The committee met at 7:15 p.m.

[P. Milobar in the chair.]

P. Milobar (Chair): Good evening, everyone. We might as well get started. I know there are one or two committee members still arriving, but they will be here shortly.

My name is Peter Milobar. I'm the MLA for Kamloops–North Thompson and Chair of the Select Standing Committee on Public Accounts.

On tonight's agenda, we're just looking at one report from the Office of the Auditor General, a report entitled B.C.'s Toxic Drug Crisis: Implementation of Harm Reduction Programs.

Welcome to our Auditor General, Michael Pickup, and I will turn the meeting over to him. Then we'll hear from the Ministry, and then we'll jump into questions, as we always do.

Consideration of
Auditor General Reports

B.C.'s TOXIC DRUG CRISIS:
IMPLEMENTATION OF
HARM REDUCTION PROGRAMS

M. Pickup: I will start by acknowledging with respect that at the Office of the Auditor General, we conduct our work on Coast Salish territories. I also acknowledge how the toxic drug crisis has had a profound impact on Indigenous families and First Nations communities. I reflect on the fact that the rate of Indigenous lives lost during the crisis far exceeds the rest of B.C.'s population.

Our report notes that including Indigenous perspectives is one of the principles of government's response to the public health emergency.

Before our presentation, I want to recognize our audit team for their tremendous work. Tonight with me are Laura Hatt, Christina Plaschka and Adam Carmichael. Several other team members contributed to the two audits that we did, including Daria Babaie, Julianne King, Kat Johnson, Mercedes Malsivai and Dara Penner.

Of course, a big thank you, as well, to our extended team, the people who support us from IT to communications to admin and finance. We couldn't do it without all of you.

On the team's behalf, I offer our gratitude to harm reduction workers across the province and to health care staff and people with lived and living experience with substance use. We appreciate the challenges you encounter every day, and we honour your care and dedication.

Thanks also to the employees of the Ministry of Mental Health and Addictions and the Ministry of Health, who are responsible for the subject matter of these two audits.

In a moment, we'll give you an overview of our two harm reduction audits, but before getting to that, of course, a word about our role as auditors, especially in the context of recent discussion about the toxic drug crisis. As a reminder, the Auditor General Act prohibits our reports from calling into question the merits of programs or of government objectives. It's not for us to say whether a particular program should or should not exist. What we do, and what I think our audit team has done exceptionally well, is provide professional and impartial reviews of the effectiveness of the implementation of these government programs or services.

A major factor in program effectiveness lies with implementation, the steps that go from concept to delivery. The implementation of harm reduction programs is at the very centre of the report before you tonight. I trust that the committee members find our report useful in navigating this aspect of the painful, difficult nature of the toxic drug crisis.

With that said, I'm going to quickly turn it over to our performance audit manager, who had such a key role on this audit. Christina Plaschka will lead us through our presentation.

C. Plaschka: Good evening, Chair and committee members. Thank you for your interest in our audits of B.C.'s Toxic Drug Crisis: Implementation of Harm Reduction Programs, which was tabled on March 19, 2024.

For today's presentation, I'm going to walk you through the Audits at a Glance, which is a summary of our two audits, main findings and our recommendations. It's a four-page document that you'll find in the package that was provided to you.

Over 14,000 deaths have been linked to drug-related toxicity since the province declared a public health emergency eight years ago, in 2016, making it B.C.'s leading cause of unnatural death. This crisis has also taken a disproportionate number of lives of Indigenous peoples.

The Ministry of Mental Health and Addictions and the Ministry of Health lead B.C.'s response to the emergency. The response spans the substance use continuum of care, from prevention and harm reduction to treatment and recovery. Harm reduction is an integral component of the response, focusing on keeping people safe from injury or death.

[7:20 p.m.]

In both audits, we focused on effective implementation, in other words, what the ministries needed to set up and run the programs effectively. We also focused on how the ministries included other perspectives, such as those of health authorities, Indigenous peoples, and people with lived and living experience.

I'll start with our first audit, which is framed around one

on effective implementation — in other words, what the ministries needed to set up and run the programs effectively. We also focused on how the ministries included other perspectives, such as those of health authorities, Indigenous peoples, and people with lived and living experience.

I'll start with our first audit, which is framed around one objective, which you'll see in the white box on page 1 of the audits at a glance. We wanted to determine if the Ministry of Mental Health and Addictions and the Ministry of Health ensured effective provincewide implementation of overdose prevention and supervised consumption services by the health authorities. I will now provide a summary of the audit's key findings.

First, we found that provincial guidance for health authorities and service providers was inadequate. While operational guidance for these programs was available, it did not include minimum service standards to support consistent quality, access, and availability of services. In addition, we found that the ministries consulted with Indigenous peoples and health authorities, but their input was not always consistently reflected in the guidance.

Second, we found that the ministries set objectives and worked with health authorities to develop performance measures, but only two health authorities had set explicit quantitative targets for the programs.

Third, we found that the ministries monitored operational and financial performance and reported publicly on overdose prevention and supervised consumption services.

