We’re not closing any rural hospitals, have you got that?

Alberta Health Minister Tyler Shandro strove to make that point perfectly clear at his news conference in Edmonton yesterday on how Ernst & Young, the multinational management consulting firm based in London, England, thinks Alberta Health Services could save nearly $2 billion a year.

Mr. Shandro (Photo: Screenshot of Government of Alberta video).

No, the United Conservative Party Government won’t be closing any rural hospitals.

Rural hospitals? None of ’em will be closing.

Mr. Shandro even interrupted a question from a reporter who seemed to be asking if any rural hospitals might be closed or … Nope! We’re not closing any rural hospitals!

Now, I’m certainly not saying closing rural hospitals would be a sound policy. On the contrary.

Nevertheless, they are among the highest cost items on Alberta Health Services’ list of expenses. So if the UCP is serious about saving $1.9 billion yearly on AHS operations — which Mr. Shandro solemnly promised to plow back into health care — it’s obvious the money’s going to have to come from somewhere in the system.

The prevailing view among progressive observers was that the government set up the Ernst & Young report published yesterday to give itself cover to implement its radical privatization agenda, which the highly ideological party made little effort to hide before it was elected.

As the UCP habitually does, critics pointed out, the government set the rules of the contract for the $2-million review so that the consultant’s conclusion would be the UCP’s obvious preference to dismantle public services generally and public health care in particular as much as it can get away with.

Dr. Yiu (Photo: Screenshot of Government of Alberta video).

“Albertans need to ask,” the Alberta Union of Provincial Employees said in a sharply worded news release, “is this Ernst & Young report any better or more reliable than the MacKinnon Report?”

That was a reference to the recent discovery that former Saskatchewan Finance Minister Janice MacKinnon, chair of the supposedly independent “Blue Ribbon Panel” on Alberta’s Finances, was using a script hatched in Premier Jason Kenney’s office at least some of the time when the panel was supposedly taking its “deep dive” into Alberta’s books last year.

That sort of thing may sting at Ernst & Young, which tries to cultivate an image of disinterested authority. That’s what you get, though, when you quote discreditable sources like the Fraser Institute, strain credulity with nearly $2-billion of suggested cuts after a hurried eight-month glance at a 110,000-employee, 400-facility, province-wide operation, and reach conclusions suspiciously in sync with Dr. MacKinnon’s controversial effort.

So none of these criticisms seems unreasonable in light of the UCP’s history of using third parties “to provide cover for their true agenda, cuts and privatization of our public services,” as the Alberta Federation of Labour put it in a news release.

Still, it wasn’t at all clear from Mr. Shandro’s news conference that the government actually plans to do much at all.

The health minister went to considerable lengths to sound reassuring, praising AHS as an asset to Alberta and saying the government won’t make all of the $1.9-billion worth of cuts recommended by the consultant and may do whatever it does over a long, long time.

This is a big change from Premier Kenney’s angry springtime-of-repeal rhetoric during last year’s election campaign.

In other words, there’s been plenty of political flexibility built into the government’s response to the Ernst & Young report too.

Mr. Bethel (Photo: Screenshot of Government of Alberta video).

What gives? Presumably the UCP strategic brain trust has concluded that if selling off public assets like long-term care facilities for a song, contracting out work to low-pay employers, or setting up inefficient private surgical clinics for line jumpers arouses too much public opposition among voters, the UCP had better leave itself some room to back off.

As the news conference made clear, they have already dropped the political hot potato of rural hospital closings in the party’s electoral heartland.

What do you want to bet that UCP MLAs have been getting an earful about small-town hospitals ever since rural constituents got wind of what Dr. MacKinnon was best known for in Saskatchewan — closing 52 rural hospitals in the name of efficiency.

There was so much flexibility built into the recommendations, indeed, that a cynical observer might have been tempted to conclude chances are good this will turn out to be nothing more than an exceptionally expensive press release.

Apparently prepped within an inch of his life, the normally bumbling Mr. Shandro smoothly handed off the occasional tough question from a reporter to AHS CEO Verna Yiu or Ernst & Young spokesperson John Bethel.

Example: What are some of the “procedures of limited clinical value” the consultant thinks could be cut? That’s for AHS to decide, Mr. Shandro parried, leaving it to Dr. Yiu to provide a single acceptable example: maybe some hernia operations.

Pro tip for journalists: Might be worth taking a closer look at this one!

Mr. Shandro also carefully tried to avoid giving the impression the government is using the review as a way to get the public on side with its bargaining positions in contract negotiations with public health care unions and physicians — a practice known in labour circles as “bargaining in the media.”

That’s a tough trick to pull off when, as United Nurses of Alberta President Heather Smith pointed out in her union’s response to the report, AHS “tabled these very proposals” in bargaining for UNA’s next collective agreement back on Jan. 15, when the report was already in the government’s hands.

Ms. Smith suggested the consultant didn’t understand how the union’s collective agreement with AHS worked when it tried to poke into its intricacies.

For example, complaining union contract language makes it difficult for AHS “to implement innovative staffing approaches to meet demands, especially in rural areas,” Ernst & Young seems to have missed the letter of understanding in UNA’s current collective agreement with AHS that allows the employer to create rural multi-site positions.

Well, maybe you just don’t get that much for $2 million nowadays.

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  1. I wouldn’t be surprised if Mr. Kenney and/or some of his aides helpfully “contributed” to the E&Y report. A good consultant knows who is paying them and what they want to hear, which is often an inherent flaw of the process. As the saying, you hire a consultant to take your watch and tell you what time it is. Economically, it is often a waste of money.

