With Alberta’s overwhelmed public health care system once again teetering at the brink, a memorandum from Alberta Health Services’ acting chief financial officer to its “senior leaders” telling them they must find ways to cut costs has surfaced.
So here we go again in Alberta, the poor little rich kid of Confederation, with health care bearing the brunt of our inability to manage our way from a good times one minute to not-so-good the next.
Alas, it’s deficit time at AHS, according to the memo from Michael Lam, who is also the agency’s acting vice-president of corporate services. “AHS is forecasting an operating deficit for the 2023/24 fiscal year,” he warned the managers.
Presumably his “introducing cost management strategies” memo wasn’t intended for public consumption.
At least, you wouldn’t think Premier Danielle Smith and Health Minister Adriana LaGrange, who keep trying to assure us that they have a plan and everything is going to be OK, would want it to be known that AHS managers had been ordered to cut the use of overtime by health care workers and the use of travel nurses contracted from private-sector nursing agencies to keep the system afloat by 10 per cent.
Everyone in the Alberta health care understands the brutal overtime worked by nurses and other health care workers, and the employment of expensive agency nurses paid much higher salaries than staff nurses, are not doing anything good for the system over the long run.
But everyone in health care in Alberta also knows that if we just stop using those Band-Aid measures, imperfect as they are, and expect exhausted staff nurses and other health care workers to pick up the slack instantly, more nurses will leave their profession or move to other jurisdictions and the system in Alberta will be pushed ever closer toward the precipice.
“This is a prescription for driving nurses and other health care workers out of the province and out of the profession,” United Nurses of Alberta President Heather Smith said in a statement yesterday. “This is absolutely contrary to what the government says it intends to do to encourage front-line health care services in Alberta.”
UNA’s statement was published in the context of its bargaining for a new collective agreement, but let’s concentrate here on some of the political implications of this situation.
According to Mr. Lam’s memo to the AHS senior leaders, the deficit faced by AHS “is largely due to increased vacancies and unplanned absences (e.g. sick leave), both of which result in increased costs and overtime. Action is required to continue to meet our high standard of care and realize a balanced result.”
If by a balanced result he means a balanced budget, that may not be possible if AHS intends to meet its promised high standard of care.
But just as seriously, this places the blame for the state of the health care system exactly where it doesn’t belong – on the nurses and other health care workers who are bailing hard to keep the ship afloat.
It’s not too much overtime and stop-gap measures like hiring agency nurses that are pushing the entire health care system into crisis, it’s the chaos introduced by Ms. Smith’s United Conservative Party government, which has chosen this moment to simultaneously introduce a senseless massive reorganization of AHS into multiple silos, each with its own expensive bureaucracy, and to all but deny the existence of COVID-19 and other respiratory illnesses that are running wild in Alberta hospitals.
Both policies are driven by the political needs of the government – especially to keep the virulently anti-vaccination and far-right Take Back Alberta faction that now dominates the party and threatens to skid Ms. Smith as premier, just as it dumped Jason Kenney, if she fails to do its bidding.
So is Ms. Smith’s claim she and Ms. Lagrange are about to embark on a tour of Alberta’s hospitals during which they’ll decide which mid-level managers to fire.
If you’re wondering why a lot of health care workers need to take time off sick, look no further than the UCP’s passive aggressive policy of making it hard to understand Alberta COVID statistics and refusing to say a word to encourage Albertans to get vaccinated against COVID, influenza and just about anything else.
So forget about blaming health care workers for sick time and overtime. The UCP Government and Ms. Smith in particular, who have concentrated all control of public health care in the premier’s and Ms. LaGrange’s offices, own this.
Mr. Lam’s memo said that to reduce spending four cost-cutting strategies are being introduced immediately.
- No more recruiting staff for vacant positions except for existing non-management positions in clinically focussed jobs without VP or executive leadership approval.
- “Discretionary spending … must not proceed,” including education for health workers.
- “Portfolios with positive variances must maintain or increase these variances for the remainder of the fiscal year.” (Possible translation: If you haven’t spent all of your old budget, what you did spend is your new budget.)
