Telus and the Politics of Privatized Health Care

B.C. Premier David Eby said he was unaware Island Health awarded a contract to Telus to provide services to people living with eating disorders, but is skeptical that privatizing health services is a good idea.

BC United Leader Kevin Falcon said he supports the government contracting out the services to Telus as long as it tracks the company’s performance to make sure it is getting positive results.

The one-year contract started on Nov. 1, 2023, a spokesperson for Island Health said. It will pay Telus Health Solutions $292,500 to support up to 35 people.

“I don’t know about that specific program,” Eby said in a pre-Christmas interview. “I know we’ve had our challenges over the last little while with Telus Health and we’ve been able to address them using the authorities we have in the law here in British Columbia.”

A year ago the province’s Medical Services Commission filed for an injunction in the B.C. Supreme Court alleging the Telus LifePlus program’s billing practices contravened the Medicare Protection Act. The parties settled the dispute in April with an agreement the corporation will no longer offer access to publicly funded family doctors for patients who pay thousands of dollars in fees.

“There’s a huge amount of interest in the private sector in getting into health care,” Eby said. “They see opportunities to make money there. The challenge is that in our health-care system, those who support privatization of health care always fail to explain to my satisfaction how adding profit margin to the limited number of health workers we have somehow improves services for people.”

The big challenge for the government is finding enough doctors, nurses and other health professionals to deliver the care, said Eby. “When you’re suddenly competing with the private sector for those same doctors and nurses, it doesn’t make sense to me how that’s going to improve the patient experience.”

In December The Tyee broke the news that Island Health, the provincial government body that provides health care on and around Vancouver Island, had awarded a contract for eating disorder services to Telus, a publicly traded telecommunications company worth $35.8 billion.

Falcon said he was unaware of the contract but supports the idea of Island Health’s contracting Telus to provide services.

“What I would care about is the results,” he said. “If they can demonstrate they’re able to get results so that these folks can get the care they need and deliver a good outcome, then I would say it’s worth supporting.”

The government needs to watch the contract carefully and make sure it can measure positive results, or it shouldn’t fund it, Falcon said.

“Eating disorders, it’s a horrific situation, there’s a mental health element to that as well, so it requires some real care,” he said. “If the choice is between getting no care and getting some care, I want to make sure they get some care and just make sure we measure whether the results are improving.”

The contract is the result of a request Island Health put out a year ago seeking proposals from organizations “with expertise in eating disorders” to provide virtual and in-person counselling and support services, including access to psychiatrists, psychologists, dietitians and primary care providers.

Eating disorders such as anorexia nervosa, bulimia and binge eating are complex mental illnesses “involving relentless unhealthy thoughts and behaviours towards food, weight and body shape,” according to Island Health.

The care was to be for young adults and adults who have had persistent struggles with eating disorders and who have not benefited from traditional recovery-focused treatment.

According to one person living with an eating disorder who was referred to Telus, patients receive a code that allows access to health services the company provides digitally. They said the service did not appear in any way tailored to people with eating disorders and seemed no better than going online and searching randomly for a counsellor.

Jonathan Morris, CEO of the B.C. division of the Canadian Mental Health Association, told The Tyee that he was concerned that the services be integrated with the public system and based on the guidance of people with lived experience.

Many in the community who might use the services are doubtful that Telus will provide the care that people need and want, said Shaely Ritchey, a co-founder of the group Vancouver Island Voices for Eating Disorders, or VIVED.

“We do have some serious concerns,” she said. “Namely that there was no consultation with [people with] lived and living experience, even though we were sitting in active meetings with Island Health, MCFD [the Ministry of Children and Family Development], MMHA [the Ministry of Mental Health and Addictions] and the Ministry of Health.” MCFD provides some services on the south Island for people with eating disorders.

VIVED wants eating disorder services on Vancouver Island that are safe, effective and accessible to all, she said, adding that would include timely access to primary, secondary and tertiary care services.

Island Health could have instead used the money to reopen the two in-patient beds for eating disorder treatment at Royal Jubilee Hospital in Victoria that were closed in 2020, she said, and outpatient services need to be more available and diverse.

“We’d really like to see community-based upstream and stepped levels of care that really reduce disruptions to work, school and family obligations and prevent people cycling through existing treatment models,” she said. “Care that is comprehensive, holistic, patient-led, longer-term, part of a continuum of services, culturally relevant and sensitive, as well as meaningfully trauma-informed, gender-affirming, weight-inclusive and intersectional.”

The care needs to be trauma-informed and it has to be up to the individuals receiving the services to say whether that is happening, she added.

Ritchey said she and others told all that and more to Island Health, but with the Telus contract the authority has gone in a different direction.

“We fought like hell to be involved in it, and we were told this is too novel, too new, it’s happening too fast,” she said. “I don’t know where it came from, but it was not anything that we advocated for and we have continued to provide them with multiple different ideas for programs that they just have no interest in.”

The health authority issued its request for proposals on Dec. 20, 2022, just four business days before the holiday break, and closed the competition on Jan. 25, 2023.

“With such a narrow window for applications it just seems really unlikely that many organizations that would have been better suited to running a program like this... would have had any chance to apply,” Ritchey said.

The service Telus will be providing is just one part of Island Health’s larger program of eating disorder services, a spokesperson for the health authority said in a Dec. 28 email. “The goal of the RFP was to find a service provider to augment these existing services, with a specific focus on the availability of a virtual platform combined with optional in-person services.”

The contract builds on significant investments Island Health has made in eating disorder services in recent years with the support of the provincial government and aims “to improve virtual support options for clients in more rural/remote areas and pilot innovative approaches to care in the current environment of health human resource shortages,” they said.

A team of clinical and non-clinical Island Health representatives evaluated bids and chose Telus Health Solutions based on the service model the company proposed and the costing.

“As with all contracts, there are performance measures and evaluation processes included to ensure clients’ needs are being met and opportunities for improvements are identified and implemented,” the spokesperson said. “Once clients receive an initial assessment, they are able to access a variety of specialized services, including dietitian, nurse practitioner, physician, and be referred to psychiatry supports.”

Island Health has advisory tables for eating disorder programs and welcomes input and feedback on the services it provides, they said. After initial feedback, there have been changes to the Telus service, they added, including adding “an on-boarding phone call with clients to support them through the process” and making both Island Health and information about eating disorder clinicians more prominent on the app.

Representatives of Telus haven’t responded to interview requests.

Health Minister Adrian Dix has not been available for an interview.

Sonia Furstenau, BC Green leader and MLA for Cowichan Valley, previously told The Tyee that in her view Island Health awarding Telus a contract to provide eating disorder services is outrageous.

“Suffering, human suffering, should not be a commodity,” said Furstenau. “But it’s more of the same and I think people need to start paying attention to what outcomes we’re getting from this government, which is that companies with a profit motive are able to enter into areas that should be seen as government services.”

VIVED co-founder Ritchey said Island Health’s contract with Telus sets a terrible precedent, as the province may consider offloading more services to private companies that it has struggled or failed to provide.

“I personally don’t believe Telus is a safe environment to host this kind of service and I’m really, really worried for the rest of the province’s difficult-to-treat situations, like mental health and substance use, the toxic drug supply crisis,” she said.

“There should never be profit happening over people, especially with such vulnerable communities.”

As an organization, VIVED will refocus its efforts outside of the health system, instead building community and peer-led supports, Ritchey said.

A year of meetings and trying to collaborate has gone nowhere, she said, and she and others have lost faith in the system’s ability to change.