Report on Performance

Overview of Ministry Results

Overall, the Ministry of Health performed well in achieving its performance targets in 2005/06. The following table provides an overview of results for the performance measures used to judge progress on the goals, objectives and strategies contained in the Ministry's 2005/06 – 2007/08 Service Plan Update (September 2005). Detailed reporting of these results, including historical data and results analysis, can be found in the section following the summary table.

Of the 17 performance measures in the 2005/06 service plan, two measures are listed as "pending" because data are not available for 2005/06 at the time of publication. In addition, two other measures are listed as "not applicable" in the summary table as they did not have targets for 2005/06, other than to begin data collection to assess performance in future years.

Of the remaining 13 measures of 2005/06 performance, the results show that 11 performance measures achieved or exceeded their targets, one measure substantially achieved the target (defined as making at least 90% of the target), and one measure is "in progress" because it is being judged against a longer-term target. These results indicate the Ministry has made good progress in providing a health system that keeps people healthy, provides high quality patient care, and is efficiently managed to ensure its sustainability.

The Ministry of Health is committed to transparent performance reporting in the health sector, and through its Knowledge Management and Technology Division is working to ensure quality data are available for management and reporting purposes. In addition to the Annual Service Plan Report, a number of other health system performance reports are currently available, including the Provincial Health Officer's Annual Report (http://www.healthservices.gov.bc.ca/pho/annual.html), the Annual Report on Health Authority Performance (http://www.healthservices.gov.bc.ca/socsec/index.html), British Columbia's Report on Nationally Comparable Indicators (http://www.healthservices.gov.bc.ca/cpa/publications/pirc_2004.pdf) and the Vital Statistics Annual Report (http://www.vs.gov.bc.ca/stats/annual/). Further, several external agencies produce reports that assess the performance of the B.C. health sector. Examples include the Conference Board of Canada, Cancer Agency of Canada, BC Progress Board, Heart and Stroke Foundation of Canada, and the Canadian Diabetes Association.

Performance Plan Summary Table

Synopsis of Ministry Performance Measure Results

Goals, Objectives, Strategies and Performance Measures

Goal 1: Improved Health and Wellness for British Columbians.

The Ministry's first goal is to support British Columbians in their pursuit of better health and wellness. This goal directly supports Government's Great Goal to "Lead the way in North America in healthy living and physical fitness."

British Columbians in general are already among the healthiest people in the world, and the Ministry wants to support their healthy lifestyles while also providing support to those in the population who do not enjoy good health or are at risk of diminishing health. Many citizens are at risk from factors such as poor dietary habits, obesity, inactivity, injuries, tobacco use and alcohol and drug misuse.

The two objectives under this goal articulate the two approaches the Ministry is taking to improve the health and wellness of British Columbians. The first objective is to promote health by supporting individuals in their efforts to stay healthy and make healthy lifestyle choices. The second objective is to protect the public's health from preventable disease, illness and injury.

An ounce of prevention is worth a pound of cure. Health promotion and protection are important to maintaining and improving the health of British Columbians while containing overall health system costs. If we can keep people healthy and out of the health care system, we win on two fronts: people have a better quality of life, and more health resources can be made available for non-preventable illness.

Two of the Ministry's core business areas, Services Delivered by Partners and Stewardship and Corporate Management, undertake work in support of this goal.

Objective 1: Individuals are supported in their efforts to stay healthy and make healthy lifestyle choices.

The Ministry and its partners across government and throughout the health system are focusing efforts on innovative health promotion and disease prevention initiatives to keep the population healthy and mitigate some of the demand for health services. We have been implementing programs to reduce the growth of chronic disease in the population by educating and supporting people to eat well, exercise and stop smoking. Also, for those already with a chronic illness, we are working with key stakeholders to improve the care they receive — by involving patients more in their care, providing evidence-based guidelines for physicians, and establishing collaboratives to share best-practice knowledge among providers.

The Ministry's main initiative to achieve this objective is ActNow BC. ActNow BC is an initiative to improve British Columbians health by targeting common risk factors for chronic diseases and taking an integrated approach to reducing these risk factors. ActNow BC is a cross-sectoral, cross-government initiative that promotes healthy lifestyles by providing people with the information and resources they need to live healthily. Specifically, ActNow BC promotes physical activity, healthy eating, living tobacco free, and making healthy choices during pregnancy. For more information on ActNow BC, please see http://www.gov.bc.ca and click on the ActNow BC logo.

In 2005/06, the Ministry also introduced programs specifically focused on healthy childhood development. These new programs are designed to identify problems with hearing, vision or dental health for children before they reach grade one. Identifying and treating these problems early can lead to better outcomes and healthier development for children in British Columbia.

Also in 2005/06, the Ministry began development of an evidence-based healthy aging framework to guide planning for healthy aging in B.C. The Ministry released a discussion paper "Healthy Aging through Healthy Living", which focuses on five key areas of intervention: healthy eating, injury prevention, physical activity, social connectedness and tobacco reduction. By encouraging healthy living for seniors within the context of ActNow BC, we can enable healthier, more active and more productive seniors, prevent or reverse frailty and poor health, and reduce demand for health care services.

Tobacco-related illness is the leading cause of preventable death and illness in B.C.;¹ accordingly reducing smoking rates is a key goal of government. Smoking reduction targets have been set in accordance with the ActNow BC initiative. For smoking rates, the target is to continue B.C.'s downward trend (see graph below) of tobacco use by a further 10 per cent — from the 2003 prevalence rate of 16 per cent to 14.4 per cent of the population by 2010.

1	Mortality Attributable to Tobacco Use in Canada and its Regions, 1998, Makomaski Illing, Eva M., Kaiserman, Murray J, Canadian Journal of Public Health January-February 2004.

Results:

DATA SOURCE: Canadian Tobacco Use Monitoring Survey (CTUMS).
*	Partial year data (February – June 2005).

Analysis:

Tobacco use rates in B.C. have dropped from 15.0 per cent in 2004 to 14.0 per cent in 2005. This represents a significant success for British Columbia as we have already reached the 2010 ActNow BC target of 14.4 per cent. The 2005 results confirm that B.C. continues to have the lowest tobacco use rates in Canada.

B.C.'s Tobacco Control Strategy, Targeting Our Efforts, has three main objectives: helping smokers quit; stopping youth and young adults from starting; and protecting British Columbians from second hand smoke. Key initiatives contributing to successfully lowering tobacco use include:

In addition, the Ministry has continued to provide leadership and nurture partnerships with stakeholders including non-governmental organizations, health authorities, the Ministry of Education, and Health Canada. Currently, the Ministry is supporting applied research (i.e., Centre for Addictions Research B.C. and Tobacco Behaviours and Attitudes Survey) that supports the Ministry and its partners to pursue evidence-based changes to tobacco-related legislation and policy. Increasing the evidence-base allows for improvements in program planning and communications that raise awareness, increase knowledge and counter tobacco industry marketing efforts.

While smoking rates in B.C. are on a downward trend, the Ministry and its partners must continue to be vigilant in efforts to keep smoking rates low. The next steps in B.C.'s tobacco reduction efforts will not only focus on the general population, but will also identify and target programs for particular population groups, based on their life situation or experience. For instance, we will continue to design and deliver programs to discourage youth smoking, as that segment of the population is most susceptible to becoming new smokers.

