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Friday, May 16, 2008

Alberta's Bold Move on Health Care Governance

The decisive move yesterday by the Stelmach government to preemptively eliminate the regional health authorities was a bold move. Others may see it as brash…not me!

I think this elimination of regional governance in health care has been coming for quite some time. It may be the health area is the proving ground for a new governance philosophy in Alberta. A taskforce looked at the governance of all agencies boards and commission a while ago and made some important and strong reform recommendations. The thrust of the findings was these groups together spend about half the provincial budget and the government better ensure they align with the GOA Business Plans and goals.

Apparently a rookie MLA asked Caucus who his constituents would call if they had a complaint about health services. Other MLAs answered in chorus “YOU!” Right on! That is exactly who citizens should be talking to if their government funded facilities and services are not meeting needs. It is government who has to resolve these issues and the provincial politicians have to have first hand information if they are going to understand and appreciate the situation.

The way I see it the beginning of the end of Health Authorities started with the fiasco around instrument sterilization in St. Joseph’s hospital in Vegreville, the Premier’s riding. Then Health Minister Dave Hancock “accepted the resignations” of the board of the authority and then he put his Deputy Minister in charge of running the hospital and the region on an interim basis. The problems were clean up, people were screened for possible infections and the entire region was reviewed from an operational perspective.

The chronic incapacity of the Calgary Health Authority to live within its budget and for them to perpetually press the government for bail out money worked under Klein but not anymore. Then the media stunt about money designed to embarrass the Premier over immediate demands for emergency cash was the last straw. I believe the fate of any continuation of the Klein era regional governance and management model in the health sector was sealed.

My observation is that some of these boards, not just in health, were formed in debt and deficit era to save money, take power from bureaucrats and to be more representative of local needs. They were political appointees but power devolved to the administration and the boards became buffers between the politicians and citizens. Not a sustainable democratic governance philosophy.

There are services government is obligated to provide to citizens. The Alberta government set up various regional authorities with appointed boards and then delegated its public interest obligation to them. Government’s obligation to provide services in areas like social services, children’s services, persons with developmental disabilities are other some examples of a delegated ( some say abdicated) governance philosophy.

It would not be surprising if some of these government responsibilities were re-centralized again. The provincial board in the persons with disabilities area was abolished a couple of years ago but the regional boards remained. There is a government level review now over service needs in the developmentally disable sector – not just nice to haves. Expect a report in June.

Insufficient public funding of community-based agencies in the developmentally disability sector has made it impossible for them to recruit and retain qualified staff. It would not surprise me if a recentralization into government happened in this sector too.

These regional boards may disappear overnight like the Health Authorities. The government may move to direct service delivery and contract with community based provider agencies – or even absorb them back into government over time too? There are arguments both ways but unless there is enough funding to compensate staff to provide services the governing philosophy is moot. The government will be inheriting much of the responsibility as service providers revise downwards the program offerings to pay staff at government rates to fit the budgets provided. Some others may close down altogether leaving the government to create needed services internally.

All we can do now is stay attuned to the happenings in the legislature.