Fourth, we found that the ministries had evaluated overdose prevention and supervised consumption services but that a new evaluation is needed, as the toxic drug supply has changed considerably since the last evaluation was completed in 2021.

Lastly, we found that the ministries had identified challenges and barriers to implementation. However, the ministries didn't work effectively with health authorities, people with lived and living experience or Indigenous peoples to develop or implement strategies to address the persistent challenges and barriers to implementation.

Overall, we concluded that the Ministry of Mental Health and Addictions and the Ministry of Health did not ensure effective provincewide implementation of overdose prevention and supervised consumption services by the health authorities. We made five recommendations for improvement that are focused on setting service standards, improving target setting, initiating a new evaluation and addressing barriers.

The ministries have accepted our recommendations and have indicated actions they will take to address them. We will follow up on their actions in a subsequent follow-up audit.

I'll now turn to our second audit, which is focused on one audit objective that can be found in the white box on page 3 of the audits at a glance. We wanted to determine if the Ministry of Mental Health and Addictions and the Ministry of Health effectively monitored the initial provincewide implementation of prescribed safer supply. I will now provide a summary of the audit's key findings.

First, we found that the ministries had implemented a data collection framework that included service utilization, program outputs, clinical outcomes and population-level impacts and outcomes.

Second, we found that the ministries had contracted an external evaluation of prescribed safer supply, which was underway during our audit.

Third, we found that the ministries monitored funding for prescribed safer supply and worked with health authorities to reallocate funds when needed.

Fourth, we found that while the ministries are aware of challenges and barriers to prescribed safer supply, current strategies do not demonstrate how the ministries will address key issues, especially in rural and remote areas. Furthermore, we found that meetings with health authorities and health sector partners have not resulted in sufficient collaborative strategies.

Lastly, we found that reporting by the ministries on prescribed safer supply was inadequate. Public reporting did not compare program performance to objectives, nor did it sufficiently inform the public about ongoing work being done to monitor and evaluate the program.

For these reasons, we concluded that the Ministry of Mental Health and Addictions and the Ministry of Health did not effectively monitor the initial provincewide implementation of prescribed safer supply. We made two recommendations for improvement that focus on addressing barriers and improving public reporting.

The ministries have accepted our recommendations and have indicated actions they will take to address them. We will follow up on their actions in a subsequent follow-up audit.

In closing, I would like to thank the Ministry of Mental Health and Addictions and the Ministry of Health for their work. And although not subject to these audits, I also want to recognize and thank the health authorities and other health sector partners for their cooperation and candidness. We are very grateful for everyone's time and effort.

Thank you, and I'll now turn it back to our Auditor General, who has some closing remarks.

[7:25 p.m.]

M. Pickup: Thank you, Christina, for tonight's presentation and for the significant work you did on these two audits as well.

I think, Chair, we will leave our comments at that.

P. Milobar (Chair): Okay. Thank you for that opening.

We'll turn it over to the Ministry of Mental Health and Addictions. I think we have Jonathan Dubé here, the acting deputy minister of Ministry of Mental Health

presentation and for the significant work you did on these two audits as well. I think we will leave our comments at that.

P. Milobar (Chair): Okay. Thank you for that opening.

We'll turn it over to the Ministry of Mental Health and Addictions. We have Jonathan Dubé here, the acting Deputy Minister of the Ministry of Mental Health and Addictions to run through their presentation before we hear from the comptroller general and then get into questions.

J. Dubé: Thank you, Chair. Good evening, and thank you for having us here tonight.

As you heard, my name is Jonathan Dubé ,the acting Deputy Minister for the Ministry of Mental Health and Addictions. With me tonight, I have Darryl Sturtevant, the assistant Deputy Minister for Mental Health and Addictions, as well as Evan Howatson, executive director with the ministry as well.

I would like to acknowledge with respect that the ministry does its work and learns on the territory of the lək̓ʷəŋən-speaking peoples.

I am pleased to be joining you here today to describe the actions that the ministries are taking in response to the recent report from the Office of the Auditor General.

Before beginning our presentation, I would be remiss not to acknowledge that this week is Mental Health Week. This year's theme is "Compassion connects." It's about how we all have the power to help people heal through kindness and compassion. We must remember that people struggling with mental health and addiction challenges are in all of our communities, and they are our friends, family, loved ones and neighbours.

Most people will struggle with mental health or addiction challenges at some point in their life. We need to create safe spaces and support for our loved ones when they come forward with their problems so they get the help they need.

The toxic drug crisis continues to impact communities in both B.C. and across Canada. Last year in B.C., we saw the highest number of deaths, as 2,546 people lost their lives to toxic drugs. There have been over 14,000 deaths since 2016, when this public health emergency was first declared.

The challenges of the toxic drug crisis were compounded by the COVID-19 pandemic. During this time, we experienced major disruptions to the delivery of health and social services and saw a significant increase in the toxicity of street drugs.

The Office of the Auditor General conducted two independent audits of the implementation of B.C.'s harm reduction services in the context of these two public health emergencies. One audit focused on overdose prevention and supervised consumption services and covered the period of January 1, 2020 to June 30, 2023.

