Health Minister Adriana LaGrange in 2021, when she was education minister, a role in which she was not a stellar success (Photo: Chris Schwarz, Government of Alberta).

The premier who centralized the management of Alberta Health Services under a single administrator who answers only to her now says she wants to decentralize the province-wide public health agency “to enhance local decision-making authority”?

Alberta Premier Danielle Smith (Photo: Alberta Newsroom/Flickr).

What’s wrong with this picture? 

According to Danielle Smith’s mandate letter to Health Minister Adriana LaGrange, this will “create a more collaborative working environment for our health care workers by incentivizing regional innovation and increasing our ability to attract and retain the health care workers we need.”

How likely is this to work as advertised, d’ya think? 

We don’t know yet, of course, whether this will be a full-blown catastrophic effort to drag Alberta Health Services back to a future that most resembles the 1950s south of the Medicine Line, or just some ideological window dressing to keep the UCP’s anti-vaccination, anti-public-health, anti-abortion, anti-everything base happy. 

Probably a bit of both. 

Friends of Medicare Director Chris Galloway (Photo: David J. Climenhaga).

There’s not actually a lot to go on in the mandate letter. It’s mostly a repeat of the one she sent to her last health minister, Jason Copping, before the voters in Calgary Varsity released him back into the wild on May 29. 

That is to say, it accurately identifies may of the problems causing the crisis in health care, and tells the minister to do something about them, which is easier said than done. It provides no hint, however, about how she might go about the task. 

The letter also mentioned that $300 health spending account, one of Ms. Smith’s big promises in her UCP leadership campaign that hasn’t held up under scrutiny. “Working with the Minister of Technology and Innovation, who is lead, to explore the feasibility of creating an Alberta health spending account to support improved health outcomes for Albertans,” sounds more like face saving than a serious plan.

The Canadian Press called the Etch-A-Sketch outline of the UCP’s plans contained in the letter “the go-ahead to decentralize the entire health-care delivery system.”

If so, it’ll be a catastrophe. But it’s said here that’s a big if. 

NDP Health Critic David Shepherd (Photo: David J. Climenhaga).

There’s not much point asking either Premier Smith or Minister LaGrange about it – that would just be an invitation to more gaslighting. Indeed, speaking on a friendly right-wing radio station yesterday, Ms. LaGrange said “all of this will involve structures, and it’s too early to say what those will look like. I don’t want to presuppose where we will go, but rest assured, we are going to be making some change. …”

Well, a bit of administrative decentralization would certainly provide political cover for a government that would clearly like to privatize public health services in a hurry, restrict access to reproductive health services, get revenge on public health officials for their response to COVID-19, and do some union busting, all of which would be unpopular with significant parts of the public. 

As for incentivizing regional innovation (other than ideological hobbyhorses like abortion services and vaccinations) or attracting and retaining the health care workers Alberta desperately needs, real decentralization would have the opposite effect. 

As everybody who knows anything about health care keeps saying over and over, yet another major restructuring of health care in Alberta is absolutely the last thing that a system already in crisis needs. Most likely, it would be an absolute catastrophe. 

Ed Stelmach, Alberta’s premier in 2009 when AHS was rolled out (Photo: David J. Climenhaga).

But Conservative provincial governments in Alberta have been constantly trying to reform health care for decades and about the only thing they’ve tried that’s actually worked was the creation of AHS, rolled out in 2009 under Progressive Conservative premier Ed Stelmach. 

It had a bumpy start, but lo and behold, eventually it ended up with the lowest administrative costs for health care in Canada. So of course the UCP has been asking ever since the party came to power, Why not mess with it?

As Friends of Medicare Director Chris Galloway put it in a news release yesterday after Ms. LaGrange’s letter landed, “This mandate letter is released at a time when Albertans are witnessing the UCP government’s health care privatization schemes fail before their eyes. Privatized food in hospitals is a disaster, privatized labs are failing to deliver, and privatized surgeries are only worsening wait times and reducing capacity. As these privatization schemes continue to pull more workers from our public system, our health care short staffing crisis is only getting worse with dozens of facilities across the province facing repeated temporary closures.”

And as NDP Health Critic David Shepherd observed, “this mandate letter basically provides a comprehensive list of all of the UCP’s failures in the health care system.”

It’s pretty reasonable to expect that whatever the government does next, whether it’s the worst case or merely a less worse case, will have the same lack of success. 

But most likely it will turn out that some things really are too big to dismantle – and that AHS is one of them. 

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  1. Well, Danielle Smith did sign a pledge to protect public health care, just like Jason Kenney, so she must mean it, right?

