care homes have provided safety plans required, and so that number is in the 400 range of the 584 care homes. They have to provide a safety plan that meets those provincial guidelines.

If there are concerns about visits, people should understand that, in fairness to the care homes, some of those concerns are with the limits that myself and Dr. Henry and the ministry and the government have placed on visits. So it's really important that people sometimes not blame the care home operator if they'd like two visitors, and it's just one, or it's one designated visitor, and they'd like to switch them off. Those rules have been set provincially, and we'll be reviewing those rules after the first month of visits.

At the beginning of next month, which is coming upon us sooner than we think, we'll be reviewing that to see if it's possible to make further extensions. And we also provided, of course, and are providing $160 million across the sector for infection control and safety around visitation, which I think is going to be needed. Those controls on visitation are going to be needed well, certainly per year, into the future.

S. Furstenau: Just to get a little more clarification, with one visitor per resident per care home, is there a limitation as to how many days per month a visitor can come? In the case of one of my constituents, she's been told she's only allowed to visit her mother once every 28 days.

Hon. A. Dix: I don't think those provisions are in the policy. I know that, at present, many care homes are on weekly routines where they're letting people through in their short visits, on 20-minute visits. If the member would make the information available to me, I can look into it.

S. Furstenau: Thank you for that. We will do that.

I'm going to move to a new topic here, which is midwifery. For a lot of parents — and most recently a dear friend of mine — a midwife was the choice for them to have their birth assisted. In 2016-2017, midwives assisted a total of 10,227 births. That's 23 percent of all births provincially, which is the highest rate in Canada. They lower the cost on the health care system by mitigating the escalation of births. When a midwife is present in care, there are 43 percent fewer Caesarean births, which significantly reduces the cost and time required in surgeries. Throughout this pandemic, the demand for midwives has increased. At-homes births spiked 40 percent in May of this year compared to 2019.

In B.C., midwives are the second-lowest paid in Canada. Unlike other primary care providers, midwives pay out of pocket for their health care benefits, parental leave, retirement savings and business costs. Can the minister confirm whether or not midwives received any pandemic pay, like other health care providers did?

pay out of pocket for their health care benefits, parental leave, retirement savings and business costs. Can the minister confirm whether or not midwives received any pandemic pay, like other health care providers did?

Hon. A. Dix: The short answer is no. Midwives, like physicians and optometrists and dentists, were not eligible for the temporary pandemic pay program, which is targeted to front-line salaried public employees in health and community services, which would include all the people who work in private long-term care for example. They would be considered "deemed as public," under those circumstances.

The member will know that short-term disability pay is typically a feature of extended health benefits organized by professional associations, who may negotiate it. That support is part of a master agreement, and these are some of the issues that are being negotiated now.

At the beginning of the public health emergency — it should be said — midwives identified safe practice concerns, and in response, their fee schedule was adapted, enabling people to be compensated for virtual consultations. Midwives have also been provided with PPE — through the regional health authorities — for home births, as with other fee-for-service health practitioners. In-home and clinic-based equipment is still the responsibility of the midwife.

I would say, in addition, I know the debate about pandemic pay. We had a little bit earlier with another member, and it is an interesting debate. B.C. has had some of the broadest allocations of pandemic pay, if not the broadest, in the country. It's partly funded through the federal and the provincial governments, and we've had a fairly broad view of it. Inevitably, there's going to be some people — and lots of people, in fact — who feel they merit pay who didn't receive it and that's a real challenge in the system. We've seen it. The member will probably ask these questions at other ministers around pandemic pay, as well.

With respect to midwives in general, the member will know that we are in the midst of negotiations with midwives. Some of my discussions will be a little bit limited as a result of that. Those negotiations started in March of last year, 2019. They arrived at a tentative agreement in October 2019. That tentative agreement was rejected by the membership, as is their right. So we are back in negotiations, which I think we started in June 2020. Obviously, we're hopeful that, I think, there are new directions from the association side for that agreement and we are, as always, hopeful to arrive at a collective agreement as we have with just about everyone else in health care.

S. Furstenau: I recognize that there's some limitations with the negotiations ongoing. Again I'll come up to sort of a more of a philosophical question about…. How does the minister see the role of the midwives in providing primary care? There's an increasing number of family doctors that are not providing obstetric and birth care for patients, and midwives can play a very important role in this.

I guess I would like to know from the minister what is his view on the role that midwives play in primary care and health care. How does he see a future where we value and retain midwives, given that there is a retention problem for these health care providers?

Hon. A. Dix: I think the retention of midwives is a key element of the discussions. Without speaking of the negotiations, which I'm duty-bound not to speak about so as to not hurt the negotiations, as they say. But I think that, you know, outside of master agreement, we're working with midwives, particularly for rural practitioners. Developing a contract template, for example, is an alternative to fee-for-service compensation, which for midwives in rural areas becomes a more difficult proposition, as the member might imagine, in terms of maintaining practice and funding those at a rate that makes the practice sustainable.