Physical activity is essential to healthy growth and development and healthy living at all stages of life. Research shows there is a direct link between child and youth participation levels in physical activity and lifelong health and well-being.² Both physical inactivity and poor eating habits are contributing to high rates of overweight and obesity among children and adults. Research data shows obesity and overweight in adolescents (12-17 years) has more than doubled, and the obesity rate tripled, in the past 25 years.³ About 70 per cent of obese adolescents will be obese as adults, putting them at risk for diseases such as type 2 diabetes, coronary health disease, hypertension, gall bladder disease and some forms of cancer.⁴ Studies have shown that a ten per cent reduction in physical inactivity could result in savings of $150 million per year in direct health care costs.⁵

Accordingly, as part of the ActNow BC initiative, the Province is aiming to increase physical activity. The target for this measure is to increase the proportion of the B.C. population classified as active to moderately active by 20 per cent — from the 2003 rate of 58 per cent to 69.5 per cent of the B.C. population by 2010.

2	McKay, H. (Nov 2004) Action Schools! BC Phase I (Pilot) Evaluation Report and Recommendations (A Report to the Ministry of Health Services).
3	Statistics Canada: Tjepkema, M. and Shileds, M. (2005) Measured Obesity: Overweight Canadian children and adolescents (Findings from the Canadian Community Health Survey, 2005).
4	Mossberg, HO (1989) 40 year follow up of overweight children. Lancet ii: 491-493.
5	Katzmarzyk, P.T., Gledhill, N., and Shephard, R.J. (2000) The Economic Burden of Physical Inactivity in Canada. CMAJ. November 28; 163 (11): 1435-1440.

Results:

DATA SOURCE: Data collected every two years through the Canadian Community Health. Starting in 2006, the CCHS will be completed annually.

Analysis:

Physical activity (active or moderately active) rates in B.C. significantly increased from 49 per cent in 2001 to 58 per cent in 2003. The 2005 data show that those increased physical activity rates have been maintained at 58% being active or moderately active. British Columbia's 2005 physical activity rates are the best in Canada — the overall Canadian average for active or moderately active citizens for 2005 was 51%.

Despite leading the country in physical activity, British Columbia is working to further improve rates of physical activity and has set a target of reaching 69.5% of British Columbians being active or moderately active by 2010. Maintaining the significant increase realized in 2003 is a good first step, and in 2005 the Ministry and its partners implemented a number of initiatives that will help raise physical activity levels in the coming years.

Among the key priorities of the Ministry and the ActNow BC initiative are programs such as Active Communities and Action Schools! BC, which promote physical activity and healthy eating. Action Schools! BC is a best practice physical activity model designed to assist schools in creating individualized action plans to promote healthy living. The program is being expanded across the Province in phases between September 2004 and June 2009. As of May 31, 2006, 893 schools were registered for the grade four to seven model; 597 workshops were delivered; 6,398 teachers and administrators were registered; and 100 per cent of school districts were involved.

Active Communities is a program to mobilize and support local governments and partner organizations to undertake actions to promote healthy lifestyles, build healthier communities and increase physical activity among their populations. Key strategies have included the development of workbooks, tool kits, and resources in the areas of active community planning, active workplaces and active living strategies for families living on low income, as well as the provision of grants to assist communities in developing or delivering community action plans.

Objective 2: Protection of the public from preventable disease,
illness and injury.

The Ministry's and health system's second major approach to keeping people healthy is through providing effective public health services to prevent illness and disability. Government plays an important role in monitoring population health and protecting public health. Legislation and regulation of food, air and water quality lays the foundation for communities and citizens to live in healthy and safe environments. In addition, programs that target and prevent certain diseases, like influenza, also contribute to maintaining and improving the health of British Columbians.

Since 2003, to help protect public health, the Ministry has brought into force a new Drinking Water Protection Act, and has modernized its Meat Inspection Regulation as part of ongoing improvements to the 2002 Food Safety Act. Under the Drinking Water Protection Act, government has dedicated additional resources to drinking water and water source protection to improve the quality of drinking water in British Columbia. Meanwhile, the new Meat Inspection Regulation harmonizes its protocols with the National Meat Code, and provides province-wide standards for the construction and operation of slaughtering facilities, including a provision that animals raised for sale require mandatory inspection before and after slaughter.

In 2005/06, the Ministry also continued its emergency preparedness work with provincial, national and international partners to plan and prepare for the possibility of an influenza pandemic in British Columbia. The Ministry has led the development of the Provincial Pandemic Influenza Preparedness Plan, and continued to take steps to ensure flu vaccines will be available for British Columbians in the event of a pandemic. For more information on pandemic planning please see http://www.health.gov.bc.ca/pandemic.

The Ministry has also continued to focus on preventable injuries, particularly falls among the elderly. B.C.'s leadership in falls prevention has attracted the interest of jurisdictions and organizations from around the globe, including the World Health Organization. Over the past four years, there has been a nine-fold increase throughout B.C. in programs designed to reduce falls and injuries among seniors. These efforts are proving successful: death rates either directly or indirectly due to falls for both senior men and women have significantly decreased since 1990, and over the past five years, the estimated annual hospital cost of fall-related injuries among seniors has reduced by $24 million (13.7 per cent). For more information, please see "The Evolution of Seniors' Falls Prevention in British Columbia", which highlights efforts in B.C. to raise awareness of the significant burden of injury from falls, at http://www.hlth.gov.bc.ca/cpa/publications/falls_report.pdf.

Another key focus under this objective is to reduce inequalities in health status among segments of the B.C. population, with a particular focus on B.C.'s Aboriginal population. In general, the Aboriginal population does not enjoy the same level of good health as the rest of the Province's population. Accordingly, and in line with Government's New Relationship with Aboriginal People,⁶ the Ministry has been working with other provincial ministries, health system partners, the federal government and Aboriginal organizations to reduce health inequalities between First Nations people and the general population. Areas of focus include integration of the ActNow BC strategy with First Nations health programs, targeting mental health and addictions programs to address substance abuse and youth suicide, enhancing maternity care and increasing the number of Aboriginal health care professionals.

6	For more information on the New Relationship with Aboriginal People see http://www.gov.bc.ca.

Immunization programs are a cornerstone for good population health. British Columbia has more than doubled funding for immunizations since 2002, and has expanded childhood immunization programs, as well as influenza and other targeted vaccination programs to help infants, their parents and seniors stay healthy.

British Columbia now has one of the most comprehensive immunization programs in the world (in terms of the number of vaccines available and the groups targeted), and maintaining and improving those programs is among the best ways to keep people healthy and to reduce health care costs caused by advanced illnesses. Depending on the vaccine, studies have shown that each dollar invested in immunization can save between $7 and $30 in medical care and other costs.⁷

For performance measures, the Ministry monitors both the percentage of two-year-olds with up-to-date immunizations, and the percentage of residents of care facilities who get influenza vaccinations for flu season. Childhood immunization is a very important health indicator as it impacts both individual and population protection against vaccine-preventable diseases. Delayed delivery of recommended immunizations extends a young child's period of vulnerability to a disease. Similarly, vulnerability toward some illnesses, such as influenza, increases among the elderly; therefore the influenza vaccination rate for at-risk residents of care facilities is also an important indicator.