    At the moment, everything that Smith said, about an Alberta pension scheme and privatizing public healthcare, was just her podcast musings, so they should not be taken seriously. Well, I guess they are musings no more; they are really going to happen.

    Is it only ideological window dressing, though? If this is just more shenanigans to distract everyone from R-Star, it’s a pretty obvious distraction. But Albertans have never struck me as being the sharpest tools in the shed — but just tools in general. Now that the election is out of the way, and a UCP government firmly in Smith’s pocket, the trouble is just getting started.

    A number of UCP candidates begging on voters’ door steps for re-election, claimed that Smith wasn’t going to be around for very long, so cast your vote for the UCP in safety. I still think the vote-for-me-and-I’ll-get-rid-of-the-boss isn’t a good reason to vote for anyone, but here we are.

  2. Hello DJC,
    I have always thought that Ed Stelmach is an under-appreciated premier who came up with some good innovations and ideas.

    1. Christine: I totally agree. History will show that Mr. Stelmach was one of the most effective, and humane, premiers in Alberta history. To his great credit, he was a builder, not a wrecker like Jason Kenney and Danielle Smith, or a steady-as-she-goes small-c conservative, like Rachel Notley. I am not sure whether he was more of a progressive than a conservative, although I lean toward the former. Despite the challenges of our neoliberal era, health care was probably in a better state during Ms. Notley’s tenure, but that was in part because of the foundation that Mr. Stelmach laid. Ironically, the AHS project began as an effort to solve a political problem – a Calgary Health Region CEO who had grown too big for his britches. But despite that bumpy beginning, it worked and is really beginning to pay dividends now, just in time for a true vandal like Ms. Smith to throw things into chaos again. DJC

  3. Dingy Smith could not have picked a worse Health Minister if she tried. LaGrange did a horrible job as Education Minister and her track record will no doubt follow her. The UCP and Conservatives of old have been trying to privatize health care for decades, and should look to B.C. how this failed. B.C. is going back to in-house resources, yet the UCP charges blindly ahead. Funny how they want to de-centralize, when they were centralized, de-centralized, and centralized again. There was an old saying in Government that goes along the lines of: “If you do not know what to do, reorganize.” Clearly the UCP does no have a clue of what to do.

    1. I hope you’re hey think more of Ms.Lagrange then we saw on Steve Allen’s war room ,wait a minute isn’t that the point
      Can’t wait to observe Ms.Lagrange tap dancing with unresolved issues and vessel s of RDRH ,where it fits in is always an audit of opportunities,long dances

  4. Back in 2008, when then-health minister Ron Liepert abruptly announced the merger of nine Regional Health Authorities & three specialized provincial health agencies — Alberta Alcohol & Drug Abuse Commission (AADAC), Alberta Cancer Board (ACB), & Alberta Mental Health Board (AMHB) — it was almost universally panned. I saw it as a solution in search of a problem, & observed that many of the issues that were stated as rationale for this move, which seemed to have been drawn up on a cocktail napkin, could have been addressed within the existing structure.

    The new organization that became AHS had a number of teething pains in its first few years of existence, from the disastrous “Cookie Monster” CEO, Stephen Duckett, to an uproar over senior executive compensation that led to the first firing of the AHS Board, to allegations of queue-jumping by Calgary Flames hockey players during H1N1 pandemic influenza mass immunization clinics in 2009 — AHS’ first real public health crisis. There was also such a revolving door on the CEO’s office for a time, the name plaque on the door should have been an erasable whiteboard.

    But, over time, it eventually arrived at a state of relative stability and began to be able to work on longer time horizon initiatives. This was after years of turmoil dating back to the mid-1990s, when hospital & health unit boards were abolished to form 17 regional health authorities, then merged into nine “health regions” (although the term “Regional Health Authority” remained in the relevant legislation), then merged again to form AHS.

    If memory serves — not a guaranteed assumption, I grant you — the Wildrose Party ran in 2015 on a platform to dissolve AHS back into Regional Health Authorities, while the NDP’s stance was to leave it alone, arguing that what the health system needed most was stability. When the NDP won government, one of new Health Minister Sarah Hoffman’s first substantive acts was to re-establish the governing Board of AHS. The Board then hired Dr Verna Yiu as CEO in June 2016, who remained in that role longer than any of her predecessors, only to be canned by Jason Kenney in April 2022.

    Now Danielle Smith is resurrecting the old Wildrose platform plank to re-regionalize the health system. What this will mean is another few years of the kind of uncertainty, turmoil & decisional paralysis that characterized the period from 1995 to 2015, as leadership at every level from CEO to front-line Manager is buffing off their CVs & having their home valuations updated, not knowing if they will still have jobs next year or what they will be.

