Alberta's new health minister has been given the green light to decentralize the entire health-care delivery system – 15 years after the province completed a multistage, multiyear process to centralize it. (Photo: Canadian Press)

By Canadian Press

Alberta moves to decentralize health-care delivery, 15 years after centralizing it

Jul 19, 2023 | 4:17 AM

EDMONTON, AB – Alberta’s new health minister has been given the go-ahead to decentralize the entire health-care delivery system — 15 years after the province completed a multistage, multiyear process to centralize it.

In a mandate letter released Tuesday, July 18, 2023, Premier Danielle Smith directed Health Minister Adriana LaGrange to reform the management and structure of Alberta Health Services to spread out decision-making to improve front-line care.

“We need to foster an environment within AHS and the entire health community that welcomes innovation and incentivizes the best patient care,” the United Conservative premier wrote.

LaGrange said it’s not clear yet what the reforms will be.

“I do see some challenges and some gaps that have been created over time, over decades,” said LaGrange.

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She said the focus will be on primary, acute and continuing care, but said, “all of this will involve structures, and it’s too early to say what those will look like.”

“I don’t want to presuppose where we will go, but rest assured, we are going to be making some changes, because obviously the status quo is not working.”

The decision sets in motion a reversal of government policy that began almost 30 years ago when then-premier Ralph Klein collapsed more than 200 health boards and agencies into 17 regional health authorities.

Those 17 authorities were later rolled into nine boards and then, in 2008, into the current stand-alone AHS.

During the COVID-19 pandemic, then-premier Jason Kenney said the unified management structure allowed Alberta to get faster access and better prices for scarce supplies.

“We could put on a political show here and restructure the whole thing and send everybody running around creating new organizations and new governance structures, instead of focusing on actual outcomes,” Kenney told reporters shortly before stepping down last September.

“What we’ve decided to do is stick to our knitting, focus on outcomes as opposed to replaying the endless cycle of structural changes at AHS.”

But Smith has sharply criticized AHS as being too slow to respond to front-line needs, particularly during the pandemic. Last year, she fired its board and replaced it with a single administrator.

Opposition NDP health critic David Shepherd said there is work to be done fixing issues within AHS, but questioned whether wholesale restructuring will fix it and whether Smith’s government has the capability to do it.

“We do need to find ways to work better with our partners across the system and ensure that all voices are being heard and considered,” Shepherd said.

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

LaGrange’s mandate letter also directs her to continue working on reducing waits for surgeries, emergency care and lab testing.

“We have made it very clear to (private lab tester) DynaLife that they need to expand and pick up their socks and really do what needs to be done to make sure that Albertans have the quality lab service that they deserve,” LaGrange said.

“While we’ve seen some improvements, they’re not where they need to be.”

In the letter, LaGrange is also tasked with streamlining certification processes and ramping up recruiting to find more doctors, nurses and other health professionals to fill gaps, particularly in obstetrics in Alberta’s north and areas south of Calgary.

Meanwhile, Smith’s long-standing promise to create health spending accounts has been downgraded. LaGrange’s predecessor was instructed by Smith last November to establish the accounts, but LaGrange is now tasked with exploring the “feasibility” of the program.

Health spending accounts were a core promise by Smith last year in her successful bid to become United Conservative Party leader and premier.

The accounts were to give $300 to every Albertan to spend on primary care suited to their individual needs not covered by medicare, such as on a chiropractor, naturopath or counsellor.

Shepherd said the downgrade is likely for the best, saying the UCP should not stretch itself on complex trail-blazing health programs given it is struggling to fix basic issues such as timely lab tests.

This report by The Canadian Press was first published July 18, 2023.

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