- A review of all overtime and agency staffing, with every manager asked to “reduce the use of overtime and agency staffing in their areas by at least 10 per cent.”
It’s that last point that will probably do the most damage in the short term.
In the meantime, no one in the government has said anything about the surplus that keeps showing up in AHS’s books, which according to the information on Page 66 of the 2021-2022 AHS annual report is now close to $1.4 billion.
NOTE: In the interests of complete disclosure, I am an employee of United Nurses of Alberta, although this blog is my own thing and expresses my own opinions. I see no reason, though, not to comment from time to time on topics that I happen to know a few things about. DJC
Of interest, Mr. Lam states that the 2023/2024 fiscal year has a projected deficit (of an unknown amount). You have linked to the 2021/2022 financial statements. Does AHS think that 2022/2023 just did not happen?
Good point, David. Perhaps they wish it hadn’t happened. Or perhaps they don’t want us to know how large the surplus has grown. DJC
DJC— an interesting article in the Tyee, by Charles Rusnell about conflict of interest etc. brought out by Alberta doctors…I’m sorry that I cannot do the links, but interesting timing here as well.
What ever happened to the announcements about infusing $57m in Oct , never mind, redundant question. If you look up “health care ” in Alberta on Google, it’s hard to keep up with all the announcements made, changed ,updated, etc. I don’t think I have a big enough spread sheet to keep up.
What this looks like to me is that the UCP are going to emulate what Ralph Klein did with his public healthcare cuts, because their ultimate goal is the same as his was – which is to get it privatized. Expect more layoffs to be seen, and this would also include nurses. Doctors are going to leave the province. With this situation, we are no further ahead. People’s lives will be put at risk, which is what happened under Ralph Klein, when he did cutbacks to the public healthcare system in Alberta. In fact, when Ralph Klein was premier, people died, because they couldn’t get into hospitals, or they were sent home early from the hospitals, and they almost died. There were people who sued the provincial government, but we don’t know what the settlement details were, because they were kept secret. Under Ralph Klein’s watch, nurses were laid off, and they were forced to retire early, or they had to move out of the province. It had to be stressful leaving your family and friends behind, and having to relocate to somewhere else, when you were reluctant to go. Ralph Klein made hospitals in Alberta get demolished, and he got them closed down. It’s not a surprise that the UCP hired someone who was a Liberal, turned NDP, turned Reformer, MLA from Saskatchewan, Janice MacKinnon, to be part of their Blue Ribbon Panel. During her time in Saskatchewan provincial politics, she was copying Ralph Klein’s bad moves, and got rural hospitals in Saskatchewan closed down, which also made the NDP in that province get defeated. When more people have their lives put at risk, because of what the UCP is doing to the public healthcare system in Alberta, you can bet that more lawsuits will happen. The UCP has a very abysmal track record for Covid-19 pandemic management, and it’s not improving. This is also putting more strain on our hospitals in Alberta. For certain, it was a huge mistake to give the UCP their first term, in 2019. Is there anyone who regrets giving the UCP a second term? It certainly is going to be a very rough four years in Alberta.
A $1.4 billion surplus? Surely there is an oil company that wants that money, or maybe an entourage waiting for a first-class trip somewhere for some cooked-up reason.
Since Danielle Smith and the UCP can’t count on pillaging the CPP, or maybe even get their cash-grab APP going, while their deficits are going to go through the roof and taxes are permanently off the table, they’ve decided to raid public healthcare budget to pay for that NHL arena and all the other excesses that they got everyone into. Yes, Dani loves to spend and it shows.
The timing couldn’t have been more perfect. With all the billions Ottawa has made available to support public healthcare, it’s time to fleece the AHS of whatever is left of it. Meanwhile, the hospitals are filling up and everything is broken. Oh, and there’s that thing that used to be called R-Star…another $200+ B in spending, huh?
You voted for this, Alberta. Stupidest people alive.
It’s amazing to think that Albertans’ health is at the mercy of David Parker and his band of medieval berserkers.
Albertans health is at the mercy of the Alberta electorate.