    Buckle up, folks, it’s about to get even bumpier.

  5. The one good thing that the Conservatives did, was to consolidate Alberta Health Services. Immediately they began undermining their own best work. Now they scapegoat and pay for their failures by rubbing our noses in their conquest! I detest these people. Phonies, morons, idiots! My vomit for their breakfast! No song would ever be written for these stupid people. So I’ll leave a song for us. Under assault by the dumbies!

  6. Now Albertans have yet more “transformative health care initiatives” to deal with: Doctors are sending out letters to patients inviting them to accept “membership-based medical services.”
    Four days of a clinic will be devoted to members. One day of the week to patients who don’t want to join. Costs for families will be $4,800 a year. Single parents $2,400/year; individual adult $2,200/year; couples $4,000/year.
    If the province encourages this, and if enough doctors take up this idea, this is the end of public health care. WTF?

  7. I’m sure the UCP has one goal in mind with public healthcare in Alberta, and that is to make it private for profit, which is what Danielle Smith’s hero, Ralph Klein wanted to do.

  8. Mission creep of opportunity,just modelled after controlling opportunities of financial power and otherwise ,”some kids may and may not have to fight for diabetic supplies and the seniors will pay “

  9. More positions for others to help them out on financial gain for regional fun and games ,at others expense ,sort of like insurance creep too

  10. Back to this region expenses for gloves compared to other regions,less gloves please ,use less

  11. I remember the regional health board where I lived making the genius decision to favor pet projects. For example, diabetes was priority #1 for adults, but forget about cardiac care at the regional hospital. Any child needing to see the local pediatrician must have cancer, otherwise forget about it. Need to see the only opthalmologist? Well, sorry. You live here, but you’re not “from” here, so one visit per customer and no treatment for chronic conditions.

    Here we go again.

  12. The goal with decentralization is to fully privatize the system, creating two tier health care in Alberta. These corporate politicians know that this can’t be done all at once, for the public won’t stand for it. Rather, it’s done piecemeal, like they did to education, starting first in jurisdictions that are most willing to accept it. These are then paraded around the province as models of success. Whether they are or not, doesn’t matter. This is about the corporate class pilfering the public health care purse.

    1. David: This is fair. There is also the factor that Premier Smith’s weird Q-adjacent ideology requires regionalization/localization so that rural hospital boards can opt out of public health measures. As someone pointed out on social media, though, they will still want to send their gravely ill relatives to urban hospitals for treatment. Nevertheless, I also think they’ll want to hang onto AHS for those major policies they want to enforce province-wide. For a parallel, consider the way Alberta privatized liquor retailing but hung onto the wholesaling arm as an exclusive government monopoly. The result: No significant savings for consumers, government profits maintained, better retail hours, worse retail selection, fewer controls on sales to minors, and revenge on public sector unions. DJC

  13. A catastrophe in the making, or ideological window dressing?
    Why not both? After all, this is the UCP we’re talking about here.

  14. If Conservatives from 40 years ago met today’s “Conservatives”, they’d send them out back to cut a switch.

  15. Sadly, sometimes politics is about giving the appearance or impression of doing something while not doing much at all. Often this is because it is difficult or expensive to fix the real problems or those in charge really don’t want to, say for ideological reasons.

    I don’t know how many times the organizational structure of AHS has been changed over the years. You would think if that was the real problem, by now it would be perfect. So we are now to the point of reversing changes made a decade ago that were made to supposedly improve things by centralizing, in the hope changing them (back) yet again now by decentralizing will improve things.

    I suppose a more decentralized approach might fit better with the current UCP mentality which leans towards their rural base. However, I wonder how well it will go over politically if say their big centralized payroll operation in Calgary is scaled back and that function is returned to individual hospitals or health regions. No doubt some of those rural centres would welcome a few extra jobs, but I can’t see a lot of the current staff being eager to relocate. So it could be very disruptive.

    Maybe we will go back having a number of health regions and all those supposed hard fought efficiencies of having just one large organization AHS will be lost. I suspect it is easier to create a bit more political distance by having more smaller organizations, but it might also be harder to coordinate and control them. However, it is easier to change the structure than spend more money or fix the real problems.

    The political problem is once this shell game is over and if the real problems are still not fixed as promised, it is going to look very bad for the current government.

  16. Humpty Dumpty ,shame on Ms.Lagrange for using RDRH as a pawn and vessels of mission creep

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