Braid: Smith's health-care reforms finally take shape. They're big, bold and risky (2024)

The forced march to a new health-care system sped up Tuesday, with a UCP bill to enable many of Premier Danielle Smith’s prized reforms.

As details emerge, it’s now obvious that this is the most wrenching change to Alberta health care since local regions were merged into Alberta Health Services in 2008.

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Changes of this magnitude can take decades to function properly — and sometimes they never do. That’s exactly what the UCP says about AHS.

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Now they’re going the other way, preaching unity while building what could become competing silos — four health agencies, each with its own CEO, for acute care, continuing care, primary care, and addictions and mental health.

It’s the end of good old AHS as the prime mover of Alberta health care. The shrinking colossus will retreat into the hospitals and by fall, I bet, will be rebranded as Alberta Hospital Services.

It seemed there might be a cabinet member for each of the four new agencies, but only Recovery Alberta will have a unique minister, Dan Williams.

Health Minister Adriana LaGrange will control the other three agencies, as yet unnamed, and also serve as boss minister for the entire health system.

“I’ll be the oversight minister for health because we want to make sure that we have an integrated health-care system where we do not end up with silos,” LaGrange told reporters. “And that is very, very important to me.”

“We work collaboratively as one government,” said Williams. “This is not going to cause a rift. In fact, this is an opportunity for collaboration to make sure that we’re not missing anything, and every minister is at the table. What we’re doing is formalized in this legislation.”

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What they’re also doing is ensuring total political control over health care, end to end. The days when a governing board could argue with the government are long gone.

There will still be such boards for each sector, with members appointed by the minister, but nobody’s pretending democracy will break out in health care.

LaGrange voiced the discontent with AHS we’ve often heard from the premier.

“The focus in 2008 was really to develop one regional health authority that was focused on acute care, but obviously Alberta Health Services has branched into so many other areas other than acute care,” LaGrange said.

“It oversees about 28 per cent of continuing care, but it holds all the contracts with all the other continuing care providers. It really is fragmented.

“Alberta Health Services dabbled in primary care. It runs a few clinics and holds contracts with others and it’s just very disjointed. There is not a clear accountability structure.

“So, we really need to make sure that Alberta Health Services is focused on what it should be doing best, which is providing excellent acute care services.

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“And we know that that has not always been the case.”

In the hospitals, clinics and care centres, the new legislation will trigger massive migration of health workers from one employer to another.

“Approximately 10,000 front-line staff will be transitioning to Recovery Alberta,” Williams said.

There will be even larger shifts of workers from AHS to the new continuing care agencies and primary care.

That doesn’t mean everybody will change workplaces. Rather, they’ll have new management and a different agency as employer.

Still, these are breathtaking changes that could create widespread anxiety in a workforce of more than 100,000 souls.

The government soothingly promises that union contracts, pay rates, union representation and bargaining units will be unchanged, no matter which agency employs a worker. These rights of “succession” will be absolute, they say.

Behind it all is the core belief that smaller agencies, with sole focus on one part of health care, will produce better, more focused results.

But one walk through an emergency ward, or down a hospital hallway, shows how incredibly complex this system has become.

Will this reform work? UCP friend and foe alike can only pray it does.

For as long as Danielle Smith is premier, this is Alberta health care.

Don Braid’s column appears regularly in the Herald

X: @DonBraid

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