Alberta’s provincial health authority has become a target in the United Conservative Party leadership race, with some candidates promising to break apart Canada’s first and largest fully integrated health system and overhaul its organizational structure.
All seven UCP candidates have outlined various ways to restructure the health care system in Alberta, from a complete overhaul of Alberta Health Services and its management ranks to more targeted plans to lessen ambulance waiting times, expand primary care and streamline credentialing after COVID-19 highlighted cracks in the system.
While much of the debate has focused on waiting times and access to care, several candidates have attacked AHS for its handling of the pandemic, which they blame for lockdowns and public-health restrictions.
Health care experts say a number of plans put forward by UCP candidates will do little to improve health services, and that decentralization would plunge the system into years of turmoil.
Perceived front-runner Danielle Smith has pledged to hire a new CEO of AHS and replace its entire board, which was appointed under the UCP government, with an interim health commissioner that would report directly to her. She has also promised to hire an independent organization within 90 days in office to provide recommendations on how to decentralize control of health care delivery.
Ms. Smith declined to comment to The Globe and Mail, but her platform says that executive management of AHS failed Albertans during the COVID-19 pandemic by not developing adequate surge capacity. Ms. Smith argues that the issue was compounded when staff were lost because of the health authority’s mandatory COVID-19 immunization policy, which led to unvaccinated staff being placed on unpaid leave and restricted hiring to those who had been vaccinated.
Travis Toews, a former finance minister who is seen as Ms. Smith’s main opponent, similarly plans to dissolve the single-health authority model and undertake a review of AHS senior management roles. He also plans to revitalize rural health care facilities with a $50-million annual budget and facilitate out-of-province delivery of procedures that have long waiting times.
“I’ve talked with doctors and nurses, front-line service providers who see ways local health care delivery could be improved in their communities. However, because of the top-heavy overly centralized model of AHS, they’ve been unable to do it, which is a tragedy,” said Mr. Toews in a statement.
Brian Jean, a former Wildrose Party leader who was Jason Kenney’s main opponent for the UCP leadership in 2017, has said he doesn’t see the need to “blow up” AHS. Instead, the candidate wants the province to adopt recommendations made in 2017 by Alberta’s auditor-general, who called for changes to AHS’s structure to focus on evidence-based decision making and increased accountability that would be tied to patient outcomes.
The report also outlined the need for better integration of physicians with AHS and other health-service providers, in addition to better clinical information systems.
Mr. Jean has also committed to review the role of the Chief Medical Officer of Health, who advises the government on public-health policy, including pandemic measures.
Todd Loewen, who was ejected from the UCP caucus last year after calling for the Premier to resign over public-health restrictions, said during a debate hosted by a pro-independence group that “AHS needs to be gutted.” His platform calls for a “complete restructuring or dissolution” of the agency and changes to ensure local decision making.
Rajan Sawhney, another candidate, said at a party debate over the summer that said she would consider moving back to regional health boards because “AHS is an inverted triangle. It needs to be flipped.”
Rebecca Schulz has said in her campaign that cuts need to middle management, while Leela Aheer said consultation is still needed before making “simplistic, fast and damaging policies” and said AHS must have authority over the management of the health system, not the government.
Steven Lewis, a health policy expert who teaches at Simon Fraser University in British Columbia, said changing the structure of AHS won’t solve any persistent issues in health care, such as primary-care gaps, employee wages and shortages or service availability.
“A cynic would say these health platforms aren’t really about fixing the Alberta health system or improving it. They’re about using whatever they can on the health file to shake loose some votes,” he said. “Every province in Canada has restructured its health system multiple times and the same problems persist.”
In 1994, Alberta began consolidating its health system. It created 17 regional health authorities from 128 hospital boards, 25 public health boards and 40 long-term care boards. In 2003, the number of health regions dipped to nine before the amalgamation in 2008 to a single health authority. It was considered a dramatic change but two provinces, Nova Scotia and Prince Edward Island, have since done the same.
Myles Leslie, associate director of research at the University of Calgary’s School of Public Policy, said setting “dynamite charges” to AHS would send the system and its workers into chaos for years because it would disrupt existing practices and functionality. He said focusing on improvements to the primary-care health system would be a better path.
“The concept here is that if you can move care upstream from the hospitals, you save time, people’s lives and money,” said Dr. Leslie, who added greater investment is needed for primary-care networks. Ms. Sawhney and Ms. Schulz have promised to do so in their platforms.
Under Mr. Kenney, the UCP government awarded a $2-million contract to Ernst & Young to review AHS. It concluded that AHS managers comprised 3.2 per cent of total employees, which is comparable to industry averages across Canada. However, it did mention some opportunities to reduce management numbers to save money.
Another report undertaken at the direction of the UCP, by KPMG, found that the province’s single health authority created “significant structural advantages” to managing COVID-19 in acute care from March to October, 2020. Neither report outlined recommendations to reorganize the system.
Jasmine Pawa, president of the Public Health Physicians of Canada, said Alberta having a centralized health authority helps with data collection and dissemination but can also limit flexibility and connections to municipalities. However, she said, the risk of overhauling a system can cause significant harm, such as worsening burnout experienced by health care staff.
She said incremental changes help mitigate uncertainty and stress, not just among these workers but the general public. Dr. Pawa also highlighted the need for governments and health authorities to openly measure outcomes of any changes and adjust as needed.
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