I am forced to wonder if this is just petty posturing ahead of what is likely to be a highly contentious round of bargaining with the three unions that represent the vast majority of employees at AHS. Aside from UNA, which employs our blogger and represents Registered Nurses and Registered Psychiatric Nurses, the Alberta Union of Provincial Employees (AUPE) represents two bargaining units at AHS: Auxiliary Nursing Care (Licensed Practical Nurse and Health Care Aides) and General Support Services (maintenance, housekeeping, clerical, etc.), and both of those bargaining units are slated to go into bargaining this year.
Then there is the Health Sciences Association of Alberta (HSAA), which represents a plethora of allied health professionals at AHS, from paramedics to diagnostic imaging technologists to pharmacists to physiotherapists to dietitians, and many others. Their collective agreement with AHS also expires this year, and so they will also be entering bargaining in 2024.
All three unions are likely to be looking for a better deal at a time when staff shortages are putting enormous strain on the system, and this seems to me like the employer crying poor — again.
[My “full disclosure”: I am a board member at one of these unions, but I have not disclosed anything here that is not already in the public domain].
Jerry: Likewise, I have not disclosed anything that is not already in the public domain, and widely distributed there at that. Nevertheless, whenever I write about UNA (and occasionally AUPE) there’s a chance someone will take me to task for not disclosing where I work. Logically, employees of once-great newspaper chains that served their communities well should have to disclose that they now work for a right-wing propaganda and click-bait organization owned by far-right U.S.-based vulture capitalists that hasn’t practiced real journalism for more than two decades. Sometimes the mood strikes me to co-operate, though, and this was one of those moments. DJC
DJC– do you mean like certain news “personalities ” that are looking for personal publicity ahead of the 24th luncheon?
He was so honored to be on the renard show, maybe he didn’t make the luncheon lists.
IMHO, Canada’s version of Roger Stone, certainly dressed the part.
Just out of curiosity, what ever happened to those 1500 new nurses that Dani was going on about last June (?) ; usually the first to go in times of staff cuts are the last hirings. Were they another figment of the UCP’s imagination?
It’s interesting that you mention Roger Stone. His boss at the National Enquirer, one David Pecker was on the board of Post Media until 2018, his involvement in that aptly named corporate entity became too toxic, even for the hedge fund vultures that have captured our “free press”! He was granted immunity down south of the medicine line though, so nothing to see here. Move along!
The TBA cult plan of deliberately wrecking health care then miraculously “fixing” it by paying public money to their political owners is proceding according to David Parker’s plan. Anybody who didn’t see this coming is asleep.
Cool Xenu: If the TBA completely infiltrates the UCP, Albertans are SOL. There are the moderates in the party, but they had the spine of a jellyfish. The political grift and gravy train washed away any remote bit of integrity and principles they may have possessed. If Danielle Smith doesn’t do the bidding of the TBA, or she isn’t performing up to their pompous standards, she’ll be dumped, and someone even more bat —- crazy will be leader of the UCP. It could even be Mr. Parker himself. That would be a nightmare. There have been extremely bad premiers of Alberta, and Ralph Klein was one. Danielle Smith is definitely another. With David Parker, it would be even worse.
Thoughts on how we might develop a culture of generosity where public services are strongly supported? It seems that we need to be reminded that we have a responsibility to care for one another. From a faith perspective, especially caring for “the least of these” brothers and sisters. We are connected to each other where my humanity is connected to everyone’s humanity. Even the golden rule about treating others as we would want to be treated – would offer quality and speedy healthcare to all, and not just to those who can afford private health care. Those of us in faith communities can and should speak up for others and challenge the selfish low tax cult that grips our province. Sadly so much of this cultish individualism is fostered by faith communities. Lord, have mercy!
Thank god I am not a Royal Bank Manager anymore listening to the nurses bawling their eyes out in my office when Klein destroyed their careers. I helped nine doctors and at least two dozen nurses relocate out of this province, mostly to the states. I heard at Christmas that another clinic in Edmonton had recently lost another 5 doctors and you can bet that there will be a lot more. They are so well respected they can work wherever they want to. The problem they face is leaving their family members behind in Alberta. Now the problem facing us seniors is where can we get medical help when we need it? Friends have already been waiting for over two years in extreme pain for hip and knee replacements.
