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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.

3 comments:

  1. Anonymous2:23 pm

    The purpose of RHAs is to devolve responsibilty and accountability away from the government. The government tried to have elected RHA members but got rid of them when they exercised independent thought and judgment. Appointees are more maleable.

    The Tories have done a dismal job of healthcare at the macro level. Klein's cuts with no plan have hurt the system for more than a decade. Vegreville is an example of lack of oversight and confusing jurisdiction.

    At some point the Tories have to accept responsibility and not in the lame way that Hancock did it (by firing the Tory hacks on the RHA board). Hancock and crew should look in the mitrror for this mess they have made.

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  2. anon @2:23 - as I recall the GOA tried to avoid having elected members on RHAs but reluctantly agreed and changed their mends again later.

    As for responsiveness I think the immediate closing of the a portion of the Vegreville hospital last January when the issue came to the awareness of the GOA was pretty responsive.

    Then ordering a thorough independent review of all the hospitals and clinic in the East Central Region and promptly releasing the report and taking immediate steps to put that entire RHA system under direct government administration is pretty decisive.

    Further ordering an update from every other RHA in Alberta on the issues uncovered in Vegreville with a tight time frame to respond is pretty decisive.

    What still disturbs me is the amount of time it is taking to get all the former patients who may have been put at some risk in for testing...there is apparently a whole bunch that have not been tested yet. Are they unaware, unconcerned or is the system unresponsive to their needs?

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  3. Anonymous4:44 pm

    Ken you are correct the REACTION of the government is adequate. It is the ACTION of Klein/Stelmach that precipitated the crisis that is the greater concern. The government created the crisis and is now scrambling to contain it. The events leading up to the crisis lead me to believe that the Tory party is tired and incapable of vision.

    However, the Tories seem to excel at crisis and media management. Too bad the federal Liberals are not in power. The Tories usually blame their crises on the Ottawa Liberals. Not having that scapegoat seems to be causing Stelmach some problems.

    The Tories can't keep putting lipstick on the pig and hope that Albertans don't notice.

    Elected RHAs were a dumb idea that the Tories included in their '97 campaign platform. At the time though, the Reform Party was pushing for more representation and it spilled over onto the Alberta Tory platform. It was a political tool to distance klein from closing hospitals blowback. He blamed the RHAs for cutbacks in health and Klein dodged blame. Asa political tool they are spent. Time to get rid of them and have one province wide RHA (called the Department of Health)

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