The neutering of Alberta Health Services should come as no surprise. Smith is focused on appeasing the far-right arm of her party
The neutering of Alberta Health Services (AHS) should come as little surprise to anyone who has been closely watching Danielle Smith’s determined campaign to convert the United Conservative Party into a de facto instrument for the Take Back Alberta radical right crowd.
The fate of the current administrators at AHS was effectively sealed when, backed by solid evidence, they refused to kowtow to Smith’s demands to ease up on COVID masking, gathering and vaccine mandate rules during the pandemic.
When Smith became premier-designate and then won the ensuing election, she had a score to settle. And, sure enough, shortly after she received her mandate, she fired the AHS board and replaced it with a single administrator.
Smith also had a promise to keep with her core constituency: to do something meaningful about the province’s chronically underperforming health authority.
Let’s give the government some credit: Most Albertans agree our faltering healthcare system needs some invasive surgery. The shortcomings are well-recorded. Albertans spend more per capita on healthcare than any other province and yet do not experience the best outcomes. Wait times at emergency rooms are too long, and family doctors are too hard to find. For two-and-a-half decades, successive conservative governments have failed to solve these intractable problems.
And so, here we are: once again blowing up the structure, as Alberta has done on no less than three occasions in the recent past. In 1994, there were 128 hospital boards, 25 public health boards and 40 long-term care boards. The conservative government of the day consolidated them into 17 regional health authorities. Nearly a decade later, they were cut in half and then, in 2008, collapsed into one entity: the AHS single health authority.
Health Minister Adriana LaGrange plans to divide AHS into four organizations: primary care, acute care, continuing care, and mental health and addictions, which will be connected by what the government calls an integration council. Smith has said some AHS bureaucrats will be moved to the Alberta Health Ministry as part of the reorganization, but, in her view, the AHS bureaucracy has become bloated, which suggests more than a few of those apparatchiks will also get their walking papers.
I have three things to say about all this government-mandated chaos.
The first is rooted in personal experience. No one in my immediate family has ever been denied healthcare when they needed it. While Alberta may be very slow at addressing non-urgent health issues, it has proven to be first-rate in addressing acute care. This is a quality in our healthcare we absolutely cannot afford to lose. Yet, radical restructuring raises the risk that we will throw out the baby with the bathwater.
Secondly, restructuring is a high-risk enterprise that holds the risk of making matters worse. Medical professionals who have lived through previous wholesale changes point out that the energy and resources required to implement extensive new structures take away from the ability to provide frontline services. If there are any benefits to be realized from the new structure – a debatable prospect at best – it will take years to see them.
That brings me to my third point. Blowing up a healthcare system for political motives, as this appears to be, is not done with the public interest in mind. It is done to consolidate power.
Where did Smith’s ideas for healthcare reform come from? Some come from the Mazankowski Report, entitled A framework for reform: report of the Premier’s Advisory Council on Health, released on Jan. 8, 2002. It seems like a lifetime ago now, but at the time, Smith and I sat on the Calgary Herald’s editorial board and agreed this document was packed with great ideas to turn around healthcare in not only Alberta but also the rest of the country.
But it’s worth noting none of the 43 recommendations in that report suggested the type of restructuring Alberta’s government is about to carry out. Instead, it recommended “unbundling the system and devolving more responsibility to regional health authorities” to encourage competition. That recommendation was ignored by the conservative government of the day, too. Just six years after the report was tabled, the conservative government defied its recommendation and created the AHS monolith.
Unbundling to encourage competition is also not what Smith’s current plan aims to do. Instead, it pays lip service to regional interests by proposing 12 regional advisory councils and an Indigenous advisory council.
How would Maz feel about Smith’s approach to healthcare reform? We’ll never know because he died in October 2020, but I suspect he would have mixed feelings.
I hate big fat bureaucracies as much as anyone. Accountability is vital in a healthcare system that, like every other one in Canada, is faced with a frightening escalation in costs.
The debate is really over the remedy. Restructuring feels very much like shifting deck chairs on the Titanic. It is effectively a way of appearing to be taking dramatic action while failing to make the genuinely tough decisions.
The tough decisions involve dealing with the core issues that are driving up costs while undermining our system’s effectiveness, such as:
- penny-wise-pound-foolish staffing decisions in which chronic understaffing forces the use of costlier temporary staff
- a culture of waste that involves the use of criminally expensive supplies and
- a reluctance to fully equip alternative facilities so the public doesn’t feel compelled to go to the ER for relatively minor issues.
Insiders have many more such tales to tell.
Fixing those issues doesn’t require a structural challenge; it requires fearless leadership. It causes one to wonder whether Stephen Duckett, the abrasive – nay, tactless – former CEO of AHS who was fired in 2017, was really so unsuited for the job. Facing down the AHS machine, after all, requires the thick skin of an elephant.
No matter. It’s too late for all that now. The restructuring train has left the station.
Will it find light at the end of the tunnel? I don’t think so. Check back in about five years. I predict I will reluctantly have to tell you, “I told you so.”
Doug Firby is an award-winning editorial writer with over four decades of experience working for newspapers, magazines and online publications in Ontario and western Canada. Previously, he served as Editorial Page Editor at the Calgary Herald.
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