    I am not surprised that closing rural hospitals was so quickly and firmly rejected, despite Dr. MacKinnon’s and the consultant’s inclinations. The UCP does not want to committ political suicide by turning its strongest base of support against it. However, it does also severely limit the financial options to save money.

    I suspect the UCP will try privatize what they can get away with and leave those things considered too politically dangerous to touch alone. Therefore their quest for savings will probably be limited to laying off some managers and fighting with doctors and other medical professionals. I think they will not win the battle with the doctors.

    I suspect in a few years, there may be some savings, but no where like the almost 2 billion headline from the consultants report today. Therefore I am sure the UCP will make an effort to soon mostly forget about this consultants report. Will there even be actual savings realized of at least 2 million to cover the cost of the report? At this point, who knows.

  2. Why on earth anyone would hand a health care system over to accountants is beyond me.

    Aren’t accountants dedicated to the most efficient use of budgets? Of course the most efficient use of a budget is to not spend it at all, but I digress.

    Rural hospitals were never going to be shuttered. Why mess with the one voting base that is looney enough to keep voting for the UCP no matter what it does to anyone else? Indeed, I see the number of rural hospitals expanding at the expense of urban health care facilities and services.

  3. Wait 100 days and see. Who does that: holding a press conference to announce an announcement in 100 days? Sounds like the UCP friends and family fire sale of Alberta assets could still be on. Maybe 100 days will instill the proper amount of fear — and loathing — in all of us.

  4. Most of the E&Y recommendations are ludicrously vague. Here are some examples:

    Recommendation 5: Our initial analysis suggests that there may be opportunities to reduce the number of managers in some areas. AHS should review positions identified as having fewer direct reports than their peers in other organizations with the objective of identifying opportunities to consolidate portfolios and reduce management levels.

    Recommendation 14: AHS should prioritize the further provincial standardization of clinical care pathways and protocols to ensure all Albertans have access to evidence-based, outcomes focused and cost-effective care.

    Recommendation 19: AHS should create a fit for purpose operating model for ambulatory care and outpatient clinics and develop a strategic vision and governance model to support AHS’ objectives both in the hospital and the community.

    I have this image of Dr Yiu sitting at the press conference and saying (in her inside voice) “Gee why didn’t I think of that”.

  5. I guess you have to hand it to the UCP – holding on to the neo-liberal nostrums that have long since been discredited by economists and, since the 2008 financial crisis, holds little esteem among the rest of us regular people. But then Alberta has never been a normal economy (nor has it been a normal polity).

  6. The questions you ask determine the answers you get and so it is with Kenney crowd and crew; where, “inefficiencies” are always viewed through an economic dollars and cents filter.

    What is always overlooked are the numerous patient complaints filed against AHS and the inaction that often follows, as the complaint is given the extended run a round treatment. Meanwhile, the frail elderly are still dying and being medically mistreated while being cared for in AHS mandated facilities. All of these things are surely viewed as inconsequential by the AHS mandarins, because as one is often told: “There are no guarantees when it comes to health care.”

    There is even less disciplinary action or penalties of any consequence meted out as well, it appears. The power imbalance between patients/the family of patients and AHS (and the government over all) is staggering; although, not surprising when the prime AHS directive remains to cover your own ass, and/or run for cover, and let the chips fall where they may; while, the big fat executive pay checks keep rolling in.

    See, for example : https://www.cbc.ca/news/canada/edmonton/extendicare-nursing-home-death-dehydration-1.5436277

    Unlike the previous government, is Mr. Lawyer, Tyler Shandro, going to start filing criminal charges against private (or even public, for that matter) health care providers (long term or otherwise) in Alberta? The lawyer cabal in Alberta, for the most part, knows enough to stay far away from any talk of medical negligence/malpractice, how about the government crowd? Or is that too much to ask from a yes man, or a clique of yes men/women? More privatization should make the friends, donors, and hangers on, of the Kenney government wealthier, but is it going to improve patient outcomes? The above example suggests not.

  7. Many small Rural Hospitals, Schools, Fire Halls and Hockey Arena’s were built by the PC Government during the 1970’s oil boom for votes. These were demanded by the rural people and are costly projects to maintain. Now that these small communities are shrinking, they can’t afford to maintain these cost and they want the Government to continue maintaining their wants through taxing larger communities. I know of a few Nurses’ (nothing against Nurses’) who made over $150,000.00 a year for looking after a few elderly, some first aid and a few baby deliveries in 10 bed rural hospitals while major centre Nurses’ made far below that income level, just check the sunshine list of those who make over $120,000.00 a year. Years ago it may have been difficult for small rural communities to access medical, education, fire halls and hockey areas but with today’s quick transpiration such as Stars to get people to major hospitals, there is little need for these expensive infrastructure costs in rural Alberta. This is where the problem lies and here we have the under educated UCP cutting spending on major Hospital spending, in urban areas, which service most of the rural communities. I respect rural communities and I have farm land in these areas but it’s time to stop several of those rural infrasture costs which do nothing in solving Alberta’s debt.

  8. Here are some of the UCP’s “unnecessary” procedures.


    Treatment for actinic keratosis seems to be one of those things. Never mind that precancerous skin lesions turn into cancer, which is much costlier to treat as it progresses. Never mind that skin cancer does kill and maim. Never mind that tonsillectomy and/or adenectomy are not routine, or that the old nemesis, rheumatic fever, still exists. It, too, can kill. Never mind that vasectomies will be covered, but tubal ligation will not.

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