Why does it feel like health care is rocket science in Alberta?
The latest move by the province to go back to the "good ol' days" of health regions...errrrr... operational districts is a fascinating one. Fascinating because it's making everyone wonder why we are where we are. Seven years ago, the province dissolved all of the health regions into the AHS superboard to "save money." And now we're going back to the way things were to "save money." How in the heck is that supposed to happen?
Let me try to dissect this whole situation. Keep in mind, I'm not a professional and I wasn't a fly on the wall during the closed-door meetings between the province and the individual health regions, then later AHS. What I am good at, though, is optics and what it looks like from an outsider's perspective. So here goes nothing.
The decision to dissolve the boards into the AHS superboard was seemingly two-fold.
One surrounded money. Each board had its own agenda and its own needs. Some were more outspoken than others. I do remember covering old Calgary Health Region meetings where the main message always seemed to be "we need more money." It became a bit of a contest, because you had each region pounding its chest saying it needed more money, and who was the province going to listen to? Likely the board with the loudest voice (aka the most voters). So you saw Calgary and Edmonton get the brunt of the attention. It created divisions with the more rural regions. So after the bickering (and if memory serves me right, even heated words between certain higher-ups), the province decided enough was enough and got rid of the boards, because frankly, if you get one board, you'll be able to spend the cash as needed without it getting hyper-politicized.
Two surrounded doctors. Right in the midst of the first big boom in Alberta, family doctors were at a premium. You couldn't get enough of them. So it became a fight amongst the different regions over resources (not just with doctors, but with nurses and support staff as well). The rural guys were saying "we need help attracting family doctors to our area because the big cities are stealing them all away" while the big city guys were saying "we need all the doctors we can get because of the population base." Even that got politicized. Creating the superboard would allow for a handful of people to make the "right decisions" to support each community and region properly without political bias.
But a funny thing happened (note the hint of sarcasm on the word "funny"). AHS was created, but some decisions were made and some failed. So in an attempt to buffer themselves from taking the heat for bad decisions, layers of management were built in. The "fall guys". The fall guys had fall guys. And the fall guys' fall guys had fall guys. Instead of looking at ways to save money (which, remember, was the original intent of AHS), more money was being spent. If I remember the quote correctly, it cost Alberta $8-billion to run health care ten years ago. Today, it costs $17-billion. That's just a tad more than inflation plus population growth, if my math is correct.
Look at the doctor situation. Did AHS actually fix the shortage? Did we attract and maintain more doctors? (I actually don't know the answer, although judging by the issues we've seen, I'd say if we did, we didn't keep up with population growth). So instead of attacking the real issue (doctor shortage), we created alternate ways of getting health care. You used to have two options: family doctors (for non-emergency stuff) and emergency rooms (emergency stuff). Because you didn't have enough family doctors, people were going into the emergency rooms for minor stuff (I once saw an older gentleman in the waiting room who was complaining about a hangnail, not a word of a lie). So the province, in trying to fix the backlog in the ER's, created primary care networks and family care clinics. And the province was never really clear on how each was supposed to work. Where do you go when you have a cough or cold? What about a pain in your back? You've created extra steps for people in trying to find simple care. So they're going to default back to what they know: the emergency room. And we're suddenly back at square one.
Meantime, you have a superboard that hasn't been overly-super. You've had firings and controversies and everything you don't want out of that group. They have been tasked with managing an entire system and knowing what is going on in every corner of the province. Yet, they didn't. They tried to blanket solution for each region and it didn't work. Will family care clinics work better in Grande Prairie than family doctors? What do the people of Lethbridge gravitate towards? Do we have enough infrastructure in Calgary to have a bigger hospital or should we go after primary care networks? The board just always seemed to be finding ways to start open heart surgery when all the taxpayers had was mild chest congestion. All people want is to be able to see a doctor when they have the sniffles.
You used to be able to do that in every community in this province. And thanks to amalgamation and centralization, you have to go to the big cities to get most things checked out. So now the big cities are having to deal with not only their regular workloads, but also the workloads of the smaller communities. They had a doctor shortage in Brooks a few years ago and a woman went into labour. She was 60-ish minutes from Medicine Hat and 90-ish minutes from Calgary. Guess who gave birth in an ambulance on the side of a highway? Even today, look at all the news surrounding EMS and ambulances being logjammed at city hospitals.
You also have the issue of specialists upon specialists. Whatever happened to a "general practitioner"? Someone who could check you over and make sure you're not dying. I've heard stories of something simple like a broken arm going to three different doctors. All because they "didn't do that kind of thing" or "you have to see this type of doctor."
And now we're going back to health regions. What I hope comes out of it is that the province will listen to all of the local concerns and that we won't re-develop the over-political, under-productive ways of the past. What I hope is that each region will be able to utilize a provincial strategy on recruiting and retaining doctors, nurses and staff, so that everyone has proper access to health care. Each region has its own unique needs (distances between facilities, population bases, etc). The province will need to treat them all differently because what works well in Fort McMurray might not work in Fort Macleod. That being said, understand that ALL Albertans deserve the same level and access of care, whether they be in a rural or urban setting.
But most importantly I hope the province finally shows Albertans what they should expect from this new/old governance model. Explain to us what each level of governance is going to control, even if that means showing a flow chart of where the managers and assistant managers are supposed to be, and how that compares to the number of doctors and nurses. Then we can actually say there's fat to be trimmed. Because right now, we know it's there, we just can't seem to differentiate between the meat and the fat. And beyond that, it's time to communicate with Albertans about how they should be accessing health care. Eliminate the question of "should I be going to the ER for this or to the family care clinic?" Explain to people what the issues are and help them understand the navigation of the system. Things have become so complicated and that's why everything ranging from expense scandals and patients waiting for hours for care are falling through the cracks.
I know it sounds silly, but "keep it simple stupid" really comes to mind here. I know health care isn't simple, nor should it be. But it's up to the province and the health authorities to make it as easy as possible for the patients. Whether that be to understand where their taxpayer dollars are going, or how to get rid of that ugly rash.
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