Health committee  No.

Health committee  Could I make a comment about the question you asked about out-of-country care?

Health committee  I wanted to mention that hormone therapy doesn't work the same for trans masculine people as it does for trans feminine people. In B.C. we've been seeing trans women suggesting things like facial feminization surgery and facial hair removal. There are other interventions that would be required that would increase safety and well-being.

Health committee  Okay, great. There's a recommendation.

Health committee  I think so. In our brief, we recommended that there's work to be done with the network of trainers and educators across the country. There are many groups doing this work but without very much dedicated funding. I think any strategy needs to be informed by the strengths and the resources that are already there.

Health committee  That's very true. Prior to Trans Care BC existing, I had six years of federal funding to do this work, but it was a bit cloak-and-dagger. We used the substance use prevention stream to apply for money to work on moving toward GSAs and community action related to LGBTQ2 prevention.

Health committee  This is where we're really excited about training health care providers all over the place to be really competent in providing this care, so those who don't want to go to a specialized service that says “trans” on it can just show up and have a conversation with their doctor, or perhaps a counsellor in their community.

Health committee  We're rolling forward a tiered training model in B.C. Starting from the basics, our shortest is a half-hour online module. It's to whet one's appetite around what we call the trans basics. Sometimes, we'll combine an online module with a live teaching opportunity. We're developing learner pathways for the different parts of the system of care where the training is needed.

Health committee  Just to add to that, we're having a big piece of work go forward around virtual health options, and we're piloting virtual care where people can be seen right from their home through a private, secure platform, through the provincial health authority. We think that will go a long way towards rural access, as long as people have the Internet.

Health committee  At this time, it will be B.C. residents with MSP coverage who will have to access the Vancouver program. It won't have capacity to serve people from other jurisdictions.

Health committee  These will be covered, and the door will remain open to Montreal, so people in B.C. will have additional options for surgery.

Health committee  It should change over time. This program is part of an overall surgical strategy in B.C. to have appropriate wait times for all surgical services. This will be captured in that work provincially. It will take time to scale up, but over time the expectation will be that those surgeries fall into the standard benchmark.

Health committee  Part of the announcement last November by our Minister of Health was also a scale-up around upper body surgery. We had only two health authorities offering chest and breast surgeries, and we have now, in the last year, moved to having those surgeries offered in every health region and to having 15 surgeons offer that care now; this number is up from five about a year ago.

Health committee  I think there will be very few costs out of pocket in the new model in our province. I think what we'll see is improved ability to return to work and less down time for people. The surgeons are quite confident that complication rates will go down because the travel will be limited and patients will have access to their surgeon much closer to home for appropriate follow-up and aftercare.

Health committee  I'm not a trans person, so I can't comment on anyone's individual reasons, but these are complex surgeries, especially the masculinizing genital surgeries. There is quite a high complication rate at the best of times. I think it would depend on what really matters for that person concerning their gender affirmation goals and what their care plan....