EDMONTON — Premier Danielle Smith says Alberta's provincewide health provider has lost its way, grown too big and become unaccountable, and that a massive reorganization can no longer wait.
Smith announced Wednesday sweeping changes to dismantle Alberta Health Services, reducing it to one of four new service delivery organizations, all reporting directly to Health Minister Adriana LaGrange.
"This isn't change for the sake of change," Smith said Wednesday at a news conference near the legislature.
"The current Alberta health-care system is one that has forgotten who should be at the centre of its existence — patients and the health-care experts who look after them."
She said some improvements have been made on finding family doctors and reducing wait times for care and surgeries, but added it's not enough and her government needs the legislative tools to make changes.
"The current health system in our province limits government's ability to provide systemwide oversight," she said.
"It also limits our ability to set priorities and require accountability for meeting them."
The transformation is to take up to two years, and while Smith says front-line health jobs will be protected, "you're going to see a process of streamlining in the management layers.
Alberta Health Services, or AHS, was created 15 years ago, amalgamating disparate health regions into one superboard tasked with centralizing decision-making, patient care and procurement.
Its annual operating budget is about $17 billion. It has 112,000 direct employees with thousands more working in labs, as physicians, and in community care facilities.
Under the proposed new system, Alberta will still have an integrated provincewide health system but with its fundamental structure and decision-making drastically altered.
AHS currently acts as an arm's-length body, with its own governing board, making decisions to implement policies set by LaGrange's Health Ministry.
Under the changes, all decisions will be squarely in the purview of LaGrange and the new oversight body she will chair, named the Integration Council.
AHS is currently subdivided into five geographic regions. The new model erases the geographic regions and creates four new subgroups organized not by geography, but by service delivery.
There will be a new acute care organization, responsible for running hospitals and, for the time being, lab and ambulance services.
AHS will become a service delivery provider answering to that organization.
Alongside the new acute care organization would be a primary care organization, with a mandate to find a family doctor for every Albertan.
There would be a continuing-care organization to oversee and run those facilities.
The fourth agency, a mental health and addiction organization, would work directly with the Mental Health and Addiction Ministry to further the broader goal of a recovery-oriented system.
All groups report to LaGrange or, in the case of the fourth group, to Mental Health and Addiction Minister Dan Williams.
Input and ideas are to be sought from 12 regional committees and one Indigenous advisory panel.
Smith said the rationale for the new model is to focus on the ultimate goal of reducing long wait times and overcrowding in emergency rooms.
Smith said ensuring Albertans get better and faster access to community care, to a family doctor, and to mental health and addiction treatment means they won't have to resort to the emergency room to get help.
"All roads lead to the emergency room," she said.
The details of the overhaul were leaked earlier this week by the Opposition NDP.
NDP Leader Rachel Notley said the reorganization represents full politicization of health care concentrated in Smith's office.
She said it will bring chaos, because the four new groups will inevitably intersect and overlap.
Notley said the move also opens the door to further health privatization. The leaked cabinet briefing notes said the United Conservative Party government will look at selling off AHS continuing-care subsidiaries CapitalCare Group and Carewest.
During question period Wednesday, Smith said that information is out of date and they have since received advice that CapitalCare and Carewest should remain with the province.
“Every decision that we make is going to be under the auspices of a publicly funded health-care system,” Smith said.
“There'll be no privatizing.”
Health policy analyst Lorian Hardcastle said it's not clear how transforming the system into four service-delivery areas improves patient care.
Hardcastle said the whole point of having AHS was so patients could move smoothly between primary care to acute care to continuing care.
"This system that is being implemented will not facilitate this," said Hardcastle, an assistant professor at the University of Calgary specializing in health law and policy.
"What it's going to do is put the services back into silos, and it's not clear how this won't impede that smooth facilitation of patients and how we won't see patients fall through the cracks.
"It almost seems like change purely for the sake of change."
Dr. Paul Parks, president of the Alberta Medical Association, said, "While the details and impacts are unclear, what is clear is that physician engagement in each of these new organizations will be critical.
"The AMA will advocate for our voice at the decision-making tables."
The Alberta Union of Provincial Employees called the plan short-sighted, disruptive and damaging.