Alan K. Spiller: I’m sure the UCP love running on chaos, confusion, and division, but at the end of the day it’s clear they don’t care, and they have gullible supporters giving them accolades. As long as it’s not them, or their rich friends who are affected, by what ever bad decisions they do, why should it matter to them? With Ralph Klein, it was the exact same way. Unfortunately, under both, Alberta became a dictatorship.
No magic wands here! It’s not going to be fixed in a few months after many years of decay. We need to understand government or taxpayer funded healthcare isn’t ever going to be all it’s cracked up to be. There’s public abuse, that no one has figured out how to deal with, at play as well.
Gayle Want: American style healthcare is definitely not what we want. Nice try though.
Yes, point 4 is going to cause some misery for patients and staff. It will also cause deaths. We’ve all heard of the long waits in the E.R. in Canada and people have died because of it. Wonder if families will sue. Smith is deliberately doing something which any person would know would cause problems. Reducing budgets by 10% for over time and agency staff will render some departments non functional. One large bus accident, with many injured being unable to receive medical care, one sudden increase in people with COVID all in the hospital, one sudden drop in staff reporting to work due to illness.
The problem with obtaining manager’s permission is, it takes too long and people die.
Smith is setting the stage for the health care system to not only fail, but to kill people
I fail to see how disincentivising our most needed, will help Dani fix healthcare in her first 90 days in office. The fix is in! There is no time machine for her bull shyte! Just because? https://youtu.be/F-z7r1pLWD8?t=4
Don Braid January 8, 2024
https://calgaryherald.com/opinion/columnists/braid-health-care-worse-danielle-smith-big-promises
Don Braid January 9, 2024
https://calgaryherald.com/opinion/columnists/braid-covid-blast-radius-trust-governments-danielle-smith
Two Don Braid articles in Calgary Herald, one day apart and totally contradicting himself.
Exactly how does this Government expect to attract health care professionals to Alberta given their record of ineptitude in the provision of health care services over the past four years????
I believe that it will take a few deaths in ER waiting rooms before any changes are forced on to this Government.
At the end of the day…what has changed over the past year? Nothing…it is in fact worse and getting worse. Perhaps the only change will be more health professionals deciding to exit the Province. Who can blame them. Just wish we could have a few politicians leaving the Province instead of any health care professionals.
With more deaths in the waiting room of the E.R. and also deaths due to not being able to access health care, period citizens will be more than happy to have privitized health care, because at least they will have health care and they or their friends and family might stop dying. Expect to haveSmith announce the only way out of the deaths is private health care and she’ll pass it off as being affordable and for a year or so it might be. Then the costs will increase just as it has in the U.S.A.
On the other hand, we know how many people are dying from drug over doses these days in Canada and still not much has been done.
Some 30 odd years ago I worked at the U of A Hospital as a social worker. I was young and foolish It was a brief time before I was caught up in the Klein mass cutbacks. Shortly after I left, AHS admin was reorganized from a silo structure to a cross task purpose structure- so much more effective. Now some 33 years later the isolated, supposedly inefficient silos org chart returns. Danni has been sold a golden crap good only to make money for vulture consultants. I am now happily retired.
