Danielle Smith to focus on immediately overhauling Alberta’s health system

Policy experts and former officials with Alberta’s health system are cautioning against Premier Danielle Smith’s plans to overhaul the structure of the province’s single health authority, saying it won’t address pressing issues such as staffing shortages and wait times for ambulances and hospital care.

Ms. Smith has committed to launch a review to examine how to increase hospital bed capacity, with a report expected in 30 days. Within 90 days, she expects recommendations from the same audit team on how to cut Alberta Health Services bureaucracy and decentralize control of health care delivery to what she has described as local decision makers.

The Premier has also pledged to hire a new chief executive officer and replace the entire AHS board with an interim health commissioner that reports directly to her and the health minister. Rebecca Polak, Ms. Smith’s press secretary, said this will allow for rapid decision making.

For months, Ms. Smith has criticized how AHS handled the COVID-19 pandemic, blaming the health authority for the province’s decision to impose restrictions such as business shutdowns and vaccine mandates. She has accused the organization of failing to develop adequate intensive-care capacity, and said the agency’s COVID-19 vaccine mandate for staff bled the organization of needed workers and prevented recruitment. In July, she said AHS was either “completely incompetent” or had “actively sabotaged” the government.

Ms. Polak declined to provide further specifics of the Premier’s plan. “There has been an incredible disconnect between front-line health care workers, especially doctors and nurses, and the top levels of AHS,” she said in a statement. “The Premier is focused on continuing to hear from the front line on what works well now and what needs to change.”

Health Minister Jason Copping, who will remain in the role after a cabinet shuffle on Monday, was not available to comment.

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Increasing ICU capacity is a worthwhile goal, said Myles Leslie, associate director of research at the School of Public Policy at the University of Calgary, but it needs to be realistic, and take into consideration how many new beds are needed and how they’ll be managed.

“It costs to build it in the first place and then what if it just sits there empty?” he said, arguing that investing in primary care to prevent illnesses that require emergency treatment would make more sense.

As of Thursday, the province’s ICU’s were 83 per cent full. There are 223 adult beds in the province, 50 of which were added this year through government funding.

But it’s the Premier’s big picture ideas for health reform that has Dr. Leslie most concerned.

He said scrapping the 12-person AHS board, which has little power in daily decision-making, will concentrate authority in Ms. Smith. This, he said runs counter to her argument that decisions should be returned to a local level, and blurs the idea that AHS is an arms-length entity from the government.

An Ernst & Young review of AHS, produced at the direction of former premier Jason Kenney, concluded that AHS managers constitute just 3.2 per cent of total employees, which is comparable to industry averages across Canada. Another report from KPMG said the province’s single health authority created “significant structural advantages” to managing COVID-19 in acute care.

Neither report outlined recommendations to reorganize the system.

As for decentralization, it’s not entirely clear what that means for Ms. Smith, but Dr. Leslie said any type of system overhaul could create turmoil at a time when health care systems across the country, including in Alberta, are buckling under staffing shortages and continued pressure from COVID-19.

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Alberta’s health care system has been transformed several times. In 1994, the province began consolidation by creating 17 regional health authorities in place of 128 hospital boards, 25 public health boards and 40 long-term care boards. Nearly a decade later, the number of health regions was cut in half.

Then, in 2008, AHS became the first single health authority in the country.

Stephen Duckett was the first president and chief executive officer of the single health authority. In a phone interview from Australia, Mr. Duckett said that public support was limited at first and that community engagement practically dissolved. He described the dysfunctional payroll system as “hopeless.”

But despite those growing pains, it was the right move to centralize Alberta’s health system, he said, because the amalgamation saved money while ensuring more fair access to services across the province.

Still, he cautioned that “any management transition just takes the eye off the ball for 12 months” and is a huge distraction to staff, which will likely worsen overall morale.

Jim Dinning, who served as chair of the Calgary Health Region at the turn of the century, recalled lots of infighting between boards and regional authorities.

During his tenure, he said, they were able to “bring about peace” and spent public money on private health services to offset MRI backlogs, reducing wait times to eight weeks from 39. He left his position as chair in 2001, and in the years since had become a “reluctant enthusiast” of the single health authority model.

“I think the pandemic proved the benefit of a single system. There was an awful lot to be said for one set of leadership, for one decision making process,” said Mr. Dinning, who is also a former Alberta cabinet minister. “Was it perfect and is it perfect today? No, perfection will elude every health care system forever.”

He declined to weigh in on Ms. Smith’s plans but said she should have open conversations with AHS board members, front-line workers, health department officials and her own Minister of Health before “pulling the trigger” on her campaign promises.

Janet Davidson, who was Alberta’s deputy health minister from 2013 to 2015 and served as an official administrator for AHS in 2013, said that when she took on her roles the idea was not to change the structure but to look for ways to make it more efficient.

“There needed to be a more comprehensive approach that said you could consolidate certain things, like policies and some practices and standards, but you need to allow for a lot of flexibility,” said Ms. Davidson, using the five AHS zones as an example.

Ms. Smith’s skepticism toward COVID-19 vaccines and advocacy for limited public health restrictions could hinder efforts to attract more health-care workers to Alberta, she added. “You have staff that worked throughout COVID to keep the patients safe and they believed in what they were they were doing.”

AHS spokesperson Kerry Williamson said they are working “aggressively” to recruit front-line workers. An additional 270 staff are working in emergency departments compared with a year ago, he added, and there are 1,800 additional registered nurses now than in March 2019.

David Shepherd, Opposition New Democratic Party health critic, said the proposed plans will not improve AHS. “This is about Danielle Smith’s ideology, her agenda to exercise her vendetta against AHS for having supported public health measures and doing that for the base that got her elected as Premier.”