Wednesday, May 12, 2010

The Alberta Health Superboard Should Go!

I am heading into a meeting this afternoon on Foresight this. Foresight is not about making prediction like a futurist but it is about extrapolating possibilities based on evidence, experience, insight and a bit of intuition.

That said here is my non-prediction anyway. I believe the Alberta Health Services Super Board will be gonzo sometime this summer. ..and it should be. The government has approved a five year spending envelope for healthcare in the last budget and covered off the deficits of the Superboard at the same time.

With assured healthcare funding for five years, I assume they are working a five year business plan for health care delivery in Alberta as well. With Registered Nurses in contract negotiations now and the Physicians into negotiations next year, my guess is the government will take back the duty of delivering health care in Alberta. Then who needs a Superboard?

The Klein era governance model was ostensibly built on regional advisory boards of local citizens who were presumed to be best able to know, assess and advise Ministers and government on local issues. In reality that policy proved to be more fiction than fact, especially in the execution and application. I know this firsthand from some of the work I do.

There is a full report done by the Province of Alberta on governance and conflict of interest around provincial government agencies, boards and commissions. The process was lead by Allan Tupper (formerly of the U of A and now at UBC) many years ago. The implementation of the report’s recommendations is now in the care of a senior provincial bureaucrat in Executive Council office. So far as I can see not much has been done about the recommendations. My guess this is mostly due to political inertia and a lack of political will.

The regional board system was implemented in health, childrens’ services, persons with developmental disabilities and perhaps other departments too. It has all turned out to be just another level of expensive governance without authority, expertise or an informed knowledge base to be very effective. They ended up being buffers to protect Ministers from having to deal with the rabble commonly known as citizens. Bottom line we have good people trying to do s job in a bad governance system and no political or administrative intent to change the dynamic.

These board members do not effectively connect with the local population or deal openly with local issues. My evidence and experiences suggest these regional advisory boards did not effectively connect with the government or the Ministers either. I had a conversation one such Minister who appointed well-meaning citizens these regional advisory boards. I asked if any of the appointed board members had ever given direct advice to that Minister. The answer was no. By the look on the Minister’s face in response to the question, I know a light bulb had just been turned. Perhaps that Minister had just realized why there were so many problems in the field that the Minister was chronically unaware.

It is in this context why I think the AHS Superboard will be extinct in a few months. The healthcare system started on this regionalization kick with 17 of them. That soon became 9 and one day, overnight and out of the blue, those were collapsed into one Superboard. The cynic in me says the Minister of the day wanted to fix an obvious regional leadership problem they had in the Calgary regional health board. The government did not want to look like they were picking on Calgary for political reasons, so they decided to dissolve all the regional health authorities into one. No advanced warning, no consultation, no review of the implications or consequences…and no thoughtful plan of implementation. It was just raw politics that were at work in that decision.

The former Minister of Health has since been shuffled and a new much more capable Minister is in place. A new Deputy Minister is in charge and he has the ear and confidence of the Premier. The government is back making the serious policy and implementation decisions about health care. The new leadership in the Department and Ministry of Health and Wellness has been reversing the mistakes of the former Minister and has taken almost all of the power away from the Superboard.

The Superboard and its administration were still (are still?) in the competitive slash and burn damn the torpedoes mindset of the former Minister. They failed refused or neglected to see there was a new Sheriff in town. As a result many the programs and initiatives the Superboard was implementing were stopped, stifled or reversed by the new Minister. The confusion as to roles, responsibilities and relationships between the Superboard, the Ministry and the department was enormous but it is being resolved – effectively, appropriately and dramatically from my point of view.

The political reality is the Minister and the Premier wears the good, bad and ugly politics of healthcare policy. Not the faceless members of the Superboard. The new Minister and Deputy Minister know this and, to their credit, they have taken back the control of the healthcare system into government. They are meeting people, professions and stakeholders to get a serious and in depth sense of what is going on in the field.

They are making positive changes, adding money and allowing for longer planning time frames. And they are burying the idea that private sector marketplace models based of competition will make the public healthcare system stronger and more accountable. The fact that the province has to spend $2.8 million of taxpayer dollars just to bailout a Calgary based private surgical centre from bankruptcy shows the folly of the radical right wing healthcare policy of past and possible future political regimes in the province…if the Wildrose replaces the Stelmach conservatives next election.

So while the governmet is on the job of discarding the AHS Superboard, I strongly suggest they do the same thing and dump all the regional buffer boards including in Childrens’ Services and Persons with Developmental Disabilities (PDD). They are doing more harm than good when it comes to open, transparent and accountable governance. They are not effectively governing or connecting community to government or service providers. They are political buffers for politicians – pure and simple.

Good governance is always good politics. The opposite is hardly ever true.