So that's an example of the priority we give to it. I give high priority to midwives. They play a very important role in care in B.C. They have an important role to play. I think the future is bright. Obviously, we're in negotiations, which creates tensions, and the association is also making its case known publicly as occasionally happens in contract negotiations role in care in B.C., and they have an important role to play. I think the future is bright. We're in negotiations, which obviously creates tensions, and the association is also making its case known publicly, as occasionally happens in contract negotiations in British Columbia.

That is absolutely their right to do, but they should know that I believe that they play a critical role in health care in B.C. I'm a strong supporter of midwives as a profession, and I believe that they're going to play not a lesser role, but an increasing role, in health care in the coming years.

S. Furstenau: Thank you to the minister for that. I'm going to shift gear to another area. We hear a lot from constituents who are paramedics and who have been struggling as well. They are considered essential service workers by the province. My understanding is that they were considered essential workers through the COVID-19 pandemic but are feeling less valued than they would like to be. They are feeling that they're not paid for their full shifts and are having to take on additional costs in their roles.

Can the minister confirm what the mandated minimum wage for a paramedic is and what the average wage is across the industry?

Hon. A. Dix: I take, I would say, a more positive outlook on ambulance paramedics. First of all, the fact is that we've funded 119 more full-time positions across B.C. in the last two years, under the action plan. We've transformed and shifted, in many rural areas, from part-time to full-time positions that we've added. We have hundreds of positions, in the hundreds, of community paramedicine in B.C. We've improved response times and the number of ambulances, and we've assigned, as the Premier noted, a significant number of new ambulances to support our COVID-19 area, in rural and remote areas.

Finally, we've restored something that had been taken away in 2010, which is the bargaining unit for ambulance paramedics. They were attached to another bargaining unit up to that point, and we created a special bargaining unit for ambulance paramedics. There hadn't been a real, true, negotiated collective agreement in decades, and we negotiated a true collective agreement. The increase in spending since I've become Minister of Health has been approximately 10 percent over two years, which is a pretty significant increase in the spending in the general area. A lot of that spending — most of that spending, as in every area of health care — is on salaries.

With respect to paramedic wage rates, they differ by licence levels, obviously, and whether they're working full-time or on-call. The minimum qualification for a primary care paramedic, working a minimum wage rate, is $27.12. There are some driver-only rates, but generally, a brand-new paramedic will make at least $27 an hour when they're on a call performing paramedic work. There are on-call rates — one that's, of course, noted is the $2 or standby on-call rate — and those are issues that were dealt with in the recent negotiations. Excluding on-call standby shifts and overtime, paramedics earned $36.47 an hour on average in 2019.

That was an advance on the collective agreement that was negotiated. Obviously, the negotiations take place between the Public Sector Employers Council, the Health Employers Association and the employees of BCEHS, who are in their own bargaining unit.

S. Furstenau: Can the minister just give a little bit more information about the on-call rate? I think that's the one that I'm hearing from some of my constituents about. Just give some elaboration on it. When he says that that has been addressed, what is the outcome of that?

Hon. A. Dix: There are some specifics here about how that's dealt with. Yes, there are concerns about that, and there is some dispute amongst paramedics as to the direction the government has gone and in what we've done in partnership with them — which is to increase full-time paramedics, to add more full-time paramedics in rural areas and to not have as much support and recognition of on-call paramedics. In the view of some, that's a debate, but there are specific amounts to the collective and that we've done in partnership with them, which is to increase full-time paramedics and add more full-time paramedics in rural areas and to not have as much support and recognition of on-call paramedics, in the view of some. That's a debate, but there are specific amounts to the collective agreement. I'm happy to share that information. We'll do so as early as Monday so that the member can have it. I just want to make sure that the information is exactly right, and I'll share that with the member on Monday.

S. Furstenau: I'm going to jump to my next topic here, which is safe supply and decriminalization of drugs.

As the minister knows, it's very tragic that June 2020 was the deadliest month in B.C.'s history for illicit drug overdoses. There have been hundreds and hundreds of people who have died this year due to drug toxicity. As Dr. Bonnie Henry said, there is widespread global recognition that the failed war on drugs and resulting criminalization and stigmatization of people who use drugs has not reduced drug use but has instead increased drug harm.

Dr. Henry has repeatedly called for a safe, regulated supply of opioids to address this crisis. Could the minister talk about his views on this step of safe supply of opioids as a way of addressing the overdose crisis in British Columbia?

Hon. A. Dix: O course, we have, on mental health and addictions issues, an extraordinary cabinet minister in my colleague, the Minister of Mental Health and Addictions. I did think that she did canvass these issues pretty thoroughly. I think it's absolutely fair that I be asked about the issues, too, but I want to acknowledge her role and her leadership on this question.