"Nothing in these reforms addresses the short-staffing crisis and it might even drive more workers away from the front lines and hinder attracting new workers," said AUPE president Guy Smith.
"The government's plan will only take things from bad to worse."
Heather Smith, president of the United Nurses of Alberta, said the changes fail to address urgent problems like wait-lists, surgery delays and ambulance bottlenecks.
"We have severe deficits in terms of people and capacity in our health-care system," she said, adding none of that was because of the structure of AHS.
"They've made the wrong diagnosis and absolutely prescribed the wrong treatment."
The premier's announcement ends simmering tensions between the province and AHS that exploded in full view during the COVID-19 pandemic.
Former premier Jason Kenney said AHS provided faulty bed numbers that hamstrung his cabinet during the crisis. Danielle Smith sharply criticized AHS for not providing adequate beds during COVID-19, as well as for mask and gathering rules she said exacerbated social woes and led to staff shortages at AHS.
In the last two years, the UCP government has replaced AHS president Dr. Verna Yiu, replaced chief medical officer of health Dr. Deena Hinshaw and fired the AHS board.
LaGrange announced Wednesday that a new AHS board is to be chaired by former Alberta cabinet minister Lyle Oberg. It is tasked with winding down AHS operations and transitioning to its new mandate.
This report by The Canadian Press was first published Nov. 8, 2023.
— With files from Colette Derworiz in Calgary
Dean Bennett, The Canadian Press
David Staples: Big plans mean zilch if Danielle Smith fails to deliver on promise of better health care
Opinion by David Staples, Edmonton Journal • 1d
Alberta Premier Danielle Smith outlines how the province plans to refocus the health care system during a news conference in Edmonton on Wednesday, Nov. 8, 2023.
© Provided by Edmonton Journal
Premier Danielle Smith can have all the big plans in the world but they will mean zilch if she fails to deliver on the promise of better health care.
At the news conference announcing major changes in the operation of Alberta’s health care system, Smith and Health Minister Adriana LaGrange did all they could to convince anxious Albertans worried about a hidden UCP agenda of privatization, job cuts and budget cuts and user pay to swallow a gargantuan chill pill.
“I want to be clear about what this plan isn’t and what it is not,” said Smith. “I made a public health care guarantee to Albertans that means no one will ever pay out of pocket for a visit to a doctor or for hospital services, and that is not changing. These reforms have nothing to do with privatization. They are also not about cuts. Alberta’s government will continue to grow the health care workforce.”
But what about the twin elephants in the room of any serious health care reform — rising costs and poor preventive medicine?
Our individual health and the system itself are threatened by ballooning costs of ever more numerous and expensive treatments and also by our lack of activity and diet of unhealthy processed foods, which can lead us to get major illnesses such as cancer, diabetes, stroke and heart attacks earlier in life.
Smith’s plan is focused first on the obvious crisis, how to lessen the tidal wave of patients overwhelming emergency rooms. But one key health care leader, Dr. Susan Prendergast, who has a Ph.D. in nursing and is president of the Nurse Practitioners Association of Alberta, said that in solving the emergency room crisis concerns over our collective deteriorating health will also be addressed.
Close to one million Albertans don’t have a primary care provider, which forces people to flood into emergency rooms, Prendergast told me in an interview.
But Prendergast said Smith’s government is bringing in a major fix, permitting nurse practitioners like her to open clinics on their own and independently provide primary care. A nurse practitioner is a registered nurse with years of field experience and a master’s degree in primary care who can essentially take on the role of family doctor.
There are 853 nurse practitioners registered in the province but they’ve only been allowed to be physician’s aids up until now, Prendergast said. Alberta is the last province to allow nurse practitioners to do what family doctors do.
“There’s an entire workforce that hasn’t been utilized up until now,” Prendergast said, adding the plan is to have 300 to 500 nurse practitioner clinics open in three years, each practitioner serving about 1,000 patients.
Prendergast praised Smith and LaGrange with pushing ahead the nurse practitioner program after years of political inaction. Prendergast said 96 per cent of nurse practitioners are women, and pointedly noted it helped having two women in power to approve the change. “It was a priority for (Smith) and she made sure we are where we are.”
