With today’s Throne Speech, the BC Liberal Government once again positioned LNG development as its moon-shot saving-grace for the economy, the climate and B.C.’s future. Yet, according to Andrew Weaver, MLA for Oak Bay-Gordon Head and Deputy Leader of the BC Green Party, while the government’s throne speech offers lofty goals, it falls far short of positioning B.C. as a leader in the 21st century economy.

“The BC Government is talking about making an economic plan and sticking to it and yet they still have no plan for what to do once LNG runs out or if it never takes off,” says Dr. Andrew Weaver. “We are still not using LNG to transition ourselves to a low carbon economy. And we still have no back-up plan for our economy if LNG fails to deliver. ”

The USA, China, and EU are all heading into renewable energy and knowledge based economies. Instead, B.C. is doubling down on its hope to become a super highway for non-renewable exports.

British Columbia has the potential to be a clean tech powerhouse but for this to happen we need a specific and actionable economic and skills training plan to position B.C. as a leader in the new global clean tech economy.

As the 2014 legislative session begins, Andrew Weaver will be looking for MLAs who are serious about building an economic future based on access to clean renewable energy, the innovative potential of British Columbians, and our desire to ensure fiscal, environmental and social sustainability for future generations.

In making this challenge, Weaver says: “To those politicians who claim to be so concerned about greenhouse gas emissions, where are your voices in opposition to the proposed expansion of thermal coal exports? To those politicians who are concerned about a strong economy, where are your backup and transition plans? ”

On April 23, 2014 Island Health (VIHA) will launch a new Patient Care Model at the Royal Jubilee and Victoria General Hospitals. According to Island Health the model (titled Care Delivery Model Redesign, or CDMR) will address strains on the health care system while increasing the care time a patient receives. According to the BC Nurses Union, it could put patients at risk as highly trained nurses are replaced with significantly less-trained health care aids.

Many constituents have already written Andrew Weaver with their concerns about the patient care model. The purpose of this town hall is to try to bring together the different perspectives so that we can all get informed about this significant change to our health care system.

Panelists include: Dr. Noreen Frisch, Professor and Director of the Uvic School of Nursing; Dr. Paddy Rodney, Director at Large – Association of Registered Nurses of British Columbia and Professor at UBC School of Nursing; Sara Shorten, representative from the Uvic Nursing Student Society; Adriane Gear, South Island Regional Co-chair – British Columbia Nurses Union.

Island Health was invited but declined to participate.

Format: Andrew Weaver will moderate a panel discussion and Q&A

Date: February 27, 2014

Time: 19:00-20:30

Location: Oak Bay Recreation Centre Lounge, 1975 Bee St.

Everyone welcome!

Overview

Island Health (formerly VIHA) is reconfiguring nursing care teams in medical and surgical units at select hospitals as a part of a new Patient Care Model called Care Delivery Model Redesign (CDMR). The reconfiguration is a part of a nation-wide trend to change how care is provided to patients in hospitals. In essence, CDMR would implement a team-based nursing approach between Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Health Care Aids (HCAs), with HCAs playing a significantly larger role in patient care delivery.

According to Island Health, the new model will address strains on the system while increasing the individual care time a patient receives. However, critics argue that the new model is overly focused on cutting costs and will put patients at risk. In essence, they argue that nurses will be stretched too thin to provide adequate care to patients, making one nurse responsible for up to 10 to 12 patients, and that Health Care Aids do not have the necessary training to safely take on this larger role.

Andrew Weaver, MLA for Oak Bay-Gordon Head and Deputy Leader of the BC Green Party, is calling on Island Health to delay further implementation of CDMR until comprehensive, independent and publically-available evaluations can be completed. If critics are right, the cost of going forward with CDMR will be borne by patients who may well receive inadequate and potentially harmful care in island hospitals.

Background

Health Authorities across the province are faced with the challenge of continuing to provide quality service in the context of limited budgets, staffing challenges and changing demographics, principally defined by an aging population. This context has led Island Health to explore new ways of meeting patients’ care needs. One approach has been CDMR.

