This week’s political intrigue, the suspension of Edmonton-Meadowlark MLA Raj Sherman and Stephen Duckett‘s cookie-tantrum, are overshadowing the larger challenges facing our health care system.
The plan proposed by Alberta Health Services top dogs late last week to deal with Emergency Room wait times is a version of a plan already initiated three years ago (known as “full capacity protocol” or “surge capacity” at some facilities).
It works like this: when the number of patients in the Emergency Room hits a magic number, patients are put on stretchers and pushed to wards in the hospital where they are placed in hallways or in rooms (in many cases with patients already admitted). It does not take a health economist or health care professional to understand that pushing patients away from the Emergency Room into hallways is not a solution to this problem. This “out of sight, out of mind” approach may decrease the number of patients physically waiting in the Emergency Room, but it does not do much to actually increase patient care. It also does not deal with the root causes of why Emergency Room wait times have increased in Alberta.
Anyone who has had the misfortune of having visited an Emergency Room will see that there is a serious under-staffing problem. In many hospitals, doctors, nurses, and other health professionals are being run off their feet trying to make up for a lack of proper staffing levels. If new beds are to be introduced, so must an appropriate number of new staffing positions. Patient care will only be improved if there are medical and nursing staff to accompany new beds.
The challenges facing Emergency Rooms go beyond just Emergency Rooms.
It is becoming increasingly difficult to find a family doctor in Alberta. This challenge and limited access to urgent care centres in many communities leaves Emergency Rooms as the only option for many Albertans. When fully operational, the new East Edmonton Health Centre could provide a good model of the kind of accessible family and urgent care that people are currently turning to the Emergency Rooms for.
The reality is that many of the problems faced by our health care system have been created by constant political restructuring of the administration of the system over the past 15 years.
As I wrote last week, stability is something that has been lacking in our public health care system since Ralph Klein became Premier in 1992. Since 1995, the administration of our system has been changed from around 200 hospital and local health boards before 1995 to seventeen, to nine in 2001, and then one centralized province-wide health authority in 2008.
As the health authorities were being restructured in the 1990s, over 10,000 health care staff were laid off or had their jobs downgraded, which has led to much of the staffing issues Albertans are witnessing today.
Current Minister Gene Zwozdesky has tried to put a kinder face on the Health & Wellness portfolio, but the last major restructuring, the creation of AHS took place under the guidance of Minister Ron Liepert in 2008.
In what some political watchers believed to be an extension of a public battle between Calgary Health Region CEO Jack Davis and the provincial government, Minister Liepert dissolved the nine remaining regional health boards and centralized them under AHS (Mr. Davis received a $4 million retirement package when his position was eliminated). Minister Liepert, who was recently criticized by his former parliamentary assistant Dr. Sherman, was not known for his diplomatic skills while serving as Health Minister:
Created only months after the March 2008 provincial election, there was no mention of intentions to dissolve the regional health authorities anywhere in the PC Party election platform. The largest overhaul of Alberta’s health care system was not made in consultation with Albertans, but in closed-door meetings.
Accentuate the positive, eliminate the negative
Couched in nice-sounding words like “European-model”, groups like the Wildrose Alliance argue that the solution is to introduce more private-for-profit involvement in the health care system.
As Albertans saw with the bankruptcy of the Health Resource Centre in Calgary, the flagship for the private health care industry in Canada, introducing more private-for-profit health care is not a viable alternative. I do not believe that this is a solution to improving our health care system. The solution is to fully support and provide stability to a public system that is accessible and accountable to the general public.
While I am disappointed that the Wildrose has taken a negative tone when talking about health care, it has helped remind many Albertans about why they support a public health care system and why it is important to our society.
“Alberta Health Act”
Eclipsed by the past month of health care news is Bill 17: the Alberta Health Act, which is up for third reading this week. This Act is vacuous on details, but as enabling legislation it will allow for more decisions about our health care laws to be made in closed-door cabinet meetings, rather than in the public and open debate on the floor of the Assembly.
As we have learned from the past month and the Alberta Health Services experience, our health care system needs decision makers who are not driven by private agendas behind closed doors, it need openness, transparency, and stability. It needs some TLC.
18 replies on “public health care is not broken, it just needs some tender loving care.”
Clearly we need to privatize delivery of services and funding of services. This is the only way to improve and this is why I support the WAP.
Matthew, the WAP doesn’t want private healthcare. Ms. Smith has stated that repeatedly.
Didn’t Danielle Smith the Calgary Herald writer say that Ron Liepert was doing a good job? Now that she’s a politicians she doesn’t? Flip flop. Flip flop.
Great post Dave.
We need more voices like yours out there. Keep up the good work!
What we are now seeing in this debate is an outbreak of “shoot the messenger” politics. The “cookie” incident may have cast Dr. Duckett in a bad light, but he didn’t hire himself. the CEO of AHS was hired by Ron Leipert’s hand-picked Board to do a job, and he seems to be taking that job seriously. The real accountability for the state of our health care system and of AHS should be laid at the feet of former minister Leipert, who created AHS, and those of the AHS Board themselves. Current Minister Zwozdeski is in the unenviable position of being assigned to repair the china in the shop after the bull has walked through it; he has been given a large bucket of glue to work with, but the china will still be broken and unsaleable due to all the obvious cracks that will remain. (I hope I haven’t strained this metaphor too much lol).
Dr. Sherman’s suspension from the Tory caucus is taken the same page in the PC playbook as Guy Boutilier’s; however, his credibility on this file is likely greater than that of his erstwhile boss, Special Ed.