7	For more information on immunization programs see http://www.healthservices.gov.bc.ca/pho/pdf/phoannual1998.pdf.

a) Two-year-olds with up-to-date immunizations

Immunization programs for children are among the most cost-effective ways to improve population health, prevent illness and reduce health care costs. In B.C., all infants and preschool children have access to immunizations that protect them from the following diseases: diphtheria, pertussis, tetanus, polio, haemophilus influenza type b, measles, mumps, rubella, and hepatitis B. In 2003, B.C. introduced the meningococcal C conjugate and pneumococcal conjugate vaccine programs. In January 2005, B.C. introduced an infant varicella (chickenpox) program and in June 2005, all infants in B.C. became eligible for a meningococcal C vaccine.

Results:

DATA SOURCE: Public Health Information System (iPHIS), British Columbia Centre for Disease Control (BCCDC).

NOTES: Data need to be interpreted with caution as it is incomplete. Differing practices exist across and within health authorities regarding delivery of immunization services and the tracking of immunization records. Consequently, this data does not include all health authorities (Fraser HA and Vancouver Coastal HA excluded); however for performance purposes it is comparable to data reported in the 2004/05 annual report. The BCCDC has been given the responsibility for data collection for this measure and is developing new reporting methodology to standardize and improve data quality.

Analysis:

The 2005 data show the B.C. rate of complete immunization for two-year-olds at 74 per cent, meeting the Ministry's target of a five percentage point increase from 2004's result of 69 per cent. Further, additional data indicates that 85 per cent of two-year-olds have received all of their shots except the booster shot given at 18 months of age.

The Ministry, British Columbia Centre for Disease Control (BCCDC) and health authorities are working to have a higher percentage of infants receive their full vaccination schedule. Together, we are working to identify and overcome barriers that may be affecting childhood immunization rates, including a lack of public knowledge about the importance and timing of immunization programs.

The Ministry has also worked with its partners, including the BCCDC, to develop an immunization strategic framework for British Columbia. The purpose of the framework is to guide collective action to ensure that all British Columbians understand the importance of immunization for themselves, their families and vulnerable populations and take the steps necessary to protect themselves and the community by being immunized. The B.C. framework is aligned with the National Immunization Strategy, which brings together partnerships to effectively improve immunization rates.

In addition, the Ministry and health authorities have been undertaking a number of other initiatives to improve childhood immunization rates. These activities include:

Through these efforts, the Ministry and its partners expect to see further improvements in childhood immunization rates in 2006/07 and beyond.

b) Influenza immunization for residents of care facilities

Influenza is a major cause of illness, hospitalization and death among older adults and residents of care facilities. Due to the age, medical condition and group living situation, this population is particularly vulnerable to influenza.

Annual influenza vaccination reduces the risk of disease and may lessen the severity of illness. In addition to protecting the overall health of the population within residential care facilities, increasing influenza immunization rates can reduce the number of deaths, hospitalizations and physician visits attributable to this common and largely preventable illness. This indicator measures the percentage of residents of care facilities immunized for influenza in a given influenza season (October to February).

Results:

DATA SOURCE: Data are submitted by Health Authorities (Annual Influenza Immunization Program Survey). Data for 2002/03 were compiled by Population Health and Wellness Division, B.C. Ministry of Health. Data for 2003/04 onward were compiled by Epidemiology Services, B.C. Centre for Disease Control.

Analysis:

Data for 2005/06 influenza immunizations for residents of care facilities show an increase from 91.8 per cent in 2004/05, to 92.4 per cent, in excess of the target rate of 90 per cent. This is an excellent rate of immunization and plays an important role in keeping residents of care facilities healthy and safe from potentially life-threatening influenza outbreaks.

Furthermore, not only does this contribute to the health and well-being of B.C.'s seniors' population, but it also helps alleviate demand on the Province's hospitals and emergency departments as fewer residents need to be transferred from facilities to receive higher levels of care in hospital. Influenza outbreaks can have a ripple effect — outbreaks can drastically increase demands on hospitals and cause delays in the health care system's ability to provide services such as elective surgeries because hospital beds are being occupied by those suffering from influenza. A strong influenza immunization program helps to prevent outbreaks, and enables services to run more smoothly throughout the health system.

As a group, Aboriginal people have a level of health below that of the general population. Excess mortality in this population is largely due to preventable causes. The Provincial government is striving to close this gap and have Aboriginal people enjoy the same good health status as the general population of British Columbia.

The Ministry tracks post neonatal infant mortality rates as one indicator of the overall health status of Aboriginal people in British Columbia. This indicator measures the number of Status Indian infant deaths occurring in the 28 to 364 days age group expressed as a rate per 1000 Status Indian live births. Post neonatal infant mortality is primarily related to infants' environment and care.

Results:

DATA SOURCE: Vital Statistics, December 2004 is the most recent data. The subset of Aboriginal people who are Status Indians is used as a proxy measure for the total Aboriginal population, as Status Indians are the only Aboriginal people who can be identified in Vital Statistics databases at this time. A five-year moving average (2000-2004) is used for this indicator. Given the relatively low number of infant deaths, a five-year average mitigates year-to-year variation and provides a better indication of longer-term trends.

Analysis:

Over the past decade, the gap between overall infant mortality rates in the Aboriginal Status Indian population and the total B.C. population has been significantly decreased. In fact, since 2001 there has been no gap between the Status Indian neonatal (<28 days of age) infant mortality rate and the rate in the general population. However, a gap still remains in the post neonatal (28 – 364 days of age) subset so that is where the Ministry and its partners are focusing attention with this indicator.

As illustrated in the graph above, the Status Indian post neonatal mortality rates have been steadily decreasing towards the provincial non-Aboriginal rate. The current rate is a vast improvement over the early and mid-1990's when the Status Indian rate was several times that of the general population. The improving results indicate better child health for Aboriginal people and the Ministry expects this positive trend to continue.

There are multiple social determinants of health that contribute to this indicator (e.g., socio-economic status), and government is working on many fronts to improve First Nations' economic and social well-being in British Columbia. In the health sector, the Ministry and health authorities have introduced a number of programs and initiatives that support and improve maternal and infant health for Aboriginal people across the Province. Examples include programs specifically targeted to Aboriginal people, such as:

Other examples include more widely targeted population health initiatives that also positively affect Aboriginal health, such as:

In addition, each regional health authority is working with its Aboriginal communities to design and deliver health services and programs that best meet the needs of those communities. Maternity and infant care is a key consideration in planning and delivering those services.

8	A Review of Infant Mortality in British Columbia: A Report of the Provincial Health Officer, October 2003.

Goal 2: High Quality Patient Care.

The vast majority of resources in the health system are directed at providing high quality patient care. High quality care means patients receive appropriate, effective, safe care at the right time in the right setting. It also means that health services are planned, managed and delivered in concert with patient needs.