According to Island Health, over the past several years researchers have been collecting data on typical patient care needs so as to better calibrate their care teams to those needs. There are 3 main types of health care professionals that make up an affected care team:

1. Registered Nurse (RN)—A licensed and regulated nurse requiring an undergraduate degree and representing the highest level of training of the three types of professionals.
2. Licensed Practical Nurse (LPN)—A licensed and regulated nurse that works under an RN and requires a two-year certificate of training.
3. Health Care Aid (HCA)—An unlicensed and unregulated care provider that supports an RN or LPN to provide basic care to patients. HCA’s generally complete a four-to-five month training course, but there are no regulated standards for HCA training programs or HCAs in general.

The conclusion from Island Health’s research is that HCAs could play a larger role in providing basic care (e.g. bed baths, patient mobility). The result is CDMR—an approach that would see HCA’s take on this larger role and effectively reduce the number of RNs and LPNs on medical and surgical units. However, HCAs are not a regulated profession meaning there is no quality control or scope of practice governing their training or role in the health care system.

Island Health introduced CDMR at Cowichan Hospital and Saanich Peninsula Hospital roughly two years ago. CDMR was then introduced at Nanaimo Regional Hospital in September 2013, with additional plans to implement it at Victoria General Hospital and Royal Jubilee Hospital in January or February 2014.

Differing Perspectives

Both Island Health and the British Columbia Nurses Union have been vocal about CDMR, offering differing perspectives.

Island Health: According to Island Health CDMR is a ‘data-driven’ model that will allow care teams to better meet patient needs, provide more staff hours per patient and address, in part, staffing issues such as overtime. Island Health asserts that HCAs are sufficiently trained to offer support services, such as bed baths and mobility support, as a part of a broader care team. Island Health also states that they have been conducting on-going studies of CDMR to evaluate the care model.

Link to Island Health’s publications on CDMR: http://www.viha.ca/about_viha/news/new-patient-care-model.htm

BCNU: The BC Nurses Union has been highly critical of CDMR citing research that suggests such care models would have negative impacts on patient care outcomes and arguing that the data on which CDMR is based has not been released for public scrutiny to know if CDMR would be any different. The BCNU is in favour of team-based care models, but argues that the teams need to have the right make-up of skills and CDMR as proposed does not offer this. They suggest that CDMR would stretch nurses too thin, making them responsible for more patients than they can safely care for and offering too large a role to unregulated and inadequately-trained HCAs. They suggest that patients may receive inadequate and potentially harmful care as one RN may be required to care for up to 10 or 12 patients.  As such, they have expressed concerns that it would be difficult for them to provide the standard of care required by the College of Registered Nurses of British Columbia, the College of Licensed Practical Nurses of British Columbia and the College of Registered Psychiatric Nurses of British Columbia.

Link to BCNU’s statements on CDMR: https://www.bcnu.org/Search.aspx?search=cdmr

Academic Research: There is no publicly available research specifically on CDMR itself, as CDMR is a tailor-made model for Vancouver Island. However there is significant academic research looking at “nurse staffing” levels and what happens when you decrease the number of highly trained RNs and increase the number of comparatively less-trained LPNs or HCAs. The research generally suggests that this change is associated with a significant drop in the quality of care a patient receives. There is enough of this research out there to raise serious questions about the risks associated with CDMR.

Two Canadian researchers who have published in this area are: Dr. Linda O’Brien-Pallas and Dr. Linda McGillis Hall

Questions

It is difficult at this stage to definitively assess whether CDMR is a good model or not. Island Health claims to have data that suggests it is. However, their evaluations are not publicly available and run contrary to existing academic research. Nurses are highly opposed, arguing they will not be able to provide sufficient quality care under CDMR since they will be responsible for more patients than they can manage. What is clear is that if critics are right, CDMR may have a significant impact on the quality of care patients receive in BC hospitals and lead to a rise in potentially harmful care situations. This context begs three key questions.

1. If there is research showing the success of CDMR, then when will Island Health make it available?
2. CDMR has been implemented at Cowichan and Saanich Peninsula Hospitals for two years. Has Island Health evaluated CDMR in these settings and if so, when will the evaluations be made publicly available?
3. If Island Health has not yet completed comprehensive evaluations showing that CDMR is a successful model, then why are they rolling it out in more and more hospitals amidst strong opposition that raises serious questions about its validity as a care model?