IMHO: The root of it all is that too many acute care beds are being taken up by people well enough to leave but have no where else to go.
Fix that and ALL the ER problems go away.
I recently spoke to some current and retired ER doctors and they indicated that a significant part of the problem with wait times in ERs is the issue of people using ER for inappropriate reasons. Going to Emerg everytime you have the sniffles or a sore knee is not a good use of resources. A significant number of people go to ER because they don’t want to wait in line at the clinic or make a doctor’s appt. People need to stop wasting resources and look after their own health. And they need to reserve the health care system for times when they really need it.
Good blog. You have identified exactly what is going on. Duckett was hired to turn healthcare upside down. Members of the Superboard have publicly stated they are going to “bleed” healthcare in AB. Duckett is doing what he was hired to do. AHS expects Albertans to accept whatever passes for healthcare. There are AHD posters througout the Foothills stating “Private room or hallway – your health is important to us” And before long patients start to accept having a bed in the hallway! This new plan for ER is already in place and results in patients in hallways and being placed on wards that are inappropriate for their health needs. Time to send AHS, Duckett and the PC govt on their way.
I’m interested in this “European Model” they’re talking about (I assume they mean the Bismark model where universality is achieved by a mix of state and employer funding). In Canada, about 70% of our HC spending is public. In Germany and Austria that number is around 76%. Belgium is at 73%, and France is at 78%. Out of those countries, only Switzerland has more private sector involvement than we do – and their 2006 per capita expenditures were greater than ours: $4,150 vs $3,960. The UK, which has the same Beveridge Model as us (insurance funded through tax $) is 82% public, and spends only $2,884 per capita. Increased privatization is associated with increased administrative costs, and is in no way more efficient than a predominantly public system.
If we’re looking at “fixes” for wait times and the other “ills” of our system, lets look at the # of doctors we have. Most of Western Europe has over 30 docs/10,000 population. We have 19. Even the US beats us (21). If we want to improve the system, we need to train (and recruit) more doctors.
I was recently living in the US and had the lovely experience of “for profit” health care.
This kind of medicine allows for anything you want, whether it is good for you or not.
There are cashiers at the exits and you don’t leave till you’ve paid or make arrangements to pay.
I was offered a colonoscopy at the competitive cost of $1500 USD. (Luckily it included the cost of blood work, anasthetic, nursing, post op and so on). Blood test alone (which you have to pay for down there because NO ONE does anything for free) are at least $40.
A visit to a walk in clinic is $49 per issue. So it’s like this: if you have a cold, that’s $49 (and this is one of the least expensive clinics I found), and if you want them to look at your ingrown toenail, that’s another $49 OR you can pay $219 and that covers a 1/2 hour of your doctor’s time to bring up as many illnesses as you can in that 1/2 hour.
Please Canadian people. Thank the stars for what we have. Stop abusing the privilege and only go when necessary — this will shorten the waitlists. This will also allow for any health care providers who want to go to the US to make millions to leave our system.
I have never been so proud to be Canadian as the day I was sitting in the doctor’s office and watched as people were turned away because they had no insurance. And as others who were visibly sick opened their wallets to pay for the visit with money they could not afford to spend.
Oh, and the colonoscopy if I had chosen to take them up on it?? It was a 5 week wait… don’t let them BS us about their wonderful system. It stinks.
Our health care system is definitely sick with a terminal illness, Progressive Conservative fasciitis. This disease is fatal if not dealt with. It eats away at the democratic ability of a society to have it’s wishes obeyed.
It’s not a simple matter of ER fixes. Systemic issues include the over-medicalization of seniors; lack of home care support for seniors/disabled; unavailability of family doctors; lack of a team approach; lack of support for prevention. Even making sure people have knowledge about nutrition and the ability to cook would improve health outcomes!
The whole system needs a relook from the bottom up – but it has nothing to do with who pays. We need to completely examine what we’re doing and why.
Stelmach is not a leader. He should have kicked Sherman out of caucus, not suspended him.
Excellent article by Physicians for a National Health Program, a group of doctors in the US.
There are excellent examples comparing Canadian and US systems and administration of health care.
[…] of Alberta’s health services, removing Dr. Duckett from his position will not solve the challenges facing the system. Although Dr. Duckett was not even close to universally loved in the health care system, he did not […]
[…] will be for him to actually deliver real improvements to a health care system that has been seen constant political interference and restructuring over the past twenty […]
[…] political interference and constant restructuring by PC Governments. As I have written before, our public health care system is not broken, it just needs some stability – and tender loving […]
I think we need an online survey, forum, blog that is outside of government control as many people are afraid of consequences to the delivery of services for themselves or relatives and they may also be afraid of consequences to their own careers or the careers of their relatives. My sister has a son who has missed 4 months of school waiting for tests and specialists. This is unacceptable. I have heard many other stories from many others. These stories are not being told because of fears people have regarding the consequences of voicing dissatisfaction with delivery of medical services. This particular doctor said, “If you are not satisfied with me as a family doctor, you can seek help from someone else.” We all know how hard it is to get a family doctor let alone a good one and we also do not want to get bumped to the end of the line. Doctors also document and these records are shared. What kind of service or where would one end up in the line if one complained. Many people consider the consequences that may follow if they were to complain and want their identity concealed for these reasons. When I looked around, the government tells people how and where they should complain – Alberta Health Services. We will never get the true stories of the people of Alberta on their concerns with the delivery of services communicating through a government department that delivers the most important service that will truly affect their life or the lives of their loved ones.
I am an educator and my wife is a nurse. I cannot identify myself as I am afraid of the consequences that this may have on myself, my wife, and the delivery of health services for my nephew.