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.)