Andrew Weaver on CDMR

In light of the potentially serious risks associated with CDMR, Andrew Weaver is calling on Island Health to:

1. Delay further roll-out of CDMR, including all plans at Victoria General and Royal Jubilee Hospitals, until comprehensive, independent and publically-available evaluations of CDMR can be completed.
2. Further involve relevant stakeholders, including representatives of BC’s Registered Nurses and Licensed Practical Nurses, in the evaluation of current CDMR pilots as well as in the development of future plans involving the realignment of care teams.

BoardVoice is dedicated to improving social services to people in their communities. We do this by speaking to government and to our communities about the importance of social services to the health and well being of our citizens, bringing to their attention key concerns and issues, and telling the good news about the work of community based social service agencies.

We promote excellence in governance by connecting board members from across the province and providing resources that assist in developing their boards.

We help build bridges between agencies at the community level to ensure community-wide understanding of how best services should be organized and delivered. Board Voice.ca

On Friday November 22nd, at the Board Voice conference in Vancouver BC, Andrew Weaver, MLA for Oak Bay – Gordon Head provided his thoughts in a keynote speech to delegates.

Board Voice Conference Speech

“We live in a province of opportunity. Not opportunity that is handed to us, but opportunity that we create. We live in an time where the challenges of today are no longer addressed by the solutions of yesterday, and so we are called upon to find new solutions to new challenges—to create new opportunities—so that together we can continue to build a more prosperous, equitable and just society.

We have heard the Liberal government talk of a generational opportunity to develop a liquefied natural gas sector in BC. Today, I would like to propose that we have another generational opportunity in front of us; a generational opportunity to rethink how we address the social challenges that for years have afflicted British Columbians—our families, friends, neighbours, and ourselves.

To do so, we must start by recognizing the reality around us. We are working in a context of budget cuts and core reviews, growing social issues and an economy that is still bouncing back from the 2008 recession. It is a context of limited resources and significant challenges where we do not have the luxury or the resources to address social, environmental or economic issues as if they are isolated siloes — each independent from the other. We have tried this for years, and it does not work.

Addressing these issues in a context of limited resources requires us to move beyond the traditional framework that a social issue is social, and an economic issue is economic.

Instead we are required to find those nexus points that wed the economic, the social and the environmental into a coherent and comprehensive framework for developing our society. Developing these nexus points requires the political will to steer our society in that direction. And that is what I would like to talk to you about today: Nexus points and political will.

What do I mean by this?

Tomorrow morning, you’ll be hearing more about what Alberta’s Social Policy Framework entails and how the Government of Alberta developed this framework. Board Voice is advocating for a similar social policy framework for BC. I believe this is an idea that has merit and deserves attention. But I would challenge us to take it one step further.

As you all know, our ability to fund and implement a social policy framework is contingent on a strong economy that provides the resources to do so. In turn, building a strong economy is contingent on addressing social issues and on the sustainable management of our environment and the resources it affords to us.

There are countless examples of where our attempts to develop the economy have caused significant social or environmental challenges, and vice versa. We need to build a framework that does not simply address social issues alongside the economic development plan, but one that integrates social issues into, and weds them with, economic development and the sustainable management of the environment.

We need to find the nexus points that allow us to move all three aspects forward for the benefit of British Columbia. These nexus points exist, but finding and developing them requires the political will to do so, and therein lies a significant challenge.

How do we create the political will to not simply take the easy way out and focus solely on a single issue, like the economy, but instead to explore those nexus points between the economy, social issues and the environment? This is where, I believe, the Albertan example can offer some guidance.

In creating their social policy framework, the government of Alberta reached out to over 31,000 Albertans in order to get their feedback. This process offered Albertans the opportunity to define Alberta’s social priorities and values in a comprehensive, holistic, and inclusive manner.

As an example, let me highlight two of the social policy goals that were identified as a priority in the framework:

(1) protect the vulnerable, and (2) reduce inequality.

These are goals derived from the people of Alberta, not the government of Alberta, nor Alberta’s governing party. And they are goals that are now being addressed as a part of a comprehensive social policy framework, because Albertans had the opportunity to raise their priorities thereby generating a social license and building political will.

The large-scale public consultation was a critical aspect of creating a social license and building political will. We could and should do the same in British Columbia.