Three objectives guide the Ministry's work under this goal. The objectives represent three important facets of high quality care: access to care, patient-centred care, and integration of care services. The Ministry and its health system partners have been undertaking numerous strategies and initiatives supporting each objective, resulting in high quality care being delivered to patients across British Columbia.

Providing a wide range of high quality health services supports two of Government's Five Great Goals. Access to health services supports the Great Goal to " Lead the way in North America in health living and physical fitness," as well as the Great Goal to " Build the best system of support in Canada for persons with disabilities, those with special needs, children at risk, and seniors".

Each of the Ministry's core business areas contributes to the attainment of this Ministry goal.

Objective 1: Timely access to appropriate health services by the appropriate provider in the appropriate setting.

All British Columbians should be able to access health services when they need them, be that for a visit to a family doctor, prescription drug therapy, emergency treatment, elective surgery or ongoing care. The Ministry and its partners have been working diligently over the past five years to ensure hospitals, community services and health professionals are used in the most efficient and effective way possible so that people get the right type of care in the right type of setting that will lead to the best health outcome. The key approaches have been to ensure there is an adequate supply of key providers, to increase the range and availability of services provided in the community, and to ensure that our hospitals are used effectively to provide emergency and acute care, such as surgery or cancer treatment.

This indicator tracks the percentage of seniors and people with disabilities who are admitted to residential care within 30 days of being approved. Clients approved for residential care have complex care needs that require close attention. Improving access to this type of care leads to better outcomes and use of resources.

Results:

DATA SOURCE: Knowledge Management and Technology Division, Ministry of Health.
NOTES:
1	This was a new measure in 2005/06 requiring new methods of data collection. As such, directly comparable data are not available for previous years.
2	The 2005/06 target was changed from "increase over prior year" because historical data was not available.
3	2005/06 data are preliminary.

Analysis:

Preliminary data from across the Province for 2005/06 show 67 per cent of clients were admitted to residential care within 30 days of being approved. While the adoption of an improved method of data collection has resulted in no directly comparable data being available for 2004/05, it is clear the Province has significantly improved waiting times for residential care over the last 5 years. In 2001, the average waiting time for residential care was close to one year, while in 2005/06 the majority of clients were placed within 90 days. Beyond the 67 per cent of clients being admitted within 30 days of approval, 82 per cent were admitted within 60 days and 90 per cent were admitted to residential care within 90 days of approval.

The Ministry and the health authorities have been able to achieve this improvement by undertaking a significant redesign of home and community care services. Over the past five years, B.C. has been expanding its home and community care sector to modernize residential care, provide more independent housing options, improve home care and provide more options for end-of-life care. These services now provide a range of health care and support services for residents who have acute, chronic, palliative or rehabilitative health care needs. These services are designed to complement and supplement, but not replace, the efforts of individuals to care for themselves with the assistance of family, friends and community.

Since 2001, the Ministry, BC Housing and health authorities have been working in partnership with for-profit and non-profit housing and care providers to give British Columbia seniors and people with disabilities more options that provide the right care in the most appropriate setting. The Province has modernized and replaced old and outdated residential care facilities across the Province, and has also been opening new assisted living units for seniors and people with disabilities who can no longer live at home but do not require the 24/7 nursing care provided in residential care facilities. Enhanced home care, independent living options, adult day programs and hospice beds are also part of the broader continuum of services that are being made available to better meet the needs of today's seniors and people with disabilities. In addition, government updated and modernized the Community Care and Assisted Living Act to better protect the health and safety of seniors and people with disabilities who reside in licensed community care facilities and registered assisted living units.

British Columbia's population is aging and it is expected there will be increased demands on home and community care services in the future. To help address these future demands, the Ministry and its partners are committed to providing 5,000 new residential care, assisted living and supportive housing beds by December 2008.

Radiation therapy and chemotherapy are principal treatments in cancer care. Ensuring treatment is available and provided in a timely manner is important to achieving the best health outcomes for patients. This indicator measures the percentage of patients that begin radiotherapy within four weeks of being ready to treat and the percentage of patients who start chemotherapy within two weeks of being ready to treat.

Results:

DATA SOURCES: a) Radiotherapy: Provincial Radiation Therapy Program, April 2006, BC Cancer Agency (BBCA). Data for this measure is from the BCCA scheduling system. Not all patients are captured because the most urgent patients never show up on the scheduling system as they receive treatment immediately. b) Chemotherapy: Provincial Systemic Therapy Program and Communities Oncology Network, April 2006, BCCA. Data involves all existing BCCA centres and does not include all hospitals in B.C.
NOTES:
1	New methods of data collection for chemotherapy were introduced in 2005/06. In previous years, the Ministry reported a result of 90% receiving treatment within two weeks based on BC Cancer Agency estimates.

Analysis:

Cancer services in British Columbia are primarily delivered through the BC Cancer Agency (BCCA). The Agency's cancer control program includes research, education, care and treatment, and is provided through its four regional centres in Vancouver, the Fraser Valley, the Southern Interior and on Vancouver Island. The BC Cancer Agency also has partnerships with other health care providers (physicians, pharmacists, nurses and others) and regional hospitals and clinics across B.C. to provide services to those who do not live in urban centres.

Radiotherapy

The 2005/06 target for radiotherapy wait times was for 90 per cent of patients to receive radiotherapy within four weeks of being ready to begin treatment. As the chart below shows, the 2005/06 target was exceeded with 96.5 per cent receiving treatment within four weeks. Over the past five years the percentage of patients receiving radiation treatment within four weeks has significantly increased from the rate of 72.3 per cent in 2000/01.

These results are especially encouraging as demand for radiation therapy is growing as the B.C. population ages and the prevalence and incidence of cancer increases. The BCCA has been experiencing increasing demands on its services and is projecting a further increase in demand for cancer services in 2006/07 and beyond. Using the BC Cancer Registry, the BCCA projects the number of new cancers in B.C. will increase by 2.5 per cent annually from 18,600 (2003) to 23,540 (2012). Further, a report entitled, "Projections 2006 – 2020 British Columbia" estimates that new cancer diagnosis is expected to increase from 19,859 in 2006 to 27,041 in 2020.⁹

9	BC Cancer Agency - Care & Research. May 2006. Projections 2006 - 2020 British Columbia.

The increasing number of cancer cases is already resulting in increased demand for radiation therapy. The number of cancer patients receiving radiation therapy in B.C. increased from 10,318 in 2004 to 10,900 in 2005. In the same period, the number of radiation treatments also increased from 161,093 to 170,116. It is expected that demand will continue to increase in the coming years.

To help meet the demand, in 2005/06 the Province completed a $20 million investment to improve radiation therapy services and increase cancer treatment access for patients. New equipment has been purchased for the radiation program, including:

This new equipment is enabling the BC Cancer Agency to increase its capacity to deliver radiation therapy and ensure British Columbians continue to receive the timeliest access to radiation treatment in Canada.

Chemotherapy

The 2005/06 target for chemotherapy treatment was for 90 per cent of patients to receive chemotherapy within two weeks of being ready to begin treatment. In B.C., about half of chemotherapy treatments are provided in therapy clinics residing within community hospitals and the other half is provided in chemotherapy centres managed by the BC Cancer Agency.

