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Good morning. It’s Wendy Cox in Vancouver

After weathering the COVID-19 pandemic with approval ratings higher than most premiers across the country, John Horgan and British Columbia’s NDP government are now faced with managing the ripple effects in the health care system. Some of those ripples have exposed long-standing weaknesses that have turned into urgent crises, leaving Health Minister Adrian Dix with a series of new challenges all at the same time.

Reporter Andrea Woo followed her in-depth investigation into cancer care in British Columbia by speaking with four former heads of BC Cancer. All say a change in governance structure at the agency shifted the organization’s priority from excellence in cancer control to fiscal management, leading to the growing waiting times and staff burnout now plaguing the system.

All of them traced the decline to 2001, when BC Cancer was placed under the purview of B.C.’s newly created Provincial Health Services Authority. PHSA has since been responsible for governing, managing and funding BC Cancer, along with dozens of other programs and services.

Simon Sutcliffe served as president of BC Cancer from 2000 to 2009 and is now president of the non-profit Two Worlds Cancer Collaboration. He said the change in governance added layers of bureaucracy that impacted care. “Decisions now aren’t the ones taken by BC Cancer. They’re taken by health authorities, and largely on the strength of the budgets that are available to support those decisions.”

BC Cancer is a provincial, government-funded treatment and research organization, with six regional cancer centres in the province. The agency once had its own board of directors and a direct line to B.C.’s Ministry of Health. Dr. Sutcliffe conceded that some budget controls were needed. “We were shifting from the 1990s into the 2000s, and economic restraint was coming with it. But we didn’t need layers of fiscal management that superseded good medicine and science,” he said.

Mr. Dix agethis week that he is aware of the complaints about governance. But he said he believes the fundamental issue facing BC Cancer is increasing demand for care owing to the province’s growing and aging population.

The agency’s current challenges, he said, would be better addressed by hiring more staff to meet demand.

“A lot of the cancer people don’t like [the structure],” he said.

“I’m not sure that’s the key problem, or that a redesign of the management structure is necessarily what we need. But I know we need more oncologists and more technologists. And we’re training more. But it’s a pressure point, no question about it.”

Mr. Dix answered The Globe and Mail’s questions on BC Cancer after a news conference to announce changes aimed at tackling another urgent problem: the lack of family physicians. Almost a million people in the province are without a family doctor, making access to primary care – including prescription renewals and other services – difficult to come by.

On Thursday, Mr. Dix announced a five-year plan that is aimed at recruiting, retaining and training new doctors, paramedics, nurses and other health practitioners.

B.C. will add new spaces for training doctors, with 40 new undergraduate medical education seats, and up to 88 new residency seats, starting in 2023 at the University of British Columbia’s Faculty of Medicine – a change that will take years to bear fruit. In the meantime, the province is broadening the scope of pharmacists and paramedics to deliver more primary services, in an effort to reduce waiting times at walk-in clinics and primary health care centres.

As of Oct. 14, pharmacists will be allowed to adapt and renew prescriptions for a wider range of drugs and conditions for patients who do not have a family doctor. Additional changes are in the works that would give pharmacists the ability to prescribe for minor ailments and contraception, starting next spring.

Paramedics and first responders will also be given more scope to better assist and treat people. For example, paramedics will be allowed to offer pain management while a patient is being transported to hospital.

“We’re confident that the scope of expansion will provide better health outcomes for patients who need emergency health services,” he said. “This is an element of redesign that is crucial to our health care system.”

Mr. Dix said further changes are coming, including measures to address British Columbia’s fee-for-service model, a payment system that many family doctors blame for making work as a general practitioner gruelling, bureaucratic and under-paid.

This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.