December 11, 2023

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Alberta health minister to decentralize AHS: mandate letter

Alberta’s new health minister has a new mandate courtesy Premier Danielle Smith.

In a letter to Adriana LaGrange released Tuesday, Smith wants to see “creativity, responsiveness” and “a willingness to reform the management and structure of Alberta Health Services to better decentralize decision-making and resources.”

Smith wrote it was in service of her government’s focus to improve access to “world-class health care.”

LaGrange said she has been meeting with health care professionals, including various associations and colleges, in the six weeks since being named health minister. She said everyone she’s spoken with has the same focus: to improve health care in Alberta.

“When we look at the current structure that’s in place, we know that there are challenges,” she said. “It has gotten quite big and a bit unruly. So we need to ensure that we do have the ability to see those decisions coming again to the local level as much as possible.”

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The decentralization of AHS echoes a similar move made by former premier Jim Prentice in 2015.

AHS was first created in May 2008 by then-health minister Ron Liepert.

Smith said she wants to “foster an environment within AHS and the entire health community that welcomes innovation and incentivizes the best patient care.”

Alberta NDP health critic David Shepherd said that phrase coming from Smith was “a bit laughable” after the UCP government’s previous term that saw the master agreement with doctors torn up, the privatization of lab and hospital food services, and “failure to listen” to healthcare workers.

“I don’t think our system would be helped by creating additional red tape, additional boards,” Shepherd said. “We have opportunities, I think in many ways, to work with and empower frontline health care workers in the system as it stands.

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“We have yet to see whether this premier and this minister of health are indeed willing to be collaborative and actually listen to those health care workers.

“If (Smith) thinks that she can go in and simply just rip apart the system at a time when it is already in chaos and already in crisis – in part due to so many of the decisions that were made by her government in its first term – well, I think we’re going to be in for, as she said previously, a bumpy ride.”

Finding, keeping more health care workers

The mandate letter also calls on the health minister to add obstetrics doctors to communities with demand for their services, like Lethbridge and Fort McMurray. LaGrange is also to invest around $10 million to implement a province-wide midwifery strategy.

The Red Deer-North MLA is to continue the work to improve EMS response times, surgery backlogs and emergency wait times. She’s also called on to assess alternative models of primary care and “leverage all health care professionals.”

LaGrange’s mandate letter focused on attracting and retaining healthcare workers, especially in rural Alberta, through measures like improved workforce planning, looking at retention policies, increasing training capacity, and fully implementing the recently-ratified agreement with the Alberta Medical Association.

The health minister said she wants to convey messages of respect and proper valuation for current and prospective Alberta health-care professionals.

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LaGrange has been directed to work with Minister of Technology and Innovation Nate Glubish to “explore the viability” of a health spending account – another Smith leadership promise – and to work with Glubish to conduct an independent review of the IT systems used in Alberta’s health systems, as a way to improve the health-care system.

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The Opposition said Albertans aren’t looking for additional health-care offerings.

“They’re looking for a competent government who can simply deliver the basics of health care,” Shepherd said.

The former education minister is also to work with Advanced Education Minister Rajan Sawhney to streamline an automated credentialing system for front-line healthcare workers, including doctors, nurses and paramedics.

Smith also expects LaGrange to “ensure that recovery from mental health and addiction and increasing the recovery capital of Albertans is a guiding policy in modernizing Alberta’s primary health care system,” in working with Minister of Mental Health and Addictions Dan Williams.

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Shepherd said the government’s “heavily-ideological” addictions treatment policy does not portend well.

“If that’s the approach they intend to take on primary care, we are going to have serious issues far greater than what we already have, after this government drove hundreds of family doctors out of practice and out of province,” he said.

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And LaGrange is going to support Justice Minister Mickey Amery in an assessment of the proposed federal changes to medical assistance in dying legislation and recommend ways to regulate that profession.

Smith did reaffirm the province’s commitment to the Canada Health Act, saying it’s “critical” the objectives in the letter “be accomplished within the pillars” of the act and her public health care guarantee that no Albertan will have to pay out-of-pocket to their doctor or receive needed treatment.

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Smith’s move to decentralize AHS comes from a promise she made while running for UCP leadership, in which she claimed the provincial health authority “failed Albertans during the COVID response.”

But a study looking at the difference in pandemic responses of centralized and decentralized provincial health systems noted the more centralized systems in Alberta and Quebec were “in a better position to launch and coordinate province-wide response measures during the early part of the COVID-19 pandemic” compared to a more decentralized system in Ontario. In the study, regional medical officers of health in Alberta said they lacked autonomy and faced “political pressures” when they tried communicating with local communities about the novel coronavirus.

Pros and cons of centralization

Lorian Hardcastle, an associate professor in health law at the University of Calgary, said there is a balance to be struck between having decision makers at local and provincial levels.

“It isn’t clear what decision-making functions will be decentralized, if we’re going to go back to having health regions that provide services within their geographic area, or if we’re going to continue to have a centralized AHS with only certain functions decentralized to those more local entities,” Hardcastle said.

“The mandate letter shows how all areas of the health care system are under strain, right from primary care right up through to emergency services. So it really is a significant mandate and I hope that LaGrange is ready to consult with experts, consult with affected people, draw on the evidence, because these are all issues that we have evidence on.”

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She said there are benefits to tailoring decisions to a local population given their health concerns.

A webinar from the University of Toronto’s North American Observatory on Health Systems and Policies also highlights flexibility for experimentation, learning and competition as another benefit.

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A centralized health system can create better continuity of care, including better integration of hospital services and other health services.

“Those were some of the reasons that we moved to two more centralized systems in the 1990s,” Hardcastle said, noting centralization can also bring increased efficiencies via economies of scale and fewer layers of bureaucracy.

“It is not just a direction that all Canadian provinces have moved in, but we can see that same centralization elsewhere.”

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Mike Parker, president of the Health Sciences Association of Alberta, said the mandate letter highlighted many of the issues they have been raising with the province for years, including raising the alarm about lab services and EMS.

But Parker said he has concerns over the phrase “alternative models.”

“There’s a lot of things that it could mean,” Parker said. “It could mean privatization, it could mean using things like chartered surgical facilities. We don’t know.

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“There’s a conflict between what the public health guarantee says and this issue of alternative models. It doesn’t quite make sense to me.”

Shepherd called the mandate letter a “tall order” for the health minister to fulfill.

“But frankly, this is work we cannot afford not to do. Albertans deserve to have timely access to the services they need in their community close to home. Thanks in part to the failures and mismanagement of the UCP government, they do not have that today,” he said.

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“We will see if the new Health Minister Adriana LaGrange, is up to that task. And we will see if Premier Smith is able to set aside her ideology and her many of her problematic previous positions to do what is right on behalf of Albertans to address these issues in the health care system.”