What does a health authority board member do?

Health authority board members do a lot more than just attend meetings, but the recent pay hikes handed out are still “fairly outrageous,” a former Fraser Health board member who served under both the NDP and BC Liberal government says.

In late August, The Current broke the news that board members for BC’s six health authorities received a 53% pay bump compared to the previous year. The pay hikes were the result of a 72% increase to retainers and a 44% increase to meeting fees. The raises left some members making as much as $2,000 for each full day of meetings.

Markus Delves, a board member and accountant who chaired Fraser Health’s audit committee, told The Current that he and his colleagues did work outside of the formal meetings for which they were paid, and that board members could play a useful role in delivering health care to communities. But even so, he said the pay now being doled out to board members seems too much.

“I think it’s fairly outrageous how much it’s dramatically increased over the years,” Delves said.

The pay

In the 2015/2016 fiscal year, board members received $125,782 in combined pay. By 2018/2019, Delves’s last on the board, that sum had increased to more than $200,000. Last year, board members took home more than $300,000 in wages.

Delves was appointed by the BC Liberals and served as the chair of the Fraser Health board’s audit committee. The BC NDP appointed a slew of newcomers following the party’s 2017 victory, but retained Delves. He announced his resignation at the end of 2018 as he began to campaign for the BC Liberal nomination in Abbotsford.

(Delves did not win in that election. In advance of this upcoming provincial election, he had been running as a BC United candidate in Abbotsford, but suspended his campaign following Kevin Falcon’s decision to endorse the BC Conservatives. Delves spoke to The Current a day after Falcon had yanked the nominations of his party’s candidates.)

In a lengthy conversation about health care in BC, Delves wasn’t overly critical about the NDP nor the work done by current health authority board members. But he said the increase to the retainers and meeting fees of those members seemed excessive.

“It’s obviously a very generous retainer, but it’s not meant to be paying you top [dollar],” he said. “You’re not a consultant, you’re not charging $100 an hour to be there. There’s supposed to be this element of service involved.”

Delves noted that not only had the retainer and meeting fees increased since his time on the board, but so too had the number of official meetings—each of which brings with it a fee for attendance.

Delves suggested that the increase in recorded meetings may speak to a philosophical shift among those serving on the board.

“With more labour folks on the board, I suspect there’s more of a culture of: ‘You worked a day you need to get paid,’ where I’d say we viewed it more as a public service,” he said.

Delves said he was also surprised to see the amount of expenses being filed by board members. Last year, expenses by board members increased by 27%.

Despite being BC’s largest regional health authority, Fraser Health board members collectively charged the lowest amount of expenses, with only two members filing for more than $600 in expenses. Delves said the only expenses when he was on the board was for mileage to and from board meetings. For the most part, the Fraser Health authority’s expenses look like that tradition may have continued, although they have risen modestly.

But next door, in the Vancouver Coastal Health Authority, board members there charged a combined $12,683 in expenses in 2023/24. The previous year, only $2,753 of expenses had been claimed and board chair Penny Ballem accounted for all but $51 of that.

The job

The work of board members largely goes unseen—chiefly because most decisions and substantive discussions occur in closed-door meetings.

And although day-to-day operations are handled by health authority executives, Delves said board members can play a useful role in delivering health care to their communities.

As an accountant and chair of the Fraser Health audit committee, Delves said he would have regular discussions with the health authority’s financial executives about budgeting. (The chair of each health authority’s audit committee receives an extra $5,750 retainer on top of their $12,940 retainer as an appointee. The retainers had been $5,000 and $7,500, respectively, during Delves time on the board.)

The board’s involvement in key decisions could be useful, Delves said, because of the power structures underlying health care in BC.

A health authority CEO reports to both the organization’s board of directors and the Ministry of Health. The health authority’s board, meanwhile, reports directly to the minister.

So if the CEO needed to convince the Ministry to take some action—or free up some funding—Delves said the board could use its reporting power to the Minister of Health to take the case directly to the person at the top of the decision-making structure.

“Sometimes, if our CEO would be trying to do something that is a little bolder, having our endorsement and for us to take that endorsement to the minister the same time she takes it to the ministry could help push things further along than they could otherwise,” he said.

In other words, the board—though itself playing an upper-middle-management role in the delivery of health care—could help a health authority CEO overcome inertia within BC’s massive health bureaucracy.

“It sometimes can be easier, or give them more sway with government, if the board can back them up.”

Health authority board members are selected in an opaque manner, with governments frequently selecting political allies to hold the positions.

Delves said he appreciated that the NDP had chosen to retain himself and a few holdovers from the previous BC Liberal-appointed board to retain some voices “from the other side.” And he said it makes sense that a government would want to choose ideological colleagues to hold the positions.

“Sometimes people say, ‘Oh, they’re aligned with that government.’ Well, I think that should be the case.” A board member opposed to what the minister of health wants to do is fundamentally unable to do the job of allowing the minister to exercise authority over how health authorities deliver care.

Delves, for his part, said he doesn’t know how he was chosen for the board in the first place. His family, certainly, had longstanding ties to the BC Liberal Party. (His mother, developer Diane Delves, was a long-time supporter of and donor to the party.) But Delves suggested his board appointment likely came because of his day job—and his location.

Boards are consciously appointed to have representatives from across the broader region served by the health authority, and Delves was appointed at a time when the health authority board needed both a member from Abbotsford and someone with a finance background to lead its audit committee. Delves said he suspects his name was recommended by someone at the firm he used to work at.

Delves said the regional representation of board members can be useful—although it can be overlooked by the broader public. The geographical diversity of board members encourages them to be advocates for their local facilities and bring a degree of local expertise to meetings.

Delves said he would often get calls from locals who hoped he could bring up issues they had encountered with the health care system.

“If there’s something you can’t solve through other means, oftentimes people reach out to the board member.”

Delves said a board member could then pass those issues along to the right person, or flag problems to management.

“Sometimes it’s something that should just be [addressed] in the ordinary course of business and you forward it along and there’s nothing you can do about it,” he said. “But sometimes people are raising real legitimate concerns of a system failure or a process breaking down and you flag it to management and stuff happens.”

Of course, members of the public have to know who their local health board representative is in the first place. Abbotsford’s current representative on the board is Archway Community Services’ Manpreet Grewal, but the only other current board member with their location easily identifiable on the Fraser Health website is Willie Charlie, a former Sts’ailes chief.

But in such a sprawling system, someone with the ear of administrators can make a difference. Even if sometimes the payoff is relatively minor.

“Just a silly example: I was at one of the care homes here in Abbotsford and they had no space because they had all these extra tables to store,” Delves said. “And later that afternoon I was at Abbotsford hospital and they had all this extra storage space, and it was literally just me saying ‘Hey guys, let’s move it from here to here.’

“But with health care being so complicated and often siloed, you really have breakdowns and sometimes it’s honestly as simple as someone in a senior position making a note about it.”