When discussing public health care in Alberta, there is a lot to be said about the lack of stability in the system over the past twenty years. I have found that much of the recent media coverage around Alberta Health Services and emergency room wait times has neglected to mention the long-term effects of the lack of stability as some of the root causes of these problems.
For example, by my count, over the past 16 years, there have been 11 different Deputy Ministers of Health, some permanent and some acting. When it comes to staffing, the health care system is still recovering from the cuts in the 1990s that eliminated or downgraded over 10,000 employees. When it comes to the administration of local health authorities, there has been a constant state of provincial government initiated restructuring over the past fifteen years:
1995: Around 200 hospital boards, public health units, long term care boards and facilities were joined together under 17 Regional Health Authorities (RHA) filled with appointed board members.
2001: The 17 RHA were merged into nine. This is the first year that a third of the RHA boards were elected, which took place in conjunction with the municipal elections.
2003: The 1/3 RHA boards members were terminated and replaced with completely appointed board members.
2008: The 9 remaining RHAs were dissolved and the Alberta Health Services superboard was appointed.
You would be hard pressed to find any Albertan who would characterize AHS as perfect, but considering all constant overhauls that have been happening in our health care system, maybe its time for some stability? In my mind, a return to regional control would be ideal, but it would need to be gradual and not as recklessly hasty as the merger that created AHS.
Do not to confuse stability with political control.
In the Alberta Legislature this week, MLAs are debating a new piece of legislation, Bill 17: The Alberta Health Act. Bill 17 is filled with vague, yet nice-sounding language, like the establishment of a Health Charter and the appointment of a Health Advocate, but what does this really mean?
A quick read of the Alberta Health Act will show that while a Health Charter may sound impressive, it is not the kind of “charter” that most Albertans would expect it to be. Rather than being a legally-binding document, it will be open to changes through Order-in-Council (or a vote at a closed-door cabinet meeting). The Health Advocate will not be an independent officer of the Assembly, but an employee of the Government of Alberta who will report to the Minister of Health & Wellness.
As a piece of “enabling legislation” the Alberta Health Act would move a number of other decison-making powers behind closed doors, including allowing the Minister of Health & Wellness to create regulations “respecting the roles and responsibilities of (regional health authorities, provincial health boards and professional colleges)” and “respecting the designation of other persons as health providers.” Under current legislation, these changes would need to be made through legislation and public debate. Not so under the Alberta Health Act.
The changes proposed in this legislation were apparently the result of a months long province-wide consultation led by Edmonton-Rutherford PC MLA Fred Horne. I am not sure who Mr. Horne consulted, but I do not know many Albertans who would list a non-binding Health Charter and more authority to cabinet ministers as their priorities for health care.
(Jonathan Teghtmeyer has written an excellent analysis about why Albertans should be concerned about the changes in the Alberta Health Act.)
11 replies on “stability and political control in our health care system & the alberta health act.”
Returning to regional control would be the worst thing we could do for this system. I remember when Jack Davis was making $1 million to run the Calgary region. Moving back to dozens of regional authorities would just hire more paperpushers and less money would go to primary care.
I don’t like Steven Duckett either, but eliminating bureacracy and moving to one board was definitely a step forward.
The one board system has been a failure and has eaten up more money with bonuses for do nothings than the bureacrats you mention. Those people are still in place but with another (the superboard) layer of management on top.
The one board system is a good idea that’s saved a lot of money. The amount of Vice Presidents have been reduced by more than 1/2, so Kevin S should check his stats.
What problems there were with the previous RHA system were easily solvable without throwing the baby out with the bath water; they only required political courage on the part of the Minister to take decisive action. For example, the Jack Davis issue: yes, he was being paid to much as CEO of the Calgary Health Region. So, the Minister should have just gone to the CHR board & told them that, and told them to find a way to fix it. Procurement? The Government could have instructed the existing health regions & boards to merge their purchasing and procurement systems and introduce economies of scale. Recruitment? Same thing. Bureaucracy? Nobody who works for AHS, except for a few senior executives, would say that the problem of a huge bureaucracy and glacially slow decision making has been resolved; indeed, most would say that it has been made worse by the centralization of many internal processes.
Yes, we need stability; however, stability that preserves a dysfunctional system isn’t all that helpful.
Moving to one board gives exactly that: stability. We don’t need board after board after board with different visions – and million dollar salaries of its CEO’s. Going to AHS from the 9 regions was a great first step.
Well put Dave. Stability including strong consistent (good) leadership which helps to break down numerous silos would be a great start. Better integrated and widely used health tracking systems (we are one of the worst jurisdictions in the world for this) is also needed. This could help set appropriate system outcomes which are clear and transparent and regularily evaluated, which may actually assist to improve the system rather than just react to the latest crises (typically by tossing $$)
Moving to one board was the best decision to control costs, and it’s worked. No paying for overpaid paperpushers like Jack Davis. This is the one good thing Liepert ever did: cutting bureaucrats and moving to one board.
[…] I wrote last week, stability is something that has been lacking in our public health care system since Ralph Klein […]
Thanks so much for the mention. I just realised it was here. You are doing some great commentary on this as well. See you at the Rally!
[…] issues that are creating the problems in the health care system. With this government’s habit of constantly tinkering and re-announcing projects and plans, Albertans should not be blamed for being skeptical about politically convenient renouncements and […]
[…] rally speakers piled on the governing PCs, who despite nearly forty years in office appear incapable of providing stability within the healthcare system. Those speakers included David Eggen from the Friends of Medicare, […]