I believe the rationale for having such a framework also exists in British Columbia. In particular let me draw your attention to the three central reasons for the implementation of Alberta’s Social Policy. Paraphrasing, they were:

(1) to clarify the priorities and goals of Albertans and how roles and responsibilities should be allocated,

(2) to coordinate and harmonize activities between government divisions and also with other stakeholders while also ensuring that there is policy alignment and consistency, and

(3) to provide overall direction and focus to planning and decision-making.

To be sure, the Albertan example is not perfect. There was criticism of both the public consultation and the framework itself and the Albertan context is quite different from the British Columbian context. But nonetheless, let’s consider these goals in the context of British Columbia and let’s do that through the lens of a specific issue: adolescent mental health care.

We have a chronically underfunded adolescent mental health care system. In fact, the Representative of Children and Youth does not even consider it a system, so much as a patchwork of services. These services are primarily offered by two ministries: the Ministry of Children and Family Development and the Ministry of Health.

The problem is, because they are offered by two ministries with insufficient coordination of care, many young people experiencing mental health issues, and their families, struggle to navigate the services and find the support they need. Effective coordination and harmonization of services is lacking and that reality is having a negative impact on our ability to deal with adolescent mental health problems.

This situation has both social and economic consequences. Socially, it means that many people in need of care are not getting the care they deserve. The significant distress and impact this lack of care has on the individual is impossible to put a number to, but sadly we all know from recent cases, just how far it can go.

Economically, mental health problems and illness are estimated to cost our province more than $6 billion each year through service costs and lost productivity. This amount does not include costs related to the criminal justice, education or child welfare systems. The longer we put off effectively treating mental health care issues, the more we suffer the long-term economic consequences of our inaction. Better coordination and harmonization of services—through a comprehensive framework—could allow for more effective allocation of public resources, making economic sense, and for more effective treatment, making social sense.

Taking this further, right now the Liberal government is administering what they call a core review. Their goal is to use public resources more efficiently by eliminating unnecessary spending. Yet issues such as better coordination and harmonization of services and long-term planning that would see the better treatment of mental health as both a smart social, and a smart economical, choice are not being fully considered.

They are not being fully considered, in part, because we see mental health as a social issue—one that is secondary to the government’s primary economic agenda. We have siloed mental health into the social realm and have failed to see that, in its essence, adolescent mental health is also an economic issue and that developing a strong economy also requires that we address what we have traditionally seen to be simply social challenges.

We need to change that. We need to build the political will for a triple-bottom-line understanding of these issues—one that looks for those nexus points and uses them to move our province forward.

Although it remains to be seen how effective the Alberta example will be, I do think there is value to considering their approach. In fact, I believe the public consultation process that Alberta ran could also serve British Columbia as we consider our own framework. It could help us define for our own government, what our priorities as citizens are and what their priorities as a government should be.

Yet, I would challenge us all to see this not simply as an opportunity to address the social challenges of our time, but also as an opportunity to create a more holistic vision for British Columbia, generated by the people of this province, and predicated on triple-bottom line priorities and finding key nexus points of interaction.

Addressing social issues, building a strong economy, and sustainably managing our environmental resources—these are significant and interconnected societal challenges that must be dealt with as such. And creating the political will to see these issues as interconnected and address them in that way is our challenge.

I believe meeting this challenge will require us to transcend partisan politics and go to the root of what matters to British Columbians. An independent, public consultation offers us the opportunity to accurately reflect the true values and priorities of British Columbians without the interference of partisan politics. And it ultimately builds the social license required to implement the resulting policies.

Thank you very much for your time and for affording me the opportunity to speak.”

Andrew Weaver – MLA for Oak Bay – Gordon Head

Are you concerned about the future of health care on Vancouver Island?

Do you or someone you know have suggestions about how to improve our health care system?

Island Health (formerly the Vancouver Island Health Authority—VIHA) has launched a public consultation process to help shape its new strategic plan, Island Health 2018—and they are asking for your feedback.

The new strategic plan will lay out how Island Health will:

• Improve health for Islanders through community partnerships and health promotion
• Create a culture of excellence, quality and safety for clients, patients and health care workers
• Engage communities, clients and our workforce more effectively
• Sustain our health and care system through sound fiscal management

Island Health will be holding a public consultation session in Victoria this month. Here are the details:

Date: Tuesday, Nov. 26, 2013

Time: 5:30-7:30pm

Location: Sandman Inn, 2852 Douglas Street, Victoria, B.C.