In 2005/06, 85.1 per cent of patients received chemotherapy treatment within two weeks of being ready to treat, which was below the provincial target of 90 per cent. More positively, 98.1 per cent of patients received chemotherapy within 4 weeks of being ready to treat.

Increased demand for cancer services, as noted above, is primarily responsible for the chemotherapy treatment indicator not meeting the provincial target of 90 per cent being treated within two weeks. To meet increases in demand and ensure British Columbians continue to receive the best standards of cancer care, the Cancer Agency is replacing and expanding the Province's cancer care infrastructure and also investing in leading edge research to prevent and treat cancers. The expansion of chemotherapy services includes adding six new chemotherapy chairs, extending treatment hours and expanding partnerships with hospitals to deliver chemotherapy treatment. In addition, work continues on the new Abbotsford Hospital and Cancer Centre which will be completed by 2008 and will provide enhanced services for residents of the Fraser Valley, the fastest growing region in B.C.

To assist cancer prevention and treatment, a new $95 million BC Cancer Research Centre opened in Vancouver in 2005. The centre houses nine research departments and conducts research into more than 100 different types of cancer. Programs include the BC Cancer Agency's Michael Smith Genome Science Centre; Cancer Control Research; Cancer Endocrinology; Cancer Genetics and Developmental Biology; Cancer Imaging; Medical Biophysics; Terry Fox Laboratory; and BC Cancer Agency's Trev & Joyce Deeley Research Centre (located in Victoria).

Overall, British Columbians are well served by the BC Cancer Agency and continue to enjoy excellent cancer outcomes. The Cancer Advocacy Coalition, an independent Toronto-based cancer advocacy group, recently noted in its annual evaluation of cancer system performance that B.C. has the best cancer outcomes and lowest cancer mortality in Canada. The report found B.C. has the best-funded and most timely access to cancer drugs within a strong, well-organized, population-based, cancer control program coordinated by the BC Cancer Agency. The Coalition's report is available at http://www.canceradvocacy.ca.

A hospital admission can either be planned, such as scheduled surgery, or unplanned, such as emergency cases. This measure focuses on unexpected hospital admissions that occur through hospital emergency departments. Many people are appropriately treated and released from emergency departments, but some people require an extended course of treatment and must be admitted to hospital. Measuring the amount of time from the decision to admit a patient from an emergency department to when the patient is admitted to an inpatient bed provides an indication of access to appropriate levels of care.

Results:

DATA SOURCE: Interior Health Authority: Meditech Data Repository and Abstracting. Fraser Health Authority: Meditech. Vancouver Coastal Health Authority: ED cubes for LGH, RH and VH and NERD cube for PHC. Vancouver Island Health Authority: Data provided by Vancouver Island Health Authority. Northern Health Authority: Emergency Department Information System (EDIS).
NOTES:
1	Major hospital sites only. Major hospital sites are those with over 35,000 emergency room visits per year and include Burnaby, Kelowna, Lion's Gate, Nanaimo, Prince George, Richmond, Royal Columbian, Royal Jubilee, Royal Inland, St. Paul's, Surrey Memorial, Vancouver General and Victoria General Hospitals.
2	This was a new measure in 2005/06 requiring new methods of data collection. As such, data are not available for previous years.
3	The 2005/06 target was changed from "increase over previous year" to "establish baseline" because comparable historical data was not available.
4	Calculated as the percentage of total cases across all major hospital sites admitted within 10 hours of the decision to admit.

Analysis:

In 2005/06, the Ministry began tracking performance in the emergency departments of B.C.'s major hospitals. This indicator is not a measure of how long it takes to be treated in these emergency rooms; rather it is a measure of the amount of time taken to admit a patient to a bed elsewhere in the hospital once the decision has been made in the emergency room that ongoing hospital care is required.

The 2005/06 data captured over 95,000 hospital admissions through emergency departments, with 66 per cent of those admissions occurring within 10 hours of the decision to admit. This data provides valuable baseline information as the Ministry and its partners strive to improve performance in the coming years.

The strategies the Ministry has been pursuing across the continuum of care, evident throughout this report, will ultimately contribute to easing demands on emergency rooms. Initiatives to promote good health, expand home and community care options and improve chronic disease management and mental health and addiction services are focused on keeping people healthy and providing care in settings other than hospitals. These initiatives improve people's quality of life while also helping to ensure our hospitals are used to provide emergency and acute care services that cannot be appropriately delivered elsewhere.

In addition, the Ministry is pursuing initiatives specifically targeted at addressing efficient patient movement through the emergency department and improving the flow of admitted patients to inpatient beds. Under the leadership of the Ministry, health authorities, physicians, nurses, paramedics and other health staff have come together to focus on developing and implementing strategies and initiatives that will diminish pressures that occur in emergency departments. Developing and implementing these strategies will be a significant priority for the Ministry in 2006/07, with an expectation that the percentage of patients admitted to hospitals through emergency rooms in a timely manner will increase from the 2005/06 baseline.

Objective 2: Patient-centred care tailored to meet the specific health needs of patients and patient sub-populations.

When people use the health care system it is important that the care they receive is centred on their needs and will lead to the best health outcomes. This means delivering services that are evidence-based and reflect best practice. Since one size does not fit all in health service delivery, the Ministry is working with health authorities and physicians to design and deliver customized care that addresses the unique needs of specific patient sub-populations. The Ministry's primary focus under this objective has been to improve the management of patients with chronic diseases and to provide more choices and better quality of care for those at the end of life.

Chronic diseases are prolonged conditions, such as diabetes, depression, congestive heart failure, hepatitis and asthma, which often do not improve and are rarely cured completely. It is estimated that over one million people in British Columbia currently suffer from one or more chronic diseases. These diseases can have a profound effect on the physical, emotional and mental well-being of individuals, often making it difficult to carry on with daily routines and relationships. However, in many cases, deterioration in health can be minimized by good care. Implementing patient-centred approaches to service delivery can improve quality of life and health outcomes for patients and provide better use of health services.

The Ministry is monitoring three key performance measures to monitor the effectiveness of the health system's approaches in these areas. Two measures relate to chronic disease management, and one is related to the availability of community services for those at the end of life.

Over 75,000 British Columbians suffer from congestive heart failure (CHF) — a chronic disease where the heart is unable to pump enough blood to meet the needs of the body's tissues. Research shows ACE inhibitor and beta blocker drugs, in combination with other treatments, significantly improve health outcomes for congestive heart failure patients; however, the rate of prescriptions for these drugs has not been in line with the highest standard of care. Accordingly, the Ministry is working to increase appropriate prescription rates of ACE inhibitors and beta blockers for those with CHF.

Results:

DATA SOURCE: Physician Framework Supply (PFS), October 25, 2005, Information Resource Management, Medical Services Branch, Medical and Pharmaceutical Services, Ministry of Health. Discharge Abstract Database (DAD), October 25, 2005, Information Resource Management, Knowledge Management and Technology Division, Ministry of Health. PharmaNet, October 25, 2005, PharmaCare Branch, Medical and Pharmaceutical Services, Ministry of Health.

