Monday, November 29, 2010

Alberta Health Services Works - Part II

Last week, I commented on how Alberta Health Services works in how it has served its function for government. Today, I argue that Alberta Health Services actually works in so far as how it serves its function for patients. However I will be clear, the Capital Health Authority also worked and would have been more effective.

My primary arguments revolve around the experience of my family and my father-in-law. Unfortunately, my father-in-law suffered an injury a few weeks ago and has been under the fantastic care of the medical professionals at the University of Alberta hospital since it happened. Day after day and shift after shift, we have experienced the care of a cadre of professional, competent and compassionate doctors, nurses and other capable healthcare professionals. Unequivocally, I can say that we are blessed to have available to us a world-class outstanding free medicare system. It is first class care that achieves incredible outcomes day-after-day patient-after-patient.

Unfortunately, that system is stretched to the maximum of its capacity and it relies far too greatly on the exceptional drive, dedication and unwavering commitment of its professional public servants. Accessing the system may be difficult and the time required to wait for care is extreme - but once you get the care, you know that it is the best possible care that money can buy, and then some. And that is why I feel obliged as a citizen of Alberta to speak out and defend that system. I will not allow our healthcare system to be jeopardised by cumbersome bureaucracy or by petty politics. We need to speak out about protecting the fantastic care we have available while voicing our concerns and worries in a respectful constructive manner.

I worry about people that need to have access to the system and cannot access it in a timely manner and I worry about what will happen when any more stress gets placed on an already burdened system.

We need to move beyond cookies and promises and look at what is really required to solve the problems and deliver the service that Albertans deserve. It starts by supporting and funding the system appropriately, and it is continued by supporting and listening to the people who are at the heart of healthcare delivery.

People like Raj Sherman, frankly.

Thursday, November 25, 2010

Alberta Health Services Works - Part I

Yesterday, it was confirmed. Alberta Health Services Works. It has done what it was designed to do.

Many Albertans in May of 2008, asked why the province chose to dismantle nine regional health authorities, a provincial cancer board, a mental health board, an effective and well-branded provincial addictions board and regional ambulance services into one large, kludgy and unmanageable provincial health authority. The purpose of that exercise became clear with the dismissal of AHS CEO Dr Stephen Duckett.

I'm not necessarily going to disagree with today's decision by the AHS board, but I will be adamant that it is about much more than a bloody cookie. There were many reasons why Dr Duckett had overextended his time here and why he needed to leave.

But none of those really account for why Duckett was fired and what the role of AHS is. Duckett was fired because healthcare became a political minefield for the Conservatives and they needed to be seen to be doing something. AHS was designed to be the fallguy when this point came.

Prior to AHS, the government figured it couldn't achieve meaningful reform in healthcare because it couldn't compel those pesky regional authorities to get on board with the changes it envisioned. Look at the problems caused when the Calgary or Palliser Health Authorities stood up on their hind legs. With a single health authority the government could exert enough influence to affect the changes it needed while maintaining the appearance of arms-length and having the scapegoat in place in case anything should go wrong.

There is no doubt in the tone and commentary provided by AHS Chair Ken Hughes yesterday that the decision to oust Duckett was made by government. Hughes stated explicity that the board was beholden to the Minister of Health and that the Minister made his wishes clear - that Duckett would take the fall.

A number of board members have now resigned from the AHS board. Their resignations are clear signals that the board is not independent from the minister and that these board members resent the lack of authority the board actually has.

We must now turn our attention on to Bill 17 - the Alberta Health Act, because it is calling for greater control and power to rest in the hands of the minister and cabinet and it also introduces another fall guy for the government to use when the need arises.

Don't worry too much about the Sherman amendment... Kill the Bill.

Monday, November 01, 2010

Bill 17: De-democratizing healthcare

My time lately has been consumed by two grad courses, an active full-time job and home and family commitments. But one emergent and urgent issue has forced me to tend to my oft-neglected blog. (Yes, Minister Zwozdesky, I do consider healthcare to be urgent.)

If I was at all surprised about the contents of Bill 17, the new Alberta Health Act, it was in how accurate my predictions for it were. While it is being positioned by government as sticking up for Albertans through a "health charter", "health advocate" and improved "public input," it is actually much more about removing power from Albertans and placing it at the cabinet table. Let's look at those three concepts and how Bill 17 is positioned to improve the power of cabinet.

Section 2 of the bill calls on the Minister to "establish a Health Charter to guide the actions of regional health authorities, provincial health boards, operators, health providers, professional colleges, Albertans, and any other persons specified in the regulations." Sounds great. Let's develop a document that outlines the rights of patients and responsibilities of the players in the system. While it is called a charter to make us think that it has some sort of higher power status like the Canadian Charter of Rights and Freedoms (part of our constitution), Bill 17 allows it to be changed by the whim of Cabinet. Section 12(c) allows the Cabinet to make regulations "respecting the establishment and review of the Health Charter." This means that your sacred Health Charter can be changed by an "Order in Council" at a roughly bi-weekly private meeting.

"Relax," you say, "the Health Charter will be enforced by the Health Advocate." But section 6(1) of the act ensures that the Advocate reports to the Minister of Health as opposed to the legislature and section 12(f) allows the Cabinet to "make regulations respecting the powers and duties of the Health Advocate." So, while the position of the Health Advocate may be valuable within itself, he or she will be under the strict control of Cabinet.

This type of act is considered enabling legislation, because it lacks restrictive clauses and enables the Cabinet and Health Minister to govern the system by regulation. Section 12 contains 11 areas for which Cabinet can enact regulations. Section 13 allows the Minister of Health to make regulations "respecting the designation of other persons as health providers" and "respecting the roles and responsibilities of (regional health authorities, provincial health boards and professional colleges)." Previously, making changes to the roles and responsibilities of regional health authorities, provincial health boards and professional colleges would mean changing legislation and having those changes approved by the democratically elected legislative assembly. With Bill 17, those changes can be made at the whim of the Minister of Health (no need to worry any longer about the pesky College of Physicians and Surgeons).

Perhaps we need not worry, perhaps we should trust the discretion of Cabinet and the Minister of Health (you do know that Ron Liepert could be reappointed as Health Minister, right?). After all, Bill 17 assures us that regulations can only be made if "the Minister has published a notice of the proposed regulation on the public website" and a "time period during which members of the public and stakeholders may submit comments, has expired" and that time period "must not end until at least 30 days after the Minister gives notice." BUT, Bill 17 also says the Minister has to pass on to Cabinet the changes which he or she considers appropriate. It also says that Cabinet may or may not make changes to the regulation, whether or not such changes are referred to in the Minister's report. Furthermore, the time period for submission of comments can be changed if in the Minister's opinion, "the urgency of the situation requires it, the proposed regulation clarifies the intent, or the proposed regulation is of a minor or technical nature." Oh and by the way, "no regulation made (by Cabinet or the Minister) is invalid as a result of non-compliance" with the Public Input section of the Act.

In the off chance that this argument is too wordy or technical, what all of this means is that the Minister has to seek Public Input, unless he doesn't want to, and Cabinet has to change regulations after listening to the Public Input, unless they don't want to.

The big intent behind Bill 17 is to remove governance of our health care system from the control of our democratically elected legislative assembly and place it neatly under the thumb of Cabinet - and done all in the name of seeking Public Input and protecting patients.

No Thanks!

Call your MLA today and demand they return democracy to our healthcare system.