Sometimes people ask me why I don't speak out more — ask me that question. I say it's because that responsibility is not…. It's not that I'm not interested in the area, because I am. It's because we have an outstanding Minister of Mental Health and Addictions who does so.

I think this is an extraordinary set of events — two public health emergencies we're facing. One, the advent of COVID-19, has clearly had a detrimental effect on the other. So in June, 175 overdose deaths and in May, 171 overdose deaths.

The member will know that the Premier has called on the federal government, written to the federal government, to ask for the decriminalization of personal amounts of drugs under the Criminal Code, which is hopefully an initiative that the federal government will undertake, and in any event is overdue. But we're not waiting for that. We've responded to this impact in terms of the services we provide and the prescribed alternatives that we are providing to people who are dealing with issues of addiction. We've significantly increased the number of people in opioid agonist programs and iOAT programs in the last number of years. So there's a significant increase in the number of prescribed alternatives, which has real costs, which I should be able to provide to the member, but also significant value.

The program and the guidelines were changed — I recall Dr. Henry announcing those changes in March of this year — which has significantly increased access to the prescribed hydromorphone program, which has increased, I believe. I don't have the numbers in front of me, but it went from approximately 600 to approximately 1,800 people, which is a significant increase. It tells us, I think, that in the people that have taken up that, the need for prescription alternatives continues to be high and significant. I believe that the increase in that access — while the results, of course, in the number of overdose deaths have been high — has meant avoided deaths, as well. It has been an effective measure that has been helpful.

We believe that the federal government should change the law. We're dramatically increasing resources throughout the system under the direction of my colleague the Minister of Mental Health and Addictions and offering prescribed alternatives. Those offers are being made and are making a significant difference.

That's some discussion of the issue. I know the member could canvass the issue with the Minister of Mental Health and Addictions, but that certainly reflects my position, in any event.

S. Furstenau: Thanks to the minister for that.

are making a significant difference. That's some discussion of the issue. I know the member could canvass the issue with the Minister of Mental Health and Addictions. But that certainly reflects my position, in any event.

S. Furstenau: Thanks to the minister for that. I appreciate him elaborating on his position on that.

I have a number of constituents in my riding — family members and children — with cystic fibrosis, which, as the minister knows, impacts thousands of people in this province. There is mental health support needed for people with cystic fibrosis. For several years, a program for standards of care in mental health has been in development, but it would need support from the ministry in order to be fully implemented. Those working on putting this program into place have estimated that it would be $5 million per year in dedicated funding to support this.

Can the minister speak to whether he imagines that there will be dedicated funding for patients with cystic fibrosis under this type of program in the upcoming budget?

Hon. A. Dix: The member will know, and I've talked a little bit about these issues in estimates, that at the end of the last fiscal year, $150,000 in funding was provided to Cystic Fibrosis Canada to support some of their immediate efforts, including efforts in support of the mental health needs of people living with cystic fibrosis.

The member will know, I think, that outcomes for people living with cystic fibrosis have increased. Life expectancies increased dramatically in recent years, something which is a very positive and truly wonderful development. It presents, of course, new problems for people living with cystic fibrosis, but it's an extraordinary development and reflects improvements in care.

I think the program the member is talking about — and forgive me; this is from memory — is a proposal that has been made by Cystic Fibrosis Canada to the Provincial Health Services Authority for supports for mental health services and so on, and that is being reviewed. But as well, I think we need to take the six existing centres which support, at the acute care level, people with cystic fibrosis — two are on Vancouver Island, two are in Metro Vancouver, and then there's Kelowna and the University Hospital in Prince George — which are associated with them and provide supports.

I think what we need to do — and I talked to our colleague earlier — is to ensure that those are fully integrated into primary care networks, that there are more supports in primary care for people with cystic fibrosis, and there are ways of doing that. The proposal that has been made by the groups to the Provincial Health Services Authority is being been reviewed and will be involved, like all other items, in the budget process for the coming year. But there is an active business plan that's been submitted. The government is looking at that, and the PHSA is looking at that at this time.

S. Furstenau: Thanks to the minister for that. That's helpful to know that that's being reviewed right now.

I'm going to jump over to surgeries, as we have go through this all very quickly within our one hour here. I'm just going to start by asking some figures that the minister, which I expect with his extraordinary capacity, is going to have at his fingertips. In 2018, the Ministry of Health announced the provincial surgical strategy was $75 million in additional targeted funding in 2018-2019 and $100 million in 2019-2020. They did not have a crystal ball to anticipate COVID-19. I'm aware that that was a bit of an abrupt hit to the planning, and now the minister has committed an extra $250 million in 2020-2021 to perform additional surgeries.