In Alberta, what’s old is new again on health care reform

All politics moves in a grand circle, apparently. The person Albertans were most surprised to see on stage with Danielle Smith this month was Ed Stelmach, the former premier whose government, 15 years ago, created Alberta Health Services – which Ms. Smith is now dismantling.

Mr. Stelmach’s explanation for his decision to support the end of the giant health agency he helped create is that the world has shifted from when his Progressive Conservative government was in office. He left politics in 2011 complaining of the rise of “U.S.-style, negative attack politics,” speaking directly to Ms. Smith’s upstart right-wing party of that day. Now, he said, it’s important to set aside differences, with addiction and mentalhealth issues being far worse than they were then, and with AHS becoming too big – especially for its britches.

“Times have really changed,” Mr. Stelmach said in an interview.

That may be, but what hasn’t changed is Alberta’s tradition of massive upheavals to the foundations of its health care system. In 2008, nine health authorities were dumped to create one super board. In 2023, we’re told things will get better if AHS is broken up into four parts, and politicians take the primary role in directing Alberta’s health care policy. “You won’t be able to blame somebody else,” Mr. Stelmach said.

Every system is facing immense stress following the pandemic. Other provinces are rolling out staff recruitment plans. But Ms. Smith is focusing first on the apparatus itself, with a grand “disaggregation” of Canada’s first single health authority.

Ms. Smith’s many critics on this file worry the move is driven by her own political brand. Her most ardent supporters are still angry about pandemic health mandates, with much of the frustration directed at AHS – much of it unfairly, as many decisions of that era came from cabinet. But at the United Conservative Party’s AGM this month, some of the loudest applause came when the Premier spoke of breaking AHS apart.

Political history now appears to be the future of health care in the province. It was old-home month as the Premier appointed Lyle Oberg – a physician and former cabinet minister from the Alberta PCs’ right flank who has long been an adviser to Ms. Smith and always wanted to be health minister – as the new chair of AHS.

In an interview, Dr. Oberg insisted the changes to the health care system have “nothing to do with the pandemic.”

Acute care has always been the main priority, he said, and primary care, continuing care and mental health and addiction have taken a back seat. That will change. “The way I’m approaching it is those other three now have an equal footing with acute care.”

That all sounds good, but the question remains about whether staff and the system – stressed to the max by the pandemic and still catching up on surgery wait lists – can cope with massive government tinkering, again.

Hiring badly needed doctors and nurses in a sea of change is the biggest issue. But close behind is the question of who leads the new organizations. It’s impossible to keep up with the flow of senior staff departing AHS under Ms. Smith’s watch. Deena Hinshaw – the chief medical officer of health she punted – wasn’t even allowed to take a job she was hired for by an Indigenous health group under the AHS umbrella.

We’re not talking about a system that is fatally flawed. Alberta’s overall health administration costs are the lowest amongst the provinces. Consolidated procurement practices meant Alberta had masks to share with others at the height of the pandemic. The electronic medical record system is second to none. Albertans have enviable access to an array of services and specialists.

It has to be noted that Mr. Stelmach is now the board chair of Covenant Health, the large Catholic health care entity that’s a key contracted service provider for the public-health system. AHS runs far more facilities, but the reorganization put AHS on a similar footing to Covenant. Ms. Smith has mused that since AHS is now the province’s main hospital operator – as opposed to the system overseer – it should be renamed “Alberta Hospital Services.”

Dr. Oberg said AHS will likely get a new name, but not that. “We’ve got to take a look at some branding,” he said, adding, “I’ve been giving thought to stuff a lot more important.”

Yes, there is more important stuff than branding. The Premier herself has said this whole upheaval “isn’t change for the sake of change.” But the dismantling of a system that has been built up for 15 years speaks to the heart of what her critics fear most, no matter how it’s branded.