Highlights of the Year

Introduction

A tremendous amount of transformation has occurred in the health system over the past four years. Significant reforms were begun in 2001, and through the dedication and hard work of health workers across the province those reforms have created a more streamlined and better-managed health system that is better able to respond to growing and changing public and patient needs. All along, the goal of these efforts has been to build a health system that delivers quality services for British Columbians and is sustainable into the future.

Though government has increased health funding every year, we also recognized that money alone would not make the health system more responsive to people's needs or sustainable over the longer term. It was also important that the health system be able to adapt and modernize to meet the changing demands of the public. In fact, a series of provincial and national studies have consistently cautioned against continuing to add resources without effecting significant change in the management and delivery of health services.

Accordingly, government undertook significant reforms to redesign the health system in British Columbia. As part of a commitment to better planning and management, government reshaped the health system and increased accountability. Key advances in improved planning, management and accountability include:

• Reduced the number of health authorities from 52 to six, resulting in a simpler, more accountable governance model for health service delivery.
• Introduced three-year service plans and funding targets for the Ministry of Health Services and health authorities.
• Instituted a population needs-based funding formula for regional health authorities, so funding is allocated based on the relative needs of residents in each region.
• Introduced performance agreements between the Ministry of Health Services and health authorities which contain specific targets for system performance in key areas, such as emergency services, surgical services, mental health and addiction services, home and community care, population health, and Aboriginal health.
• Balanced budgets for the Ministry of Health Services and each health authority.

A critical step toward a population-based approach to care was the amalgamation of 52 diverse health authorities into five geographic authorities responsible for health services within their region and one provincial authority responsible for province-wide tertiary or highly specialized services. This streamlined structure is better able to manage the complexity of the health system, take advantage of the ability to adapt to change, make strategic investments across the continuum of care in order to be nimble, and be responsive to the changing needs of the population.

In 2004/05, the Ministry of Health Services continued with its health system reform efforts. While many of the major structural and governance changes have now been completed, many challenges remain. Even though British Columbians currently enjoy the best health status in Canada, there are worrying trends that are already creating unprecedented demands on the health system. Rising rates of obesity, a lack of physical activity, injuries, tobacco use and problematic substance use all impact individual health and create demands for health services. In addition, an aging population with a rising burden of chronic illness is resulting in the continuing rise in demand for increasingly complex and expensive health care services.

This annual report contains information on the ministry's key strategies and accomplishments in 2004/05, as well as performance results for system indicators. Significant reforms and new initiatives have continued across the health system, as the ministry works with health authorities and health professionals to build a system that meets the needs of British Columbians and is sustainable into the future.

Key Accomplishments in 2004/05

To support health reforms, and help meet rising demands for service, government once again increased health funding in 2004/05. Annual funding for health services has increased every year, and in 2004/05 more surgeries and more services were delivered in B.C.'s health system than ever before.

In September 2004, British Columbia played a leading role as the provinces and territories negotiated a new health deal with the federal government. As a result of this agreement, British Columbia expects to receive a total of $5.4 billion in new federal health funding over the next ten years. This new federal funding, which over 10 years represents approximately four per cent of the expected spending on health services, is not the panacea to our challenge of funding the health care system, but is an improvement to what B.C. would otherwise have faced.

While increased funding will help, government recognizes the system will not be sustainable, nor will it meet people's needs, unless it is redesigned to support good health and foster improved quality. The health system of the future must do more than provide short-term episodic care that is often based in a hospital. It must provide services across the continuum of care; services that help people stay healthy (health promotion and disease prevention), get better (intermittent use of primary, community and hospital care), manage disease or disability (chronic care), and cope with end of life (hospice/palliative care).

Accordingly, in 2004/05 the ministry introduced or continued a number of strategies across the span of health services, including population health and safety, primary care, chronic disease management, Fair PharmaCare, ambulance services, community programs for mental health and addictions, hospital and surgical services, home care, assisted living, residential care and end-of-life care. The ministry has also worked to ensure an adequate supply of skilled providers across all these programs.

Rebalancing the system to provide access to quality health care and services across one's life span will help improve the health of our population, ensure the right services are provided to meet people's needs, and assist in keeping the health system sustainable.

Keeping People Healthy

The health system has long been focused on treating people when they are sick or injured. While that is certainly a very important role for the system, it is also important that efforts be made to assist British Columbians to stay healthy. Good health enables people to enjoy their lives to the fullest and actively participate in society and the economy. In addition, investing in keeping people healthy reduces demand for expensive health care services and helps keep the system sustainable.