The second audit focused on prescribed safer supply, a program now known as prescribed alternatives. This audit covered the period July 1, 2021 to June 30, 2023.

It is important to note that the harm reduction programs that the Auditor General audited were built on a considerable foundation of public health responses to drug use in B.C. and Canada.

Vancouver's Insite, which opened in 2003, was the first supervised consumption site in North America, replicating evidence-based European programs to effectively prevent HIV transmission and overdose deaths.

Following B.C.'s declaration of a public health emergency in 2016, the Ministerial Order No. M488 to open overdose prevention services was issued. Through this, B.C. was able to rapidly stand up many OPSs for observed consumption and rapid response to toxic drug poisonings, saving thousands of lives.

In spring 2020, the COVID-19 pandemic further disrupted the drug supply. Since then, illicit drugs have become even more toxic with potent and exotic adulterants such as illicit benzodiazepines and veterinary tranquilizers added to fentanyl and high-strength fentanyl analogues.

This increased toxicity of street drugs resulted in the introduction of the prescribed alternatives program with the release of risk mitigation guidance on March 26, 2020, followed by an updated safer supply policy in June 2021, with the goal of separating people from using toxic illicit street drugs. These policies and programs represent two lifesaving interventions that B.C. introduced in response to the toxic drug crisis.

The ministries welcome the recommendations from the Auditor General which will help support our continued stewardship of these important programs.

Slide three just notes that there were recommendations made, five for the OPS and two for the prescribed safer supply. The ministries have accepted all recommendations and have begun working to address them.

For OPS and SCS, the Auditor General's key findings were that the service's operational performance and funding were monitored, with funding adjusted as necessary, and that public reporting was provided on the implementation.

[7:30 p.m.]

The Auditor General's presentation talked about the deficiencies in three areas. The OAG concluded that the ministries did not ensure effective provincewide implementation of these services and has made five recommendations to address them. Again, we have accepted these recommendations which will be discussed in more detail.

implementation.

As the Auditor General's presentation talked about the deficiencies in three areas…. The OAG concluded that the ministries did not ensure effective provincewide implementation of these services and has made five recommendations to address them. Again, we've accepted these recommendations, which will be discussed in more detail in the following slides.

The ministry is leading the development of minimum service standards for overdose prevention services with the advice and input of harm reduction service experts at health authorities, the B.C. Centre for Disease Control, the B.C. Centre for Substance Use and people with lived and living experience and organizations specializing in service delivery for Indigenous people. While the development of the minimum service standards is underway, the standards will, in fact, codify the core elements of operating and governing community-based OPS. This will benefit all parties involved in these services, not least of which are clients and staff.

The minimum service standards project is a priority and will deliver published standards within the '24-25 fiscal year, with implementation beginning immediately after. Recognizing that codifying standards for service delivery is distinct from assessing community needs and the availability of services, the ministry is already working with the BCCDC and our health authority colleagues to develop needs assessment standards that will inform regular, collaborative service planning for harm reduction services at the community level. The ministry expects that an initial version of the standardized needs assessment tools will be available in late '24-25.

The ministry accepts the Auditor General recommendation that it adopt a proactive role in working with health authorities to develop achievable, time-bound targets for implementing OPS. The standards that will be articulated in the minimum service standards will provide a common reference point for service-planning discussions between health authorities and ministry staff and support provincewide implementation through clear and consistent definition of core services that OPS are expected to deliver and how they should be delivered. The standards will begin to be implemented in '24-25, including data collection requirements that will assist with service planning. The ministry is indeed changing how it works with health authorities to ensure that the necessary processes and discussions are constantly and consistently occurring.

These changes are focused on ensuring critical information necessary to inform effective and timely co-planning among the ministry and our many partners. These changes in how the ministry and the health authorities work together to ensure effective planning and implementation are already starting to be implemented and will be fully realized before the close of this fiscal year.

The ministry accepts a recommendation to develop a draft service evaluation plan with the input of health authorities, Indigenous people and people with lived and living experience and will begin planning for this work this fiscal year so that it can be conducted in '25-26. This plan will define the scope of evaluation and key areas of review and define the questions and associated metrics to ensure the relevance of the evaluation to service planning and delivery in order to improve the participant and provider experience at OPS in B.C.

The plan will also account for the minimum standards that are set for OPS once that other work is completed this year. Once the draft plan is approved before the end of '24-25 and the necessary resources to conduct and oversee the evaluation are committed, the ministry will begin an ongoing structured evaluation of OPS services.

The ministry accepts the recommendation to work with health authorities to develop provincewide strategies to address barriers to implementation. In improving service planning processes between the ministry and health authorities, as previously discussed in response to recommendation 2, the ministry will ensure that barriers to OPS implementation are a consistent topic of discussion and ongoing analysis between the teams responsible for establishing them.

As barriers are consistently identified and categorized in the updated planning processes, the ministry will report out and involve relevant system partners and ministries such as Municipal Affairs, Public Safety and Solicitor General and the Ministry of Housing so that they are aware of the frequency and severity of common barriers, so we can discuss ways to potentially address them. As part of the evolution of the ministry's role from emergency response coordinator to administering and planning what are now established essential health services that serve vulnerable populations, the ministry will define, formalize and standardize responsibilities for implementation and oversight of OPS.

