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Friday, July 27, 2007

Will There be Big Changes in the Alberta Health System?

The over-arching political and policy question facing the Stelmach government around hospital safety standards is how Alberta got into this situation in the first place. The facts are starting to come out and more will emerge over time no doubt. The resignation of the East Central Health Board is a start; media reports say more changes of people in positions of authority will be forthcoming. Hancock has ordered all other RHAs to review their situation on infection control and sterilization practices and to report to HIM in a month.

This is clearly a situation where we must fix the problem but I also think we need to fix the blame too. I have not yet read the Health Quality Council of Alberta report or the GOA response but I will. I may have more to say on the subject then too. In the meantime I think there is some blame to be fixed on the old policy around the political reasons behind the decision to decentralize health care into regional authorities in Alberta.

Personally I think the idea of regional health care authorities has merit. It can help inform and design policy that can better understand and respond to local differences and realities in the province. That said it has not always worked that way and until the recent leadership change and Hancock taking over Health and Wellness the unique health care needs of the people Wood Buffalo were blithely ignored. Hancock almost immediately upon his swearing in put a couple of hundred million into health care needs into Wood Buffalo…and acknowledged that was just a start.

The problem of the good idea of RHAs is that they had some serious political flaws from the get go. Those flaws were the unspoken political motives behind the policy decision. First they were supposed to save money in the system by getting the system out of the hands of bureaucrats and into local people who would be “right thinking” about serving the health care needs of their region. It did not save money, it tended to starve the local systems instead. Once the debt and deficit was done we ended up paying a lot more just to catch up to the infrastructure deficit and the need to respond to growth.

The second flaw was the governance issue of the relationship between the RHAs and the GOA politically. The stated reason for RHAs was to get the decision making power closer to the people and “out of the dome.” That did not really happen. Instead the RHAs became a buffer to protect the politicians from having to deal directly with citizen concerns. That was (and is?) true of may other regional boards in other areas from Children's Services to Persons with Developmental Disabilities just name a couple.,

So when we fix blame, it is not just the board members and the problem with professionals meeting standards…it is the governance and politics that motivated the RHAs in the original instances that must carry some of the blame load.

I’ll bet the accountability and governance concerns are what Hancock is looking at when he says he will work with the RHAs “…to work towards a more cohesive provincial system.” Or when he says “this is not about reorganizing the health authorities again, at this stage. That is not to say it wouldn’t be an outcome of the whole process.”

Good government is always good politics. Rarely is the reverse true and we are seeing the consequences of that in this major health safety issue in Alberta today.