Accordingly, in 2004/05 the ministry introduced a number of innovative initiatives in the area of health promotion and disease prevention to improve the health and wellness of British Columbians. Efforts are being made to increase access to quality health information and support programs, and to provide services that prevent illness and disease. Highlights include:

• Launched ActNow BC, a program which cuts across all sectors to promote healthy lifestyles, prevent disease and mobilize communities by providing people with the information, resources and support they need to make healthy lifestyle decisions.
• Expanded Action Schools! BC to increase elementary students' physical activity levels and provide them with information on healthy lifestyles.
• Supported healthy childhood development by introducing programs to identify problems with hearing, vision or dental health for children before they reach Grade 1.
• Protected health through immunization programs, infectious disease and injury prevention and control measures, monitoring and regulating water and environmental safety, reproductive health, food security and health emergency management.
• Invested an additional $12.75 million in expanding childhood immunization programs for meningitis and chickenpox. Also, B.C. successfully met record demand for influenza immunization by providing well over 1,000,000 doses to B.C. citizens for the flu season.
• Strengthened prevention measures relating to West Nile virus through the addition of $5 million to ensure local mosquito control programs are in place. The ministry is working with the Provincial Health Officer, the BC Centre for Disease Control, health authorities and municipal governments to address the potential outbreak of West Nile.
• Continued to implement coordinated approaches for responding to major public health risks, emergencies or epidemics.

Providing Access to High Quality Care and Services

When people do get sick, they need access to health services to help them get better or manage their condition. The ministry, health authorities and health professionals have worked together to provide increased access to high quality services for British Columbians.

Increasing Access

Access has been expanded across the spectrum of care, from NurseLine services to heart surgery and cancer treatment. Highlights include:

• Increased overall funding for the health system to $10.7 billion, including an increase of $123 million to a record $6.2 billion for the province's six health authorities, to provide care and services that meets people's needs.
• Targeted over $45 million in additional funding to provide 240 more heart surgeries, 2,000 more orthopaedic procedures (including hip and knee replacements, arthroscopy and spine surgeries), 500 more cataract procedures and nearly 17,000 more diagnostic procedures. This builds on increased capacity built between 2001 and 2003, including a 21 per cent increase in hip replacements, 33 per cent increase in knee replacements, 20 per cent increase in cataract removals, and 40 per cent increase in angioplasties.
• Released B.C.'s first comprehensive survey of ER care — it revealed that 85 per cent of the over 14,000 patients surveyed rated the quality of care they received in B.C. emergency rooms as good to excellent. Also, almost 80 per cent reported waiting an hour or less to see the ER doctor.
• Added $20 million in new funding to B.C.'s cancer care system to improve radiation therapy services and increase cancer treatment access to stay ahead of demand for cancer services. Our cancer care network already contributes to B.C. having the best survival rates in Canada.
• Invested $3 million to increase the number of women having a screening mammogram every two years, a critical component of catching breast cancer early.
• Strengthened rural health services with a $6 million commitment for programs such as telehealth, recruitment programs, and improved ambulance services, and introduced a new rural travel assistance program to help eligible rural residents travel for medical services.
• Continued to expand the BC NurseLine service, which provides 24-hour, toll-free access to registered nurses specially trained to provide confidential health information and advice to citizens.
• Provided British Columbians with access to prescription drug coverage through the Fair PharmaCare plan, which focuses financial assistance on B.C. families who need it the most, with benefit levels based on a family's combined income. In January 2005, the program introduced a new monthly deductible payment option to further assist families in managing prescription drug costs.
• Led the charge on a National Pharmaceuticals Strategy to provide all Canadians access to catastrophic drug coverage, to accelerate access to breakthrough drugs, to strengthen the national evaluation of drug safety and effectiveness, and pursue national purchasing strategies to obtain drugs and vaccines at the best price possible. B.C. will continue to lead work on the strategy in 2005.
• Increased the threshold for eligibility for the Medical Services Plan premium assistance program by $4,000 per year. The change reduced or eliminated monthly payments for an estimated 215,000 British Columbians.