[7:35 p.m.]

This work is underway now and is expected to be finalized and in effect for 2025-26. I will speak to the development of the updated harm reduction community guide in the following slide, but updating the guide will better illustrate what contemporary harm reduction looks like in practice and how services are established at the local level.

The ministry accepts the recommendation to work with health authorities to develop community-level guidance that supports system partners with OPS

and community guide in the following slide. But updating the guide will better illustrate what contemporary harm reduction looks like in practice and how services are established at the local level.

Moving to slide 9. The ministry accepts the recommendation to work with health authorities to develop community-level guidance that supports system partners with OPS implementation. As one piece of this work, the ministry is currently working with a wide range of partners to update the harm reduction community guide. The refreshed guide will support contemporary policy development and service planning at the municipal and health authority levels. The guide will serve as an accessible common resource and reference point that reflects contemporary public health evidence and best practice for reducing the harms arising from substance use in the toxic drug supply.

It will also aim to include new content reflective of the contemporary experience of local governments in the planning and delivery of harm reduction services in partnership with community organizations, health authorities, and people with lived and living experience.

The updated guide's goal is to translate knowledge and best practices for harm reduction service planning and delivery that are necessary for the success of these initiatives at the local level. This relies on the input and cooperation of many partners across organizations to be established, relevant and sustained. It must consider interests and roles of partners that collectively bring services. Work on the updated guide is underway and on track to be completed in '24-25.

Moving to slide 10. This brings us to the Auditor General's findings on prescribed alternatives. For prescribed alternatives, the Auditor General found that we had developed a data collection framework, monitored and adjusted funding, and initiated an evaluation of prescribed safer supply. The Auditor General also noted that the ministry had developed an enhanced plan to further monitor the impact of diversion following concerns expressed by the public.

However, the Auditor General identified some deficiencies in how we address barriers to prescribed alternatives and report publicly. As a result, the Auditor General concluded the ministries did not meet all criteria for effectively monitoring implementation.

Slide 11. In response to these findings, the Auditor General recommended developing an action plan to address barriers to implementation. The ministries were advised to undertake this work in partnership with health authorities and to engage with rural and remote communities, people with lived and living experience, Indigenous peoples and professional medical associations. We accept this recommendation.

We are exploring opportunities to better support access in rural and remote communities through innovations like virtual services. We will also work with health authorities to address barriers and clearly define responsibilities as part of the work we're undertaking between the ministry and our partners, as previously discussed. Addressing barriers is an ongoing activity in an ongoing challenge. Our timeline to complete this work is fiscal year '24-25.

Moving to slide 12. The Auditor General also recommended that ministries report regularly to partners on whether the prescribed alternatives program is meeting its objectives, which include reducing the use of street drugs and preventing illicit drug toxicity events.

To address this recommendation, we are coordinating with the B.C. Centre on Substance Use to develop a knowledge hub with resources on prescribed alternatives for clinicians and the general public. The knowledge hub will include practice support tools in education, clinical resources to support conversations between providers and clients, and a video explainer and infographic explaining prescribed alternatives and their role in the continuum of care. We anticipate developing this hub in fiscal year '24-25.

In the time since the release of this report, the ministry has also partnered with the BCCDC to launch a publicly available dashboard that includes regularly updated data on prescribed alternatives. The dashboard was launched in April of this year. It includes monthly client and prescriber numbers, which can be broken down by health authority and class of medication.

Moving to slide 13. In summary, I would like to extend my sincere thanks to the Office of the Auditor General for their work on this audit. The ministries remain committed to these important life-saving and harm reduction programs. Again, we have accepted all recommendations and are working to address them within the time frames provided.

With that, I want to thank everyone for the opportunity to make this presentation and am happy to answer any questions.

P. Milobar (Chair): Great. Thank you for that.

We'll just check in with our Comptroller General, Nicole, and see if there's anything she'd like to add.

N. Wright: Thank you, Chair.

No.

P. Milobar (Chair): Okay. Any questions?

I'll jump in with one or two.

I'd better preface this. It's never great when you always have to have a preface, but I do appreciate and understand the significance of the work that's being undertaken and the stress and the importance of it.

[7:40 p.m.]

However, I have a bit of an overarching question, because I hear a lot of "fiscal '24-25", which is what we're currently in. The audit spanned January 2020 to June 30, 2023. I recognize this isn't an audit around the decrim program, but there is overlap in terms of the overall harm

which is what we're currently in. The audit spanned January 2020 to June 30, 2023. I recognize this isn't an audit around the decrim program, but there is overlap in terms of the overall harm reduction goals and things of that nature.