Nurse practitioners are looking for equal pay for doing equal work of family physicians, but there will be one crucial difference. Nurse practitioners won’t be paid on the fee-for-service model, but will get a salary. This will allow them to spend more time with each patient and dig in and make changes to prevent poor health down the road, Prendergast said.
“The system of fee-for-service doesn’t allow primary caregivers to do that. It’s short, brief appointments. When you provide a funding model to a primary care provider that allows for flexibility in the time spent with the patient, they spend the time on lifestyle management. That is one thing nurse practitioners do extremely well. Every single appointment we’re talking about diet, exercise, smoking, alcohol use, drug use.”
It’s staggering when you deal with patients who have never been asked about their sleep patterns or how much and what kind of exercise they do. “They’ve been told they have high cholesterol but they’re given no support around addressing it, except a medication. And that’s unacceptable.”
The current model is also expensive for taxpayers as patients come in with multiple serious conditions. “It’s great to say that people should stay home (for home care) but the reality is they’re too sick to stay home. We’ve got to take a more preventive approach, otherwise nothing will improve.”
Again, the only thing that matters with Smith’s plan is better results. We shall see.
But the nurse practitioner part of the overall plan looks like it will work, helping us all get better so we delay getting woefully sick. It represents a crucial step in the right direction.
Story by Paige Parsons • CBC
Alberta's ethics commissioner will suspend investigations into provincial politicians during future election periods if proposed legislation becomes law.
A bill tabled by Justice Minister Mickey Amery Thursday proposes updating several pieces of justice legislation, including a change that would suspend investigations by the ethics commissioner during the period leading up to a general election.
"Voters are entitled to proceed during an election without undue influence. These amendments help eliminate some of those influences," Amery said.
Amery said he doesn't believe the change will result in important information being kept back from voters because he says there are other mechanisms to keep governments accountable to the public.
The minister said the proposed change was prompted by a recommendation from Alberta ethics commissioner Marguerite Trussler, who pointed to similar Ontario legislation that sees investigations paused from when the writs are issued for a general election until the polls close and the votes are counted.
Alberta Ethics Commissioner Marguerite Trussler made a reccomendation that ethics investigations be suspended during election periods. (Alberta Legislature)© Provided by cbc.ca
Trussler recommended that the legislative assembly consider the change in her May 2023 report in which she found that Premier Danielle Smith had contravened the Conflicts of Interest Act during interactions with the minister of justice in relation to criminal charges faced by Calgary street preacher Artur Pawlowski.
"Not having such a provision puts the Ethics Commissioner and the Speaker of the Legislative Assembly in an extremely difficult position with respect to the timing and release of any report," Trussler wrote.
Her report was released on May 18, just 11 days before Alberta held its general election when Smith and the United Conservative Party went on to recapture a majority government.
Trussler's findings followed an investigation that began on March 31 after a member of the public asked if there were ongoing investigations into whether Smith pressured cabinet members or employees of the government in relation to the Coutts border blockade.
The complaint followed a January CBC news story about the premier's office contacting Crown prosecutors by email about COVID-related prosecutions.
Trussler wrote that she found no evidence of emails, and CBC has since updated its reporting.
'Doesn't add up'
The proposal to suspend ethics investigations during elections is puzzling, says University of British Columbia political scientist Max Cameron.
"It looks like the premier has got herself into trouble around conflict of interest and the solution is, well, we're not going to have conflict of interest investigations during an election," Cameron said.
"It just doesn't sort of seem to add up."
Cameron said he also thinks it's odd that the commissioner herself made the recommendation at the end of a report where an investigation during an election period ended up finding that a conflict of interest occurred.
He said that while it's important for ethics commissioners to be politically sensitive, they ought to be able to use discretion about whether or not it makes sense to proceed with an investigation or to release a report.
"You know elections are short, right? If you don't want to release a report in the middle of an election, you hold off on doing that. I just don't get that. It just seems, to me, very strange," Cameron said.
Earlier this week, a legislative committee voted to replace both Trussler and the province's chief electoral officer, Glen Resler. The standing committee on legislative officers voted to establish selection committees to replace each position.
Both non-partisan positions have contracts that expire in May 2024, and Amery said Thursday that Trussler is welcome to apply for the job again.
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