Alberta’s government is dismantling its provincial health-care delivery organization into four entities in a sweeping overhaul that will change the structure and decision-making for the entire health system.
Heralding it as a “new day for health care in Alberta,” Premier Danielle Smith says dividing Alberta Health Services (AHS) into new agencies with a narrower focus, to be overseen by a council of politicians and senior government bureaucrats, will improve access to care in a system under strain.
“The current Alberta health-care system is one that has forgotten who should be at the centre of its existence — patients, and the health-care experts that look after them,” Smith said at a news conference in Edmonton on Wednesday.
The move prompted critics to say the United Conservative Party government is laying the groundwork for more privatized delivery of public health services.
Smith insisted the reforms have nothing to do with privatization and anticipates no job cuts.
NDP Leader Rachel Notley told CBC News the new structure will allow the government and new agencies to pick and choose who will deliver services currently performed by public health-care workers.
Smith’s plan would break apart Canada’s first provincewide health authority about 14 years after the Ed Stelmach Progressive Conservative government created it.
The goals of the reform are to reduce emergency room and surgery wait times, improve access to innovative treatments and recruit more staff.
Organized by function
The new organizations will deliver health services in primary care, acute care, continuing care and mental health and addiction care.
AHS will be the organization responsible for acute care, and is likely to get a new name.
Health Minister Adriana LaGrange appointed former cabinet minister Lyle Oberg as the new board chair of AHS on Wednesday. A temporary administrator has been at the helm for a year since Smith fired the previous AHS board.
Smith has criticized AHS as too top-down and monolithic in its decision-making. She has said previously that the health authority failed to respond to rising hospitalization rates during the COVID-19 pandemic. She has also said AHS needs fewer managers and more front-line workers.
The new structure would create several new bureaucratic entities, including the supervising integration council, a procurement secretariat, a centre of excellence for addictions recovery, and revamp 13 groups allowing for local and Indigenous input.
The AHS breakup will take up to two years and has a budget of $85 million.
LaGrange said Wednesday the government will create the new organization overseeing continuing care by spring 2024, to be closely followed by a new mental health and addictions authority.
The new primary and acute care organizations will be unveiled in fall 2024, LaGrange said.
She emphasized patients should move seamlessly through services run or overseen by the four new organizations.
In a technical briefing, health officials were unable to point to another jurisdiction that uses the model proposed by the government, instead saying Alberta is a leader in health care.
Concerns plan will lead to privatized services
The government’s unveiling was pre-empted by a Tuesday leak of information purportedly presented to cabinet.
The documents, obtained by the Alberta NDP and confirmed as authentic by a senior government source, said the government planned to sell off AHS subsidiaries CapitalCare and Carewest, which operate continuing care facilities.
Smith said in the legislature on Wednesday that selling the agencies was no longer the plan.
At an NDP news conference Wednesday and in media releases, union leaders said the restructuring won’t solve worker recruitment and retention problems and will direct more public health dollars to generate corporate profits.
“Who is going to move to Alberta to work in health care when they don’t even know what agency or organization they will be working for?” United Nurses of Alberta president Heather Smith said in a news release.
The plan contains no imminent salve for a system collapsing under pressure, Alberta Federation of Labour president Gil McGowan said.
“This is a plan to eviscerate our public health-care system,” he said. “It’s an attack dressed up as a cure.”
Expecting seamless integration ‘naive,’ consultant says
Steven Lewis, an adjunct professor of health policy at Simon Fraser University and Vancouver-based consultant, said restructuring health systems is rarely the solution when they are underperforming.
He said even with a new agency in charge, it will be difficult to reform primary care until the Alberta Medical Association reaches new agreements with the government on how family doctors are compensated for their work and overhead costs.
Expecting a council of ministers and deputy ministers to foster seamless integration between the new organizations is “extraordinarily naive,” given each new entity will develop its own culture, and may compete for resources and workers, Lewis said.
“I think a lot of this [change] was a concession to the rural base, which always used AHS as the piñata,” he said.
Alberta Medical Association president Dr. Paul Parks is reserving judgment on the proposed changes until he sees the details of how it will transpire.
Doctors must be involved in guiding the transition, he said, and it should be as minimally disruptive to patients as possible.
The government will begin holding town halls and feedback sessions with the province’s 250,000 health-care workers on Thursday. The premier said a revamped system should be more responsive to their suggestions.
Union leaders said the government should have consulted workers before unveiling its intentions.
“Not one [worker] would have recommended this complicated and expensive reorganization plan,” said CUPE Alberta president Rory Gill.