Where I'm going with that is that on the letter of requirements to support B.C.'s exemption, which was issued on May 31, 2022, by the federal government, the ministry and the government committed to a lot of the same things the Auditor General is essentially asking for. There needed to be alternative measures to continue to expand harm reduction services, meaningful and ongoing engagement with partners and stakeholders, significant Indigenous engagement, readiness capacity of health and social systems, communications and public education. Very similar themes and commitments made by the government on May 31, 2022 — the province of B.C. — needed to be in place officially for January 31, 2023.

This audit was still taking place for the first five months of decrim. Yet those commitments weren't met. They're still not met. Here we are in fiscal '24-25, and the ministry is saying we're going to meet these commitments now. But even before the Auditor General was asking for similar commitments to be made, the federal government did back on May 31, 2022.

What assurances does the public have that acceptance of recommendations and true implementation of recommendations are now going to happen when they don't appear to have been meaningfully enacted based on the letter of requirements for the exemptions?

J. Dubé: I would say that for decriminalization, we continue to work with the federal government, as you're more than aware. We continue to provide the data and information that's been requested. We know that we provide a snapshot that is also available to the public if people want to look on our website. It is available. We also provide regular reporting to the federal government about the letter of requirements.

You probably will have seen that the letter of requirements has been adjusted to reflect the new exemption that was granted just yesterday. And again, that request was granted based on us providing the information that Health Canada wanted to see to be able to validate and justify the need for the exemption that was granted.

P. Milobar: Thank you for that, but that wasn't really the meat of the question. The meat of the question was…. The original letter of requirements was issued on May 31, 2022. It required several of the same steps to be undertaken around harm reduction initiatives, Indigenous community engagement, things of that nature, that the Auditor General has just released as well in an audit that was still ongoing until June of 2023. Decrim started in January of 2023.

I'm just simply wondering…. It wasn't enacted in time, despite commitments by the province. Not you personally. I'm saying, truly: the province, the ministry, the government made commitments to the federal government in that time frame that they would enact very similar actions as the Auditor General is asking to be done.

I'm just wondering what…. We're now here partway into fiscal '24-25. Most of these recommendations are required or, as the ministry is saying, will be actioned and operational by fiscal '24-25. But those same commitments were made then. What has changed? How do we, as a public, have confidence that these will truly be implemented? Not just agreed upon but actually implemented? Because they were agreed upon back with the letter of requirements as well.

J. Dubé: Thank you again, Chair, for the question. For decriminalization, there is an ongoing table. That was in place while it was being first started, and it continues. It's called, I think, the core project team, and it includes the various ministry partners. It also has people with lived and living experience. It has Indigenous representation.

[7:45 p.m.]

That has been the table that meets regularly to discuss implementation, monitoring, changes and adjustments to decriminalization. Because as we know, since it was granted in January of 2023, there's also been a further exception to

it has Indigenous representation. That has been the table that meets regularly to discuss implementation, monitoring, changes and adjustments to decriminalization.

Because as we know, since it was granted in January of 2023, there's also been a further exception to capture things like splash parks and skate parks. There is an ongoing table. That table continues to this day. In fact, we hope we will be meeting very shortly to discuss the changes to the exemption.

So with respect to decriminalization, there is a table that meets and that does have representation from the people and the organizations and partners that we need to continue to look at both our requirements as well as the input of the partners that we need to continue monitoring and the commitments that we've made on decrim.

P. Milobar (Chair): Okay, I'll come back to this. I don't want to…. I know, Ronna-Rae, you had a question. I'll come back and maybe reframe my question a little more tightly, because we're not on the same page here. Fair enough.

R. Leonard: Thank you for the report. This is a very difficult topic for our province, for everybody in the country and across the continent. Being on the cutting edge, I would say, of action on this front, it's important that we have a lot of critical eyes at it to see that we move in the right direction. The opportunity to have that independent oversight to provide that critical look is very helpful. I really appreciate the ministry for responding in the way that you have.

I have a few questions. One of the first things that struck me is that…. I was on the Health committee, and we heard from the different communities, especially the distinct differences between remote rural areas and urban areas…. When it comes to service standards, my gut reaction was, "Well, any service is better than nothing," which seemed to be the case of what was going on. If you have minimum standards, and you can't meet the minimum standards, does that mean that there will be no service? That's my first question, basically.

I recognize that this audit was not focused on health authorities, and I'm curious about how that distinction was made. Because there's such an interplay between the health authorities and the ministries, and how that all played out that you focused on the ministries, but you interviewed the health authorities…. I didn't quite understand how that rolled out. I'll start with that.

If I could have a response, if that's the will of the Chair.

P. Milobar (Chair): I kind of assumed they would respond.

M. Pickup: One is for us, and one is for the Deputy. Do you want us to go first?

P. Milobar (Chair): Yes.

M. Pickup: Ours may be the easy one. Folks may want to supplement this as well.

What we really focused on here was looking at the responsibilities as laid out in this for the two ministries. That was where we focused, rather than looking at the responsibilities assigned to a health authority or to a partner or to another group. It was important, and you'll see, throughout the two reports, the amount of work that the team did in interviewing, meeting with, talking with partners, talking with health authorities as well.

