The Alberta government plans to completely revamp how health care is delivered by dismantling its provincial health authority and minimizing its role to that of a hospital administrator, while creating separate organizations to oversee acute, primary, continuing and mental health and addictions care.
Details of the massive overhaul, which will cost tens of millions of dollars and take months to implement, are contained in a document released by the Official Opposition New Democratic Party on Tuesday morning. The document says Alberta Health Services (AHS) will be reorganized to a “single focus of acute care service delivery.”
Later on Tuesday, during Question Period in the legislature, NDP Leader Rachel Notley, asked Premier Danielle Smith if she was committed to the plan outlined in the leaked document.
“One hundred per cent,” the Premier replied. The government, she said, tried to improve the health care system under the existing framework with some success, “but we need to do so much more if we are going to be able make greater progress.”
Last fall, Ms. Smith garnered much support as she campaigned to lead the United Conservative Party by vowing to break apart the single health authority. At the time, she railed against AHS for having, in her view, bloated management and the inability to develop adequate intensive care capacity. She also blamed the authority for the province’s decision to impose COVID-19 pandemic restrictions, which she opposed.
After her win, Ms. Smith moved swiftly to replace the 12-person AHS board with a single administrator and has been making piecemeal changes ever since. In August, it was clear a larger plan was coming, after AHS received a directive from the province to consolidate all mental health and addiction services under the provincial ministry to align programs with the government’s recovery-oriented approach.
The leaked document says the health authority was delivering mental health and addictions services “at times, counter to government direction.”
Ms. Notley characterized the coming changes as a “demolition plan” that sets the stage for privatization of the health care system. The document itself indicates AHS’s new board will “review the potential to sell AHS continuing care subsidiaries – Capital Care Group and Carewest.”
The new board, according to the document, will also have “one or two members with experience on mergers and acquisitions of a large organizational reform.” Financial experts of that kind are frequently involved in breaking up or selling companies or assets.
Ms. Smith, however, said the NDP was misconstruing the overhaul.
“Our reforms are about getting more dollars down to the front line, down to individual hospitals, so more decision-making can be made in the communities where the care is provided,” she said in the legislature. “It’s about reducing the layers of management, reducing the layers of bureaucracy.”
The document does not explicitly indicate whether those reductions will mean layoffs, although details surrounding severance indicate some job losses may be in the works.
Ms. Notley noted that Ms. Smith had previously mused about privatizing parts of the health care system but that, during the election campaign, the Premier argued those ideas were a thing of the past. Ms. Smith, in turn, said AHS will continue to deliver hospital services and that the government supports all of its service providers, such as chartered surgical facilities and Covenant Health, which runs the province’s parallel Catholic health system.
“We just think this is going to deliver better health care for patients, and give more options for health care workers, which I think is going to improve working conditions,” Ms. Smith said.
The Premier dismissed accusations that the plan, which calls for the establishment of 12 regional advisory councils and an Indigenous advisory council, will create a system thick with bureaucracy. She noted regional councils already exist.
“They’re going to be playing an enhanced advisory role in ensuring that we’re able to refocus each and every facility in each community,” Ms. Smith said. “So it’s delivering the best possible care, not only for patients but also the best possible work environment for health care professionals.”
During Question Period, Health Minister Adriana LaGrange also denied that this new structure will lead to privatization.
“There is absolutely no plan to privatize health care,” she said, noting the government’s “real plan” will be released Wednesday.
But the document provides a blueprint for what’s to come. It states that challenges in health care delivery are linked, in the opinion of the government, to a “lack of focused leadership and governance in AHS” and a “complex, uncoordinated health system.” The overarching goal is that the health ministry will take on control of health care planning, capital planning and contracting, which will be brought forward with legislation.
According to the document, the government expects to spend $85-million on legal, consulting, system integration, potential severances and other supports to transition over the next 18 months. However, it added that “potential future costs to establish the new organizations is to be determined.” Those costs would include capital planning, administration and other continuing operational expenses.
The document notes that Alberta spent $80-million in 2008-2009 to consolidate its regional health authorities into AHS. The total included $65-million for severance and $15-million for legal, consulting, system integration and salaries.
Risks outlined in the document include the “potential to fragment care delivery, risk of service disruption/failure and delays in implementation.” It also says that there could be challenges with public perception.
What the government calls an “integration council” will be created to ensure the new organizations won’t create “unintentional silos.” And other subcommittees and council structures will be established, the document says, to ensure the proper integration of governance and operations.
About 250,000 health care workers will be impacted by the changes, according to the document.