Danielle Smith’s health care overhaul strips Alberta Health Services of policy-powers

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Alberta Premier Danielle Smith is stripping her province’s health authority of the power to formulate policy, allocate funding and make other major decisions – and shifting those responsibilities to the government.

Alberta Health Services, which oversees and delivers care across the province, accumulated power thanks to a creeping mandate, Ms. Smith told reporters Wednesday. The governing United Conservative Party’s shakeup of the province’s health care system will rectify this, the Premier said, as she unveiled her plan alongside some of her ministers a day after some details in a leaked document were made public.

“AHS became all things. It is a policy-making body. It is the recipient of the lion’s share of funding. It is a service provider. It contracts out to its competitors. And then it evaluates its performance,” Ms. Smith said.

The Premier argues that dismantling AHS will improve care for Albertans, although it is unclear how the reorganization of the system will lessen the crisis in emergency rooms or improve access to primary care. For example, the government did not earmark more cash to hire staff or expand facilities.

Ms. Smith said the plan’s “fundamental change” will be putting Alberta Health, the government department, in charge of policies and funding, rather than AHS. Under the plan, AHS will focus on delivering acute care services.

The Premier’s skepticism around AHS intensified during the COVID-19 pandemic, especially when restrictions, such as mask mandates and vaccine passports, were introduced to prevent hospitals from collapsing. Ms. Smith viewed the near-calamity more as a reflection of poor management of resources rather than a consequence of a novel virus ripping through the population with little resistance.

Ms. Smith, while campaigning to become the UCP’s leader, pledged to never adopt the types of restrictions her predecessor imposed and public-health experts said were necessary. She has also long argued that AHS is bloated with middle managers.

Some AHS bureaucrats will move to Alberta Health as part of the reorganization. While she said front-line staff will remain in place, she did not indicate how many people will lose their jobs in the transition.

Alberta’s health system has taken on many forms. In 1994, 128 hospital boards, 25 public-health boards and 40 long-term care boards were consolidated into 17 regional health authorities, which were then cut in half nearly a decade later. Then, in 2008, AHS became the first single healthy authority in Canada.

In this new iteration, the UCP said it will divide AHS into four organizations: primary care, acute care, continuing care, and mental health and addictions. They will be connected by what the government calls an integration council.

Experts in health policy from across Canada say integrated health systems have become the “Holy Grail” approach. They said the Alberta plan, which runs contrary and will take years to become functional, will only cause turmoil for health care workers and patients alike with no guarantees of improvement. It will also come at a significant cost, which government officials declined to estimate on Wednesday.

Steven Lewis, a Saskatchewan-based health policy expert who teaches at British Columbia’s Simon Fraser University, said dividing the health system creates “competition, friction at the seams” and reduces flexibility for planning and resource allocation.

“You don’t get rid of problems by moving the boxes around in an organizational chart,” he said. “Restructuring sucks energy out of a whole lot of talented people to try to rebuild this thing, get used to new reporting patterns, new relationships, new mandates, new ways of getting and spending money.”

Mr. Lewis said he agreed there were problems with the power granted to AHS but that the Premier’s assertion that it was “colouring outside of the lines” was absurd. He said the government always had authority over AHS, demonstrated by a list of executives who have been turfed by the province.

Katherine Fierlbeck, a professor at Dalhousie University in Nova Scotia who specializes in health policy and politics, said there are levels of bureaucracy sewn into the creation of four separate organizations and that accountability measures, which were not detailed by the province, are the key to effectiveness.

But she said it is difficult, without a clear blueprint, to determine whether the Alberta government is more interested in the appearance of addressing health care shortfalls or actually doing so.

“Is this the deck chair on the Titanic kind of rearrangement” or is it “actually substantive?” Prof. Fierlbeck asked.

There is also nothing in the plan to suggest smaller communities will have any authority to allocate funding or streamline recommendations to people in power, said Janet Davidson, who served as a deputy health minister in Alberta and AHS administrator. She said the same talking point – that local decision making will be prioritized – has been recycled for years to defend structural changes to the health system.

“If you’re living in a little town, now you don’t have just acute care, but you’ve got four different organizations that you could be dealing with,” said Ms. Davidson, who is now an administrator with the Nova Scotia Health Authority.

Also on Wednesday, the province announced a new slate of AHS board members after firing the previous board last November. The new board includes three deputy ministers – Cynthia Farmer, Evan Romanow and Andre Tremblay – as well as former Progressive Conservative MLA and physician Lyle Oberg, investment banker Sandy Edmonstone and Alberta Enterprise Corporation chairman Paul George Haggis.