You'll see a lot of the specifics that come through these reports, in terms of the examples that are given, come from many of the health authorities and partners sharing that. So certainly not ignored in this group, not ignored in the work that we did, but the focus, again, as per the design of the programs, was on the two ministries and what they were required to do so as to answer those audit objectives.

Team, do you want to add anything?

L. Hatt: Yeah, I would also like to add that when you look at the terms of reference and the letter of understanding between the ministries, it's really clear — the ministries' role in terms of responding to the toxic drug crisis.

[7:50 p.m.]

Obviously, the health authorities do have an important role to play. In fact, they stand up the services. But that takes a good policy framework and leadership and direction and monitoring from the ministry, and we felt that that was a good way for us to provide that

responding to the toxic drug crisis. Obviously the health authorities do have an important role to play. In fact, they stand up the services, but that takes a good policy framework and leadership and direction and monitoring from the ministry. We felt that that was a good way for us to provide that provincewide look at the implementation of these services.

And as Michael pointed out, we did do significant work with the health authorities to be able to say how effectively the ministry is operating in terms of these implementations. Rather than just looking at the monitoring templates and the funding, which we noted were going well and the ministry had done a lot of work, we also wanted to see what it was like for the health authorities to implement these programs in working with the two ministries. So that became the focus of our work.

R. Leonard: If I could just add that what we saw in the health committee was that each of the health authorities had responded to the call to action differently. It was hard to distinguish if the differences were geographic as opposed to cultural. I don't know if I can say it that way.

L. Hatt: Yeah, I think it's fair to say that each of the health authorities would have their own unique challenges given where they operate, their populations. They do have responsibility for that. But we see the two ministries, and this is built into the legislation, that their role is in terms of stewardship and providing that leadership to help at least to have a minimum level of access to those services and setting those standards. So we did take a look at it from that perspective.

R. Leonard: Thanks.

E. Howatson: The intent is not to reduce services by creating a minimum standard so high that it creates a barrier. We're working through with many partners. Understanding the vast differences in OPSs, rural and remote, and understanding what those would look like. But the intent is not to create a minimum standard that's so high that it's a barrier to access. It's also understanding that during implementation of a minimum standard, there would have to be a harmonization period to ensure that that doesn't happen. And work with the vast array of OPSs out there to ensure that this is enhancement of services.

R. Leonard: Just a quick follow-up in terms of public confidence in what's being provided, because that has been very varied, if I may say.

Do you see the minimum standards changing who the delivery partners are?

E. Howatson: In terms of between community groups and health authorities? I think we have to be mindful that this started as a grassroots piece. I think we need to make sure that it's the appropriate service provider that takes into consideration all aspects. I don't think there's one aspect that is the be-all and end-all of the provider space.

R. Leonard: Thank you.

J. Tegart: Thank you for the report, and thank you for the work that you do.

Reading the material just reinforces the complexity of the programs and the complexity of the issues that are being dealt with. As someone who has some experience in dealing with multiple ministries and trying to get to the core of what we do, I have to say I was a little sad reading the report. We've got a lot of work to do.

This is an issue that is in communities. It's in their main streets. It's in their back lanes. It's in their homes. And it's, I guess, up to all of us to work to get the most we can for our most vulnerable people. I'm sure you feel the same way we do.

Six people a day. They can't wait around for all of us to get together for a meeting. The focus needs to be very clear. When I look at the complexity of the two ministries, the health authorities, the who's who and who do you go to….

[7:55 p.m.]

As an advocate in your area, I guess my question is: how do we establish clear lines of accountability to support the programs that are happening? How do we measure success?

is: how do we establish clear lines of accountability to support the programs that are happening? How do we measure success? Keeping in mind, as I read the recommendations and the plans for 2025-2026, I'm thinking six people a day.

D. Sturtevant: Thank you for the question, and maybe I'll just jump in. I really appreciate your comments. As you noted, it is a really complex and really complicated public policy issue that we're all grappling with here.

Just the nature of the illicit street drugs themselves is changing faster than I've ever encountered in our lives and so a lot of our responses are very much in a kind of catch-up environment. But from an accountability perspective, obviously, we work through things like our ministry service plan. We have mandate letters with our health authorities where we set out our expectations. We try to establish targets, where it makes sense to do that, and we're continuing to do that.

I would say we're still building up our data environment, to be quite frank. I think that it's one of the areas within the health system that has really not had the attention that we need to collect the data that we really need to do to drive the services that we need out there. That's a big job that we're still continuing to do. I've been working with my colleagues in the data division in the Ministry of Health to think about a data strategy for what we're trying to do in the mental health and substance use area. Because we just need to get better information if we're going to drive the kinds of programs and hold the accountability that we need not only with our health authorities but with our contracted services.

That's all work that we're actively doing. It takes time to make that happen and, at the same time, we're driven every day by the fact that 6.4 people die and that sometimes it's been up to seven and higher. I have to say when my staff come in every day, I can see it: their commitment to the work that they do. I sometimes hear their frustration that we, as a government and as a ministry, aren't moving fast enough even for them. I think that pressure is there, and it's something that I feel every day when we come in to do the job we have in front of us.

