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When is a reorganization not a reorganization? When it's at Alberta Health Services

Ed Stelmach

Just in case you misunderstood, Alberta Health Services is not being dismantled and Alberta is not returning to regional health authorities. Indeed, it's highly unlikely any more significant decisions about health care will be made at the local level in the future than is happening now.

There's been a lot of reporting lately suggesting that the opposite is so. It's based on ambiguous statements made last week by Premier Jim Prentice and Health Minister Stephen Mandel.

A government news release on Wednesday stated that "the Rural Health Services Review Committee has delivered its final report and recommended actions -- a number of which are under way, including … establishing eight to 10 Alberta Health Services operational districts to give communities a stronger voice in local decision-making." (Emphasis added.)

The new AHS "operational districts" will be implemented on July 1, the release said.

The meaning of