Alberta announces new health delivery system, promises to try to protect jobs

Premier Danielle Smith says Alberta's provincewide health provider has lost its way, grown too big and become unaccountable, and that a massive reorganization can no longer wait.

Smith announced Wednesday sweeping changes to dismantle Alberta Health Services, reducing it to one of four new service delivery organizations, all reporting directly to Health Minister Adriana LaGrange.

"This isn't change for the sake of change," Smith said Wednesday at a news conference near the legislature.

"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 who look after them."

She said some improvements have been made on finding family doctors and reducing wait times for care and surgeries, but added it's not enough and her government needs the legislative tools to make changes.

"The current health system in our province limits government's ability to provide systemwide oversight," she said.

"It also limits our ability to set priorities and require accountability for meeting them."

The transformation is to take up to two years, and while Smith says front-line health jobs will be protected, "you're going to see a process of streamlining in the management layers."

Alberta Health Services, or AHS, was created 15 years ago, amalgamating disparate health regions into one superboard tasked with centralizing decision-making, patient care and procurement.

Its annual operating budget is about $17 billion. It has 112,000 direct employees with thousands more working in labs, as physicians, and in community care facilities.

Under the proposed new system, Alberta will still have an integrated provincewide health system but with its fundamental structure and decision-making drastically altered.

AHS currently acts as an arm's-length body, with its own governing board, making decisions to implement policies set by LaGrange's Health Ministry.

Under the changes, all decisions will be squarely in the purview of LaGrange and the new oversight body she will chair, named the Integration Council.

AHS is currently subdivided into five geographic regions. The new model erases the geographic regions and creates four new subgroups organized not by geography, but by service delivery.

There will be a new acute care organization, responsible for running hospitals and, for the time being, lab and ambulance services.

AHS will become a service delivery provider answering to that organization.

Alongside the new acute care organization would be a primary care organization, with a mandate to find a family doctor for every Albertan.

There would be a continuing-care organization to oversee and run those facilities.

The fourth agency, a mental health and addiction organization, would work directly with the Mental Health and Addiction Ministry to further the broader goal of a recovery-oriented system.

All groups report to LaGrange or, in the case of the fourth group, to Mental Health and Addiction Minister Dan Williams.

Input and ideas are to be sought from 12 regional committees and one Indigenous advisory panel.

Smith said the rationale for the new model is to focus on the ultimate goal of reducing long wait times and overcrowding in emergency rooms.

Smith said ensuring Albertans get better and faster access to community care, to a family doctor, and to mental health and addiction treatment means they won't have to resort to the emergency room to get help.

"All roads lead to the emergency room," she said.

The details of the overhaul were leaked earlier this week by the Opposition NDP.

NDP Leader Rachel Notley said the reorganization represents full politicization of health care concentrated in Smith's office.

She said it will bring chaos, because the four new groups will inevitably intersect and overlap.

Notley said the move also opens the door to further health privatization. The leaked cabinet briefing notes said the United Conservative Party government will look at selling off AHS continuing-care subsidiaries CapitalCare Group and Carewest.

During question period Wednesday, Smith said that information is out of date and they have since received advice that CapitalCare and Carewest should remain with the province.

“Every decision that we make is going to be under the auspices of a publicly funded health-care system,” Smith said.

“There'll be no privatizing.”

Health policy analyst Lorian Hardcastle said it's not clear how transforming the system into four service-delivery areas improves patient care.

Hardcastle said the whole point of having AHS was so patients could move smoothly between primary care to acute care to continuing care.

"This system that is being implemented will not facilitate this," said Hardcastle, an assistant professor at the University of Calgary specializing in health law and policy.

"What it's going to do is put the services back into silos, and it's not clear how this won't impede that smooth facilitation of patients and how we won't see patients fall through the cracks.

"It almost seems like change purely for the sake of change."

Dr. Paul Parks, president of the Alberta Medical Association, said, "While the details and impacts are unclear, what is clear is that physician engagement in each of these new organizations will be critical.

"The AMA will advocate for our voice at the decision-making tables."

The Alberta Union of Provincial Employees called the plan short-sighted, disruptive and damaging.

"Nothing in these reforms addresses the short-staffing crisis and it might even drive more workers away from the front lines and hinder attracting new workers," said AUPE president Guy Smith.

"The government's plan will only take things from bad to worse."

Heather Smith, president of the United Nurses of Alberta, said the changes fail to address urgent problems like wait-lists, surgery delays and ambulance bottlenecks.

"We have severe deficits in terms of people and capacity in our health-care system," she said, adding none of that was because of the structure of AHS.

"They've made the wrong diagnosis and absolutely prescribed the wrong treatment."

The premier's announcement ends simmering tensions between the province and AHS that exploded in full view during the COVID-19 pandemic.

Former premier Jason Kenney said AHS provided faulty bed numbers that hamstrung his cabinet during the crisis. Danielle Smith sharply criticized AHS for not providing adequate beds during COVID-19, as well as for mask and gathering rules she said exacerbated social woes and led to staff shortages at AHS.

In the last two years, the UCP government has replaced AHS president Dr. Verna Yiu, replaced chief medical officer of health Dr. Deena Hinshaw and fired the AHS board.

LaGrange announced Wednesday that a new AHS board is to be chaired by former Alberta cabinet minister Lyle Oberg. It is tasked with winding down AHS operations and transitioning to its new mandate.

This report by The Canadian Press was first published Nov. 8, 2023.