G. Begg: I want to build on what Jackie said. Did you sense a need for some streamlining of process? We have a Ministry of Mental Health and Addictions separate and apart from the Ministry of Health. These are common problems, or they're residual problems. Did you sense a need for streamlining? That's not the best word to use.

D. Sturtevant: Well, I would say that one of the things that we've been doing is we've been evolving as the public emergency has been evolving. We have recently done a look at our overall governance environment, trying to sort of think about what committees we have. Are they the right committees anymore? Are they the most responsive ways that we can do it?

I have the pleasure of being both an ADM in the Ministry of Mental Health and Addictions as well as an ADM in the Ministry of Health. For me, I chair the ADM-VP table with the health authorities. They're all represented there, and we drive change through that structure. We are putting in place some of those structures that you want to see to drive the kind of thing that we need to do.

We're continuing to look at what is working and what's not working. There's a new committee that we're setting up that Evan's leading with the health authority executive director leads in order to really kind of look at the operational implementation of all the initiatives that we have underway. That whole governance environment is something that is always constantly evolving for us, and it's something we look to quite frequently and make the changes we need to make to create the alignment that I think we need with the health authorities and with our other partners.

G. Begg: Thank you.

J. Dubé: I would add too, though, that despite the challenges in terms of building the governance and processes, I think some of the findings of the Auditor General recognize actually kind of the flip-side of this that a lot of these services were stood up quickly.

[8:00 p.m.]

Which is, I think, what you see in some of the recommendations as well. We understand that we have stood up more OPS than any other jurisdiction in Canada, and it was done quickly because we were taking this very seriously. And this is from 2016 on. This is not about a particular part of

I think, what you see in some of the recommendations as well. So we understand that we have stood up more OPS than any other jurisdiction in Canada, and it was done quickly because we were taking this very seriously. And this is from 2016 on. This is not about a particular part of government or who was in power at the time.

But these services…. There has been progress made. Everyone wants it to be faster, but what you see in some of this report is the fact that they were stood up quickly because it was in response to what we see on the streets and what we see that's happening to our neighbours and our friends and loved ones. So this is a balance that has tried to be struck over a period of time.

In the background, yes, there's work underway to look at minimum service standards, things that, obviously, in a perfect policy environment you would have before you implement. In this case, it is an emergency, a public health emergency, and we were trying to get services up and running as soon as possible.

P. Milobar (Chair): In terms of the recommendations, they all would have an impact. Some are an expansion of existing programs. Some I recognize would be a brand-new type of programming. This was an audit that finished up on June 30, 2023, so fiscal '23-24. The commitment has been for the vast majority to be implemented in fiscal '24-25, which we're currently in.

What was the overall budget for these types of programs in fiscal '23-24, and what is it now for fiscal '24-25 to actually accomplish all the recommendations?

J. Dubé: When I look at most of these recommendations, I don't see a significant cost. A lot of this is working through governance and processes and developing service standards. That's not the big-ticket items, and so I think Darryl will be able to provide some information on the budgets for some of these programs, but I don't see these recommendations requiring significant budget. They just require the work that people need to do in partnership. But the big-ticket item is actually the provision of service, which is not really what the focus of the recommendations are.

I'll turn it over to Darryl.

D. Sturtevant: Well, for the OPS services themselves, the annual budget for that with health authorities is $42.8 million. And we have some increase in Budget 2024 to help with some of the work that Evan talked about earlier. With our prescribed alternative program and including Budget 2023, that comes up to $40.7 million.

S. Chandra Herbert: I vaguely recall — it's been a few years — a conversation with then Minister Lake, I believe, where we talked about how this emergency really required kind of building…. I think the analogy was building a plane in mid-air, because it was an emergency. We found ourselves flying in this troubled zone and really did have to construct a plane so we could try and land it. Obviously, that hasn't happened yet, in terms of the landing. We're still very much in that emergency.

But I just wanted to reflect on how we're now trying to do that paperwork, so really operationalizing what we've already done and trying to get those best practices to go from — I don't know — a handful of OPS sites to over 50. There's been a lot of learning done in that and, I think, a recognition that one size doesn't fit all. So I want to acknowledge that.

I think the accepting of the recommendations is a good thing. But I, too, I'm sure, share that frustration of: why haven't we solved this by now? I think it's so vexing that really looking to each other in the community…. And I acknowledge the Auditor General acknowledging folks using substances with lived and living experiences — how vitally important that is as well. So I thought I had a question in there, but I….

Anyways, I just want to acknowledge the work. I'm sure someone else will have a better question than I had.

P. Milobar (Chair): I'll jump back in then. I don't see a hand.

In terms of the jurisdictional, as we've heard, cross-ministry and things of that nature, it strikes me that the budgets that we just heard are higher than the budget for the Ministry of Mental Health and Addictions, and I get that they also fall underneath the Ministry of Health. So is there…?

[8:05 p.m.]