Improving Quality

Important initiatives have been undertaken across the health system to improve the quality of health services. Encouraging innovation, integrating services and applying proven best practices in the treatment of health conditions can all lead to better health outcomes for patients. Achieving system-wide quality improvement is not possible when individuals work alone, so many of the ministry's strategies have involved initiatives to share information and work together in the best interests of patients. Highlights include:

• Worked with physicians and health authorities to enhance primary care services. Through the 2004 working agreement with the British Columbia Medical Association, 30 Professional Quality Improvement Days involving approximately 800 physicians from across the province were held to provide opportunities for doctors, health authorities and the ministry to work together to enhance primary care services. Over 2,000 clinicians are now involved in primary care quality improvement initiatives across the province.
• Implemented innovative approaches for managing chronic diseases. A number of initiatives have been implemented, including a secure, web-based Chronic Disease Management Toolkit that gives authorized doctors, nurses and other care providers access to tools and information incorporating proven best practices for the treatment and management of chronic conditions.
• Invested $10 million to enhance patient safety. Among other initiatives linked to this investment is a $3 million one-time endowment to establish a research chair of patient safety at UBC's faculty of medicine and $6 million to support the work of a new Patient Safety Task Force.
• Provided $30 million to the Michael Smith Foundation for Health Research for new programs in B.C., which continue to develop, attract and retain outstanding health scientists and researchers. This funding supports research in priority areas such as health care re-engineering and innovation.
• Expanded emergency response services by having paramedics at ambulance stations 24 hours a day, in both rural and urban communities.
• Released Every Door is the Right Door: A British Columbia Planning Framework to Address Problematic Substance Use and Addiction that gives health authorities a common planning model to deliver comprehensive, responsive services from prevention through harm reduction and treatment.
• Continued the strengthening of mental health and addiction services across the province, including breaking ground on a 44-bed, $17 million psychiatric acute care facility at the Royal Inland Hospital to benefit patients in the Interior. The project is scheduled for completion by summer of 2005.
• Continued to implement a new model of home and residential care that expands options and better meets the needs of seniors. Government has added, replaced or upgraded over 4,000 residential care and assisted living units for seniors to date, and will complete 5,000 new residential care and assisted living spaces by 2008.
• Expanded end-of-life care choices, including the palliative benefits program that provides people who choose to die at home with medications, medical supplies and equipment.
• Invested in leading edge medical equipment, such as the first PET unit for B.C., to be located at the Vancouver Cancer Centre; new CT scanners for Royal Columbian Hospital, Royal Jubilee Hospital, Vancouver General Hospital, Lion's Gate Hospital and Kelowna General Hospital; and a new MRI scanner at Children's and Women's Hospital, a mobile MRI scanner for the Kootenays and South Okanagan, and an upgraded MRI scanner at UBC Hospital.
• Established an Electronic Health Steering Committee to accelerate the development and implementation of eHealth for British Columbia. A number of projects are underway, including development of an electronic health record, which will improve efficiency and safety by enabling care providers to access clinical information, such as patient medication profiles, lab and other testing results, using web-based technology.

Investing for Future Sustainability

Part of managing the system well is making the right strategic investments now that will help ensure our health system is sustainable into the future. Investing in infrastructure and health human resources are key priorities for government. Highlights include:

• Started construction of a new 300-bed Abbotsford Regional Hospital and Cancer Centre for the residents of the Fraser Valley, to be completed by 2008.
• Completed the Prince George Regional Hospital redevelopment, including a new patient care building with new medical/surgical beds, improved critical care services and a new emergency department.
• Redeveloped the Royal Inland Hospital in Kamloops, with a new emergency department opened and a new medical imaging department scheduled to be open in the summer of 2005.
• Began construction of the Nanaimo Regional General Hospital expansion to improve patient care, surgical services and maternal programs.
• Began the renovation and redesign of St. Paul's emergency department, due to be completed in 2005.
• Opened the 19-storey Jim Pattison Pavilion at Vancouver General Hospital, with 459 new beds and modern equipment and care facilities.
• Launched major improvements to the Fraser Valley Cancer Centre in Surrey and the Vancouver Cancer Centre to acquire and accommodate eight new and replacement linear accelerators.
• Started building a new 11-storey Academic Ambulatory Care Centre in Vancouver that will coordinate patient care services and academic programs in medical education, physician teaching clinics and research.
• Expanded B.C.'s medical training program, almost doubling the number of doctors in training. In September 2004, 72 more medical students than the previous year began their studies in B.C., bringing the total number of students in each year to 200. By 2008, there will be almost 900 medical students in training at any given time in B.C. Also, to strengthen medical education, government invested $27.6 million to expand and upgrade academic space in teaching hospitals around B.C.
• Strengthened government's relationship with physicians by reaching a new three-year working agreement. The agreement sets a framework for greater physician participation in health system issues like increasing physician use of information technology, supporting full service family practice and laboratory reform.
• Continued the Nursing Strategy to expand the number of nurses in B.C.'s health system. This year, an additional 321 seats were added to nursing programs, bringing the total number of new nursing seats to 2,134 since 2001. In addition, B.C.'s first group of nurse practitioners graduated in May 2005, adding a new and important level of care to the system.
• Entered an agreement to improve delivery of MSP and PharmaCare services to British Columbians and improve the protection and privacy of personal data.