Health Minister Adrian Dix’s budget for ministry operations this year is $25,308,645,000, which is $3 billion more than the entire provincial budget at the turn of the century.
He opened the scrutiny of his ministry this week with a dry observation: “As we like to say in the Ministry of Health, it’s just $25 billion.”
The initial arguments made clear that the health care crisis is a human resource crisis. Despite a staggering increase in staffing, thousands more people are needed, everywhere, in all fields.
Dix said the share of the budget that goes to paycheques is 72 per cent. There have been 38,000 new people hired in public health care in the last four years, many due to the pandemic. The head count has gone from 184,000 in 2018 to about 223,000 in 2022.
The ministry calculates that will have to increase by 14 per cent over the next eight years (about 30,000 more).
Recruiting, training and retaining staff in all disciplines — to work in all regions of B.C. — is the central question about the future of health care, he said. The aging population needs more health care but people in the health system are aging just like the population. There are 400 doctors in B.C. over age 70. One of them is 85 and still seeing patients.
The ministry started work on a long-range human resources strategy but it is now a year overdue. Dix acknowledged the pandemic-related delay and said the strategy is now expected to be released in September.
Numerous moves have been made in the interim. “We’re not waiting for the strategy to take action,” said Dix. Hiring challenges are so severe that some vacancies are just theoretical. They’re posted with no hope of being filled.
Dix told Opposition Leader Shirley Bond in the house: “There are positions in some parts of the province that haven’t been filled in a long, long time — maybe since she was minister of health. So what happens, effectively, is that service isn’t offered. I mean the position may be open and may exist as a vacant position, but effectively isn’t offered.”
Releasing the human resources strategy is just a bare start on easing some of the pressure. Dix warned that it takes years for moves being made in the present to show results. Announcing 602 new spaces to train nurses “doesn’t have an immediate impact. … Most of the impact will be felt a year, two years, three years from now. But if we don’t do it, then we’re going to be worse off.”
Long-term trends pushed the system into crisis and projections don’t provide a lot of encouragement. Most provinces expect the senior population to peak in 10 years, but B.C. doesn’t expect to see that because so many seniors move here. “It is not going to get easier for us 20, 25, 30 years from now,” said Dix.
Meanwhile, more immediate problems exacerbate the crisis. Dix said 17,996 health care workers were off sick in the last week of April and COVID-19 was a massive factor. It’s an extraordinarily high rate.
Various measures will be announced before the human resource strategy eventually arrives.
One of them is a provincial loan-forgiveness program. “I think we have to do more on loan forgiveness, perhaps in exchange for return of service, to get people started in a good way and not have our health-care workers facing very significant burdens that would limit them.”
But there’s a clear indicator of where the system is being forced to go to cope with demands.
It’s in the primary care system’s response to the pandemic, which involved what Dix said was the most radical change ever seen in health care.
There were 17.9 million fee-for-service visits the year before COVID-19, and 647,000 virtual visits.
In the first year of the pandemic, in-person visits dropped to 5.5 million, and virtual visits jumped to about 13 million. The switch wasn’t as extreme in the second year, but is still obvious.
Also being set up online is a health-connect registry where people can sign up to make contact with a primary care network.
Moving some services online isn’t just a matter of convenience, it’s a measure of desperation.