Maybe can you walk us through how that actually works, then? Who ultimately signs off on all these programs actually going to be changed and implemented? Is it the Minister of Health? Is it the Minister of Mental Health and Addictions asking the Minister of Health to sign off on these programs? It seems that there are two ministers but only one in charge of the actual dollars. And so I'm just kind of trying to understand

going to be changed and implemented. Is it the Minister of Mental Health and Addictions asking the Minister of Health to sign off on these programs? It seems that there are two ministers but only one in charge of the actual dollars. So just kind of trying to understand how it interconnects behind the scenes when decisions on things obviously are not rolling out at the speed that people would have thought they were going to be rolling out at?

J. Dubé: Sure, I'll give that one a shot. Apologies, I'm, I think, 3½ weeks into this new role. But I will say that I did come from the Ministry of Health, so I do have some insight on that. \

You are correct. The Ministry of Mental Health and Addictions budget is not really about programs. It's about the policy work that gets done, primarily. But the funding is requested on behalf of both ministries.

So for those of you that are familiar with the Treasury Board process — and I see a few of you in this room that I've seen in my past life at Treasury Board — the ministries go together, and what is approved is…. Yes, it is an appropriation of the Ministry of Health and under the authority of the Minister of Health. But for those particular initiatives and funding that is tied to them, which are the responsibility of the Ministry of Mental Health and Addictions, that funding is then put forward through the health authorities by the Ministry of Mental Health and Addictions. That funding letter, for lack of a better term, is translated into the larger Ministry of Health funding letters that go out to health authorities. That, in a nutshell, is how the money flows for particular projects related to the ministry.

P. Milobar (Chair): So then my follow-up, I guess, would be on the auditor side of the equation. Does that make any sense, as an auditor, that there's not an internal, at least, transfer on the books showing the Ministry of Health is transferring over for…? I mean, we've just had the back-and-forth with yourself and the comptroller general about how school gets booked, based on whether or not it's a grant or not a grant, or things of that nature.

It just seems like you only have the $15 or $16 million or whatever is, off the top of my head, for Ministry of Mental Health and Addictions. Final sign-off, final approval of these programs ultimately is the Minister of Health actually saying yes to the expenditure. And there doesn't seem to be an internal transfer.

So either to yourself or the comptroller, I guess: can you walk us through how that...?

N. Wright: I'm happy to take a stab at that. I think that when the Ministry of Mental Health and Addictions was stood up, it was stood up to put a focus on this particular issue, to have some dedicated resources attached to it focused strictly on this issue. But the intent was not to duplicate the operational arm of the Ministry of Health, which already had the relationships with the health authorities in place.

I think the structure is reflective of, as Jonathan said, the policy focus for the Ministry of Health in terms of coming up with solutions. But it really does depend on the Ministry of Health to help operationalize that. So we're not duplicating government bureaucracy, for lack of a better term. If that helps.

J. Dubé: I think the Auditor General will probably weigh in here, but also, as we know through the estimates process, the appropriations and the voted appropriations that are set out provide the Ministry of Health with the authority to spend on these kinds of programs. And as we know, for those of you that enjoyed the estimates process, every year the appropriation for the Ministry of Health that authorizes particular expenditures is approved through that process.

M. Pickup: Yeah, we've never audited the estimates process, of course. We're auditing the actual numbers which don't get into that kind of detail. So I wouldn't add anything beyond what the controller general and the deputy said.

P. Milobar (Chair): It sounds like you say the Minister of Mental Health and Addictions who gets approval from the Minister of Health who then has to go and convince the health authorities to implement something and then find some other partners. So we already have a chain of command thing going on here that creates issues, but anyways.

[8:10 p.m.]

R. Leonard: I'm changing directions a little bit again. On page 27, there's reference to a lack of tools to support the OPS/SCS implementation. And there's reference made to the challenges that health authorities were having

R. Leonard: I'm changing directions a little bit again.

On page 27, there's reference to a lack of tools to support the OPS-SCS implementation. There's reference made to the challenges that health authorities were having with local governments to implement those programs.

I certainly recognize that as an issue in many, many communities. I know it's one thing to say this is something that needs to be addressed, but it sounds like the solutions are probably more difficult to attain. I'm just wondering if there is any sense of what solutions were envisioned in terms of being able to implement that recommendation in particular.

There was another one, too, around…. Well, I won't go there. I'll just start with that.

L. Hatt: For sure. Yeah, I think one of the barriers or persistent challenges that was identified in the report is around municipal resistance. It is a challenging issue.

I think what we found, and it's reflected in the report, is that sometimes there is a lack of clarity in roles and responsibilities in terms of how to address those types of resistance. Our recommendation is really around clarifying the roles between the ministry and the health authorities when there is that kind of resistance.

If the health authority has done their assessment and has decided that a particular area should have an OPS site and there is resistance, where do they turn to? How do they deal with that? How do they address that?

Just clarifying the roles and responsibilities in each of those cases between the ministry and the health authorities is what was behind that recommendation. Because that's the first step in getting anything solved, deciding who's going to do what action.

P. Milobar (Chair): Any other questions? No? Must have a lot of Canucks fans in the room. You're off the hook.

All right. Thanks so much, folks.

We have no other new business, so a motion to adjourn. All done.

The committee adjourned at 8:12 p.m.