That loud noise you heard on Wednesday wasn’t an apology from Ed Stelmach or Gene Zwozdesky or even Ron Liepert for that matter. It was the collective shout of “I told you so” from frontline health care workers, health economists, politicians and critics from every corner in the province. But finger-pointing aside, Zwozdesky’s announcement — that the province is partially reversing course on its decision to centralize health care — is a sign Alberta Health Services (AHS) is on the right track to fixing a three-year-old wrong. But it also raises questions about whether they’ve gone far enough and if other critical services should be on the table for decentralization.
There was a lot of disbelief in 2008 when former health minister Liepert dissolved the nine health regions that oversaw a regional health system that at the time was a standard for other provinces in the country. The Capital Health Authority in particular was recognized as a leader in the country, often on the cutting edge of innovative programs that challenged traditional forms of health care delivery like the hip and knee replacement project that cut wait times. But the cuts went ahead as Alberta Health looked for ways to chop about $1 billion in costs with Liepert targeting what he saw as duplication of administrations among the nine regions, including some hefty CEO salaries.
But for all the extra cost and health region budgetary misfires, the system still functioned better than the superboard, which time and again has shown a profound disconnect between frontline physicians and workers. Nowhere has that been more evident than in emergency rooms across the province where wait times have skyrocketed to the point where top physicians feared the system was in danger of collapse.
Five health zones won’t restore the old health regional model, but they will give top physicians and managers the authority to hire staff and buy equipment. That kind of frontline input has been missing to the point of the absurd where all new hires had to go through one individual at AHS. That should create flexibility and allow different health zones to respond to their unique needs and rightly so since services offered in a major centre like the Capital region cannot and should not be the same as those offered by a rural hospital serving a fraction of the population.
It’s the kind of fix that’s needed for another critical health delivery service, ground ambulance, which has suffered from slower response times due to the Stelmach government’s flirtation with centralization. While it could be argued the creation of one ambulance authority has led to greater consistency in delivery in some communities, here in St. Albert ambulance service has been noticeably poorer and more expensive to operate. Response times have slowed to the point where even AHS took notice and agreed to give St. Albert a third ambulance. But unless the province agrees to allow for greater autonomy the inflexible centralized structure will always remain inefficient compared to St. Albert’s old integrated fire/EMS model that allowed more flexibility for fire and EMS calls, with dispatchers stationed in the community they know and serve.
There are still many questions about how far the government wants to backtrack on its centralized approach, but what is clear is there’s a significant amount of heavy lifting left to cure what ails the system — staff shortfalls, too few beds and long-term care facilities. Five years of stable funding helps, but that doesn’t address ongoing questions about the long-term sustainability of the system. Those are some serious issues to address and thankfully it won’t be one individual or a central superboard coming up with the answers. Government, doctors, frontline health care workers and the public must be part of the solution.