Diabetes is one of the most common chronic diseases. It affects about five per cent of British Columbians and is steadily increasing in prevalence. By taking two A_1Ctests per year, patients and their physicians can be aware of abnormalities faster, and lower complication rates.¹⁰ With the right tools and information, patients with diabetes are aware of the importance of receiving two A_1Ctests a year and are proactive in ensuring the tests are scheduled and the results discussed with their physician.

10	The hemoglobin A1C test is a simple lab test that shows the average amount of sugar (also called glucose) that has been in a person's blood over the previous three months. The A1C test shows if a person's blood sugar is close to normal or too high, and is a valuable tool for a health care provider to assess if a patient's blood sugar is under control.

Results:

DATA SOURCE: Physician Framework Supply (PFS), October 13, 2005, Information Resource Management; Medical Services Branch, Medical and Pharmaceutical Services, Ministry of Health. Discharge Abstract Database (DAD), October 13, 2005, Information Resource Management, Knowledge Management and Technology Division, Ministry of Health. PharmaNet, October 13, 2005, PharmaCare Branch, Medical and Pharmaceutical Services, Ministry of Health.

Analysis:

At the time of publishing, data for 2005/06 are not available for either the congestive heart failure or the diabetes performance measures. However, historical data shows that both measures have been improving over the past few years. The Ministry is pleased to see these improvements in chronic disease management, and is working hard to realize further and more rapid gains in this area.

Chronic diseases are a significant burden on the population and the health system, and rates of chronic disease are continuing to rise. Quality care and management of chronic disease is essential to slowing the progression of the disease and keeping people healthy. Alternatively, the consequences of poor chronic disease management is deteriorating health for the individual and increased costs for the health system as more complex care is required to deal with advancing diseases. For instance in B.C., 39 per cent of coronary bypass surgeries, 49 per cent of dialysis, 62 per cent of lower limb amputations and 70 per cent of retinal surgeries are performed on patients with advancing diabetes.¹¹

11	Based on 2004/05 B.C. data.

The Ministry and its partners are taking a coordinated and multi-pronged approach to improving the quality of care to prevent or slow the progression of chronic diseases. The approach includes implementing disease prevention measures, providing tools help patients with self-management, improving standards of care and encouraging team approaches to care delivery.

B.C.'s prevention strategies, through the ActNow BC initiative, have been discussed under Goal 1 in this report. ActNow BC is targeting the risk factors leading to chronic disease and is key to reducing the prevalence of chronic disease in British Columbia.

Patient self-management of chronic diseases is crucial to achieving the best health outcomes. Health care can be delivered more effectively and efficiently if patients with chronic diseases take an active role in their own care and providers are supported with the necessary resources and expertise to better assist their patients in managing their illness. Accordingly, the Ministry has developed a number of tools and information sources to assist people in taking action to control pain and fatigue, use medications properly and incorporate diet, exercise and stress reduction into their daily routines. To further advance this aspect of chronic disease management, the Ministry has invested over $2 million in a program delivered through the University of Victoria to provide self-management education and training to thousands of people across the Province.

The Ministry is also working with physicians and health authorities to improve the quality of care for those with chronic conditions. In 2005/06 government and the physicians of B.C. negotiated a new agreement that better supports full service family practice and specifically targets the management of chronic diseases. The new agreement provides additional incentives and payments for physicians to manage their patients' chronic conditions according to best practices and guidelines-based care. The new agreement also includes provisions for making the Chronic Disease Management Toolkit, which assists physicians to deliver best practice care, electronically accessible within physicians' offices.

With these initiatives and others in place, the Ministry is expecting to see continued improvement in the management of chronic diseases in British Columbia. For more information on chronic disease management, see the Ministry's website at http://www.healthservices.gov.bc.ca/cdm/index.html.

As part of a comprehensive plan to improve end-of-life care, the Ministry monitors the percentage of natural deaths that occur in hospital.¹² A decrease in the percentage of natural deaths occurring in hospital serves as a proxy measure for improvements in the availability of a range of appropriate non-hospital choices for end-of-life care.

12	A natural death is defined as occurring through natural causes (e.g., old age or disease). A non-natural death is defined as a death from non-natural causes (e.g., accidents, poisonings or suicides)

Results:

DATA SOURCE: Vital Statistics Agency, Knowledge Management & Technology Division, Ministry of Health.

NOTES: Data are reported by calendar year, not fiscal year. The Ministry is investigating the accuracy of reporting the location of deaths to Vital Statistics. Discrepancies may exist regarding the reporting of hospice and residential care deaths (may be incorrectly reported as hospital), which when rectified will affect the number of deaths reported as occurring in hospitals.

Analysis:

In 2005 the percentage of natural deaths occurring in hospital decreased slightly, continuing the decrease seen between 2003 and 2004. Results from the first quarter of 2006 indicate the percentage has decreased further, to 52.1 per cent.

End-of-life care is the specialized care of people who are dying, and is an integral part of a health system that meets the needs of people across their lifespan. Good end-of-life care is provided, where possible, in the setting of a person's choice and is delivered by coordinated teams of physicians, nurses and other health professionals such as pharmacists and nutritionists, and includes family input and volunteer services.

The major direction of the Ministry's end-of-life strategy is to enhance and improve care for all persons at end of life, and to focus on developing end-of-life services within a community-based system where the greatest emphasis is placed on supporting people to remain at home (i.e., private home, assisted living, supportive housing, or residential care) for as long as possible and in accordance with their preferences.

Across the Province, end-of-life services, including hospice and home-based palliative care, are being expanded to provide dying people with greater choice and access to services. The Ministry has worked with partners, including health authorities, physicians and the B.C. Hospice Palliative Care Association, to enhance and coordinate end-of-life services. In B.C., publicly funded end-of-life care includes care provided in palliative care units or hospices in hospitals, as well as care provided in a person's home or other community-based setting. To promote innovative palliative care services, the Ministry introduced the Palliative Care Drug Program in 2001, which provides medications, medical supplies and equipment to those who choose to die at home. Previously, those items were only covered if the patient receive care in hospital. The Palliative Care Drug Program is an important resource that allows health authorities and care providers to design programs to support people who choose to die at home or in settings outside the hospital. Over 21,000 clients have enrolled in the program since its introduction.

The Province's regional health authorities have been implementing new services for end of life care while engaging in longer term planning to ensure the appropriate community-based programs and specialized services, such as hospices, are in place to allow for patients needing care at end-of-life to be supported in settings outside hospital. The number of publicly subsidized hospice beds has increased from 57 to 145 since 2001, and more are planned. It is expected that over time the proportion of natural deaths occurring in hospital will continue to decrease as community-based services are enhanced.

Objective 3: Improved integration of health care providers, processes and systems to allow patients to move seamlessly through the system.

The health care system is very complex. The diversity of health care needs across the Province means the system is always caring for unique patients through different caregivers, in different settings, every day. The Ministry and its partners have been working to improve the integration of those services so care can be provided in the most coordinated and seamless manner possible to the benefit of patients and health care providers.

