During her campaign for leadership of the UCP party, Danielle Smith made clear her plans to overhaul Alberta Health Services (AHS).
She threatened to fire the entire AHS board and appoint an interim health commissioner reporting directly to herself and the health minister. While concentrating power into her hands, she says she wants to decentralize healthcare delivery to local decision-makers.
To understand the implications of her proposals, we first need to understand the history of healthcare delivery in Alberta and how AHS came about.
In the early 1990s, health services in Alberta were delivered by more than 200 separate administrative bodies including hospitals, long-term care and public health boards. In 1994, these were replaced by seventeen regional health authorities and then further consolidated to nine a decade later.
AHS was established in 2008 by the conservative government as Alberta's single health authority, making it Canada’s first integrated healthcare system. Providing health services to more than 4.3 million Albertans, AHS remains the largest health authority in the country.
AHS is governed by a single board of directors, and carries out the health mandate set by Alberta Health (the provincial ministry of health) while operating at arm's length from government.
A single structure for healthcare governance and delivery has its advantages. A single authority can streamline health care services thus eliminating duplication and addressing gaps in services. This approach increases access to services for rural, remote and difficult-to-reach populations and improves equity in service delivery across the province. Administrative efficiencies are created and accountability is increased when governance is limited to a singular board.
The COVID-19 pandemic put the effectiveness of Alberta's health service delivery system to the test. A review of Alberta's COVID-19 pandemic response conducted by KPMG in 2020 highlighted the structural advantages of a single integrated provincial authority.
The review found decision-making was swift and AHS had the ability to make system wide-changes to increase capacity in acute care beds province-wide and assure patients in small communities that ICUs in bigger cities would receive them. One set of leadership ensured one decision-making process and fair and equitable access to COVID-19 testing and treatment for all Albertans.
With centralized procurement and distribution of PPE by AHS, healthcare workers even in remote parts of Alberta were supplied with high-quality PPE at all stages of the pandemic. Similarly, distribution of COVID-19 testing kits, vaccines and medications to treat COVID-19 has been efficient and AHS has exercised its significant purchasing power leading to cost savings and efficiencies.
AHS has health data from across the province and uses real-time evidence for pandemic modelling and informed decision-making. As a single health authority, AHS has been effective in creating and disseminating treatment pathways for COVID-19 infections to healthcare providers, ensuring that all Albertans receive the most up-to-date, evidence-informed treatment.
As we enter the third winter of the pandemic, we are facing a surge in COVID-19 cases as well as resurgence of severe influenza and children's respiratory illnesses. Hospitals are filling up, staffing shortages loom large and burnout among healthcare workers is high. At the same time, Albertans are finding it increasingly difficult to find family doctors in the community.
Overhauling the healthcare system during multiple healthcare crises will be disastrous. It will lead to unnecessary added burdens for staff and remove the focus from providing quality patient care. Instead, now is the time to strengthen AHS.
The provincial government needs to implement policy to increase recruitment and retention of healthcare workers. It needs to invest more in training healthcare professionals so current and future gaps can be addressed and the government needs to build respectful relationships with organizations representing healthcare workers so they continue working in our province.
AHS too needs to do its part in reviewing and learning from its handling of the pandemic response. Patients delayed seeking care for serious symptoms like chest pain early in the pandemic and this led to poor outcomes and preventable deaths. Messaging to the public about seeking care for urgent conditions should have been stronger and clearer in the early days of the pandemic.
AHS also needs to increase connections to local communities and work with them to identify local issues and provide public health solutions that are context-specific. Public health doctors are concentrated in big cities and not on the ground in rural and remote areas to understand the unique circumstances of these communities.
The healthcare deficit has worsened during the pandemic as surgeries were cancelled, cancer screening declined and opioid-related deaths increased. AHS needs to focus on increasing resources to address these care gaps and ramp up services in surgery, cancer treatment and screening, and addictions and mental health treatment.
Supporting and strengthening health care is going to be a key issue in the spring provincial elections. All Albertans want a high-quality healthcare system that is there for them when they need it. Any party hoping to win the election will have to have a robust plan to strengthen – not dismantle – our healthcare system.
Vamini Selvanandan is a rural family physician and public health practitioner in the Bow Valley. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.