Nothing surprises me anymore with regards to nursing in alberta. Unfortunately I was one of RK cuts at the time I was working at a college and was a nursing instructor who taught in class and in clinical areas. I remember being at the R Alex many May think a nurse is a nurse is a nurse In some basic way this is true. But then and for sure now in 2024 a nurse is usually more specialized. I. Remember a RN with over 15 yrs experience in labor and delivery being bumped down to replace another in orthopaedic surgery imagine the stress Regarding no more education I guess no money for orientation to a new area that you may have no experience since a student nurse The 1 st to go is middle managers and educators. At start of pandemic can you imagine the amount of clinical education had to be done not only to nursing staff but all staff as information changed I don’t know if any middle managers exist since RK cuts. But I will never forget the NICU mgr being told to take her purse as she was marched by 2 security guards to the entrance. It was humiliating at this time this mgr alongside with the clinical NICU educator oriented new grads to the high expertise skills required After RK cuts it seemed nursing never recovered. Less and less permanent positions were posted. More and more one saw jobs that were deemed casual contract temporary Resulting in loss of full time benefits Regarding travel nurses some Atlantic provinces are experiencing backlash fr both union and association as seen in provincial news. We can’t forget the HCW in assisted living. Home care. And long term care. It was bad staffing in 1980 s up Imagine what the staff to patient ratio will be. Especially as DS is planning to make LTC public perhaps she hopes seniors will choose MAID either before entering or while being a resident. Yes this may seem far fetched but if you do some researching especially in BC. You will find people who were inappropriately euthanized possibly due poor safeguards. MAID is a subject for another time Returning to the present the loss of nurses from all areas will have a downward effect in the community. Many nurses have children in daycare or day homes That is one loss of income another is lost of activities that require money like music or dance. The teacher loses students we can’t forget the biggies with a job loss mortgages rent. Food bills We have all these new people fr other provinces here due to Alberta’s campaign. I heard it was the largest amount since earlier way way earlier time I wonder after uprooting themselves how do they feel now Thank you Dave and commenters for reading my rant RK put nurses on a cross and DS nailed the cross the door.
Geri: The truth is that we have not recovered from Ralph Klein’s butchering of the public healthcare system in Alberta. The UCP will compound the problems. Danielle Smith and TBA (Take Back Alberta) will see to that.
The conservative approach in Alberta to health care seems to be if it is not broken, break it and then when it starts to hurt their chances of being re-elected, frantically throw money at it and try fix it. Of course, we are no where near another election, so currently we are at the breaking it stage.
It is quite a change in tone from spring before and during the last election when Smith tried to sound very reassuring and say she would keep spending on health care as needed. Of course the opposition pointed out the conservatives repeatedly bad track record with health care. Unfortunately just enough voters again fell for Smith’s reassuring bs.
So, if something else does not lead to Smith’s removal, it is quite possible she will go down the same path as Kenney, where anger about the state of health care led to him becoming very unpopular and even his party realized their chances of being reelected were better without him.
Smith sounds confident and is glib now, but somehow I feel she has really failed to absorb the lessons of recent history and as the saying goes, those who do not learn from history are doomed to repeat it.
I agree with you 100%. AHS is polluted with leaders who can’t separate politics/beliefs from the reality of healthcare. Smith was voted in by people who think education is “elite” and vaccines are the “anti-Christ.” These are not tenets that can sustain a healthcare system. We now have leaders who were appointed by Facebook-following, fake-news consumers. If you’re religious, great. That’s between you and your God, not between you and your employer. If you’re afraid of science and/or vaccines, then great – healthcare is not for you. If you have no empathy or managerial skills, fine, don’t work at AHS. We’re having a massive education problem in a field of public service that cannot be intertwined with personal beliefs and political stances. This is, in essence, why it’s failing. Smith is hacking and tearing up AHS for votes, not for the good of the people. And, the poor folks who voted for her don’t seem to grasp that.
I’m an employee of AHS. One of the major, major problems is the lack of competence at managerial levels; we have entire departments being drowned by management who have no right – and no qualification – to be in the roles they’re in. An essential part of healthcare is a genuine desire to help people by way of empathy for both employee and patient. In actuality, we have management who treats employees like worthless cattle, then instruct us to treat patients the same way. There is no loyalty, no honour – no empathy and no managerial vision. Obviously, this is a blanket statement and there are some who don’t fit this description. But, for the most part, AHS is suffering because there are far too many unqualified leaders who genuinely don’t care about patients or their subordinates. Those who go “above and beyond” are scolded and mocked. It’s a very, very sad and miserable place to work and a huge part of it is because of inept management.
as a recently laid off employee of AHS, Nurse Jon is spot on.