Under this objective, particular attention has been focused on mental health and addiction services. People with mental illness or substance use disorders often must access various providers to receive care, and too many times end up in hospital emergency rooms. The Ministry and its partners are working to ensure services, from child and youth to adult programs, are integrated and available within patients' home communities to improve and simplify the patient experience with the health system, improve outcomes and maximize efficiency.

The intent of this measure is to assess the continuity in care for people who experience mental health and/or substance use disorder. A high rate of community and physician follow-up after a hospitalization for a mental illness or substance use disorder indicates well-coordinated, integrated and accessible care is being delivered. Service coordination and effective discharge planning is critical for improved outcomes for persons with mental health and substance use disorders.

Results:

DATA SOURCE: Mental Health Research Database: April 4, 2006 Refresh (data extracted April 4, 2006). MRR/CPIM Integration March 31, 2006. Discharge Abstract Database (DAD), March 25, 2006. Medical Services Plan fee-for-service database (MSP) payments to March 31, 2006. Information Resource Management, Knowledge Management and Technology Division, Ministry of Health.

NOTES: 2005/06 data are preliminary (partial year).

 

DATA SOURCE: Information Resource Management, Knowledge Management & Technology Division, Ministry of Health.

NOTES: 2005/06 partial year data.

Analysis:

The 30-day follow-up rate for the approximately 20,000 mental health and addictions clients discharged each year from hospital continues to increase, reaching 76.8 per cent in 2005/06 from 71.5 per cent in 2000/01.¹³ The increasing follow-up rate is important for the recovery and stability of patients discharged from hospitals as it indicates that patients are linked with appropriate community programs and resources for subsequent care, treatment and support.

13	Based on 2005/06 preliminary data.

An important facet of improving follow-up is to expand access and availability of mental health and addiction services in community settings and to ensure effective discharge planning processes are in place that link patients with community resources. Monitoring and working to increase the follow-up rate for mental health and addictions clients serves as a high-level gauge of whether the health system is meeting its objective of providing a full continuum of services within each health authority which better integrates primary, secondary, community and tertiary care.

Mental health has become a major public health concern worldwide, and the World Health Organization (WHO) has placed a high focus on the importance of mental health. The Global Burden of Disease Study (2001) estimates that mental and addictive disorders make up 12 per cent of the Global Burden of Disease — a burden greater than that for AIDS, tuberculosis and malaria combined (11.4 per cent). Of the ten leading causes of disability worldwide, five are mental disorders: Major Depression, Schizophrenia, Bipolar Disorder, Alcohol Use Disorder and Obsessive Compulsive Disorder.

Across Canada, mental illness represents one of the top categories of "frequent users" of emergency room services. In B.C., 2004/05 data indicates that approximately 19 per cent, or 632,000 individuals 20 years of age and over, received some treatment for a mental or substance use disorder. Mental health and addictions services operating expenditures across the B.C. health system for 2005/06 were approximately $1.02 billion, an increase of 20 per cent since 2001/02.

British Columbia recognizes the importance of strong mental health and addiction services that meet people's needs. Over the last five years, B.C. has established an integrated mental health and addictions system that includes: mental health promotion, outreach, early intervention and crisis response services, outpatient services, case management services, withdrawal management services such as inpatient/residential detox, home detox services, residential treatment, rehabilitation and support recovery services, methadone maintenance treatment, harm reduction services, community residential and family care homes, and supported housing programs, as well as specific mental health and addictions services for children and youth. This continuum supports people with mental health and addiction problems, and is strongly aligned with the government's Great Goal to "Build the best system of support in Canada for people with disabilities, those with special needs, children at risk, and seniors."

British Columbia's approach to mental illness and addiction is also well aligned with recommendations made by the federal Senate Committee on Social Affairs, Science and Technology chaired by Senator Michael Kirby. The Committee's extensive review of policies and programs relating to mental health, mental illness and addiction in Canada considered B.C. to be one of the leading jurisdictions in Canada working to improve mental health and addictions services. The Committee's report can be found at http://www.hc-sc.gc.ca/hcs-sss/com/kirby/index_e.html.

Goal 3: A Sustainable, Affordable, Publicly Funded Health System.

This goal focuses on managing the health system to ensure it is affordable, efficient and accountable, with governors, providers and patients taking responsibility for the provision and use of services. The Ministry is guided in reaching this goal by four objectives: providing effective leadership and direction, making the right investments in information technology, ensuring appropriate human resources are in place, and managing the system's finances. Work in these areas enables the health system to provide modern services to the people of British Columbia, and supports achievement of the Ministry's other two goals of improving the health and wellness of British Columbians and delivering high quality patient care.

Two of the Ministry's core business areas, Services Delivered by Partners and Stewardship and Corporate Management, undertake work in support of this goal.

Objective 1: Effective vision, leadership, direction and support for the health system.

The Ministry must provide clear strategic leadership, direction and support in order for the health system to function efficiently. In 2005/06 the Ministry undertook several strategies in support of this objective. The Ministry provided strategic direction through its service plan and through performance agreements with health authorities that articulated measurable expectations to guide the delivery of health services. The Ministry also ensured the appropriate legislative, regulatory and policy frameworks were in place to ensure health services were delivered safely and in the best interests of British Columbians.

In 2005/06 the Ministry also supported the delivery of high quality care by developing (with subject experts) and promoting the use of best practice guidelines, standards, benchmarks and protocols. As detailed earlier in this report, the Ministry has made particular progress in developing best practice tools to assist health providers and patients in the management of chronic diseases.

In addition, the Ministry also continued its support of health research. In 2005/06 the Ministry completed its commitment to provide $100 million to the Michael Smith Foundation to expand health research in British Columbia. Promoting research supports the system in making evidence-based decisions and leads to continuous improvements in service delivery which benefits patients and the general population.

The Ministry is committed to ensuring that administrative processes between itself and B.C.'s health authorities are achieving the desired results. Conducting a survey can be a useful information tool in assessing the effectiveness and efficiency of current processes.

Results:

Analysis:

A survey of health authority executives and management was conducted late in the 2005/06 fiscal year through the BC Stats Agency. The Ministry and health authorities will use the survey findings (expected in July 2006) to identify areas where the efficiency and effectiveness of communications and processes can be improved. This exercise is part of a commitment to strive for continuous improvement in all areas of the health system. Improving administrative processes can ultimately have a positive effect on patient care and the health of the population.

Objective 2: Strategic investments in information management and technology to improve patient care and system integration.

The Ministry is committed to making strategic investments in information management systems and new technologies to support the health system in meeting its goals and objectives. Technology can improve system integration and efficiency, improve access to services across the Province, assist managers and practitioners to make evidence-based decisions, and help citizens access valuable health information in a timely and convenient manner. The Ministry has been working with its health system partners to realize the potential in each of these areas.

In 2005/06 the Ministry released British Columbia's eHealth Strategic Framework, which outlines how eHealth initiatives will improve patient care; help health professionals deliver better, faster and safer care; and improve the efficiency of the health system. The Ministry's eHealth strategy comprises 22 projects grouped into nine areas — primary care, hospital care, home and community care, public health, laboratories, pharmacies, diagnostic imaging, telehealth and foundational projects — which will combine to build an integrated, electronic record of a patient's journey through the health system. The eHealth Strategic Framework can be found at http://www.healthservices.gov.bc.ca/cpa/publications/ehealth_framework.pdf.

As part of the eHealth strategy, the Ministry entered into an agreement with Canada Health Infoway, an independent national organization that invests in electronic health record systems across Canada in partnership with provinces and territories. Infoway has conditionally agreed to allocate up to $120 million to B.C. for eHealth initiatives between 2005/06 and 2008/09. The Ministry is providing an additional $30 million over the same period.

In 2005/06 a number of key eHealth projects were initiated, including the Provincial Laboratory Information Solution (PLIS), the Integrated Electronic Health Record (iEHR), eDrug, telehealth, and Provincial Diagnostic Imaging projects. Each of these projects will help improve patient care and system efficiency. For example, PLIS will permit a patient's laboratory results to be available when and where needed across the Province, and ensure that costly duplicate testing will be virtually eliminated. The iEHR initiative will deliver critical, comprehensive electronic patient information to health care providers as needed for timely clinical decision making. The eDrug project will result in a patient's medication history being available to physicians anywhere in B.C., allow the most appropriate drugs to be electronically prescribed and transmitted to the patient's pharmacy of choice, and will mean potential adverse drug reactions will be very significantly reduced. Each of these projects, and all other eHealth projects, will also focus on safeguarding the privacy and security of personal information and will adhere to all applicable legislation protecting personal privacy.

B.C.'s eHealth strategy is modernizing the provincial health system, and will benefit both patients and health service providers.

Objective 3: Optimum human resource development to ensure there are enough, and the right mix of, health professionals.

To be sustainable the system must have enough, and the right mix of, health professionals to provide services today and in the future. The system must ensure health workers are employed in the most efficient and effective manner, and that their work environments are supportive of them delivering high quality services. As the population ages, so too does the health care workforce, which means many health system workers will be retiring at the same time as demand for health services continues to increase. Therefore, health human resource planning to meet both current and future needs is vitally important to the system's ability to deliver high quality care.

The Ministry has been working to address both short and long-term health human resource needs across the Province, and has made significant progress in many areas. To ensure the long-term supply of physicians, the Province has significantly expanded B.C.'s medical school program. B.C.'s annual intake for medical students was 128 in 2003. The medical school's expansion doubles the number of first-year spaces to 256 by 2007, with courses offered at the University of British Columbia, the University of Victoria and the University of Northern British Columbia. In 2005, a further expansion was announced with the new Okanagan medical program expected to add an additional 30 spaces by 2009.

The Ministry has also been expanding postgraduate medical education positions (residencies) to keep pace with the medical school expansions. Since July 2003, the Ministry has approved funding for 89 new residency positions. The number of entry-level residency positions will increase to at least 256 by 2011/12. In addition, the Province has expanded residency positions for international (foreign) medical graduates, and also introduced measures through the Provincial Nominee program to expedite immigration processes for foreign doctors. These expanded programs will allow more foreign-trained physicians to practice in areas of need in British Columbia.

Similarly, the Ministry has worked with the Ministry of Advanced Education to add over 2,500 new nursing education seats (over a 60 per cent expansion) since 2001. Further, since December 2001, almost 1,000 nurses have been funded through the Return to Nursing initiative and more than 1,200 Licensed Practical Nurses (LPN) have received funding through the LPN Upgrade Program. In addition, in 2005/06 B.C. added Nurse Practitioners to the provincial health system, with the first group graduating in May 2005. Nurse Practitioners are Registered Nurses with advanced education and skills. They perform the full range of nursing functions, as well as functions shared with physicians such as diagnosing and managing common acute and chronic illnesses, prescribing, ordering diagnostic tests and referring to specialists.

Government has also added almost 500 new educational spaces for allied health professionals throughout the Province in the last five years, and has developed a number of strategies that better support the education and deployment of pharmacists and paramedics, two of the largest groups of allied health professionals. Specialized software is now providing pharmacists with a platform for on-line meetings and collaboration, making it easier for pharmacy professionals to participate in continuing education and other professional development activities. The B.C. Ambulance Service is moving forward with strategies that will provide more Advanced Care Paramedics, help paramedics deal with violence in the workplace and train high school students in CPR.

In late 2005/06 the Province reached agreements with all of the health sector bargaining associations as well as the British Columbia Medical Association. These agreements represent approximately 120,000 health workers across the Province and include doctors, nurses, paramedicals, community health workers and professional residents in B.C. Overall, more than 90 per cent of voting members supported these agreements. In addition to the collective bargaining process, government and association representatives held a series of policy discussions which have strengthened cooperation and ensured the labour agreements reflect the current concerns and interests of all parties. These joint policy tables will continue to meet and work together throughout the duration of the negotiated agreements.

Reaching these agreements is a significant accomplishment and signifies a new and improved relationship between labour and government in the health sector. These agreements provide a tremendous opportunity for the Ministry and its partners to move forward with health professionals and health workers to provide world-class health services for the people of British Columbia.

Objective 4: Sound business practices to manage within the available budget while meeting the priority needs of the population.

Sound financial and accountability practices are fundamental to delivering a high quality system and ensuring services are delivered that meet people's needs. To do so, the Ministry works with health authorities and other system partners to ensure their services and outcomes are aligned with government direction and policy.

To enable good management the Ministry provides three-year funding commitments to health authorities, updated annually, to allow them to plan and act with certainty. To ensure accountability, the Ministry develops and implements three-year performance agreements with health authorities that detail responsibilities and expectations for service delivery. In addition, the Ministry monitors and evaluates the delivery of physician services through the Medical Services Plan, prescription drug coverage through BC PharmaCare, and emergency services through the B.C. Ambulance Service.

The continuous evaluation and monitoring of health services and the health of the population is used by the Ministry to inform strategic direction and policy, and facilitate course correction where warranted.

B.C.'s health services budget has continued to grow — the Ministry's budget for 2005/06 was over $11.4 billion and health spending consumed approximately 43 per cent of all government spending. It is important this funding is used wisely to provide the best care and achieve the best outcomes for patients. The Ministry monitors financial status throughout the year so any problems can be identified and addressed, and ensures overall costs remain within its budget. Staying within the budget provides a high-level indication of whether the health system is well managed and on a sustainable path.

Results:

Analysis:

Ministry of Health expenses did not exceed budgeted expenses for 2005/06. For details, please see the Report on Resources on page 54.

Deregulation Summary

In 2001, government committed to reduce the overall regulatory burden in B.C. by one third, to be consistent with global trends in regulatory reform and management. That target has been met, and the Ministry of Health has continued to contribute to government's intention to maintain a " 0" net increase to the baseline regulatory count. The Ministry has continued to identify regulatory reduction and reform opportunities, and focus on improving regulations to ensure they are consistently results-based, cost-effective, flexible and promote competitiveness and innovation while maintaining a firm commitment to public health and safety.

At the conclusion of the three-year Deregulation Initiative, June 5, 2004, the Ministry of Health had a baseline regulatory count of 7,744. As of March 31, 2006, the Ministry had a regulatory count of 7,613. This represents a net decrease of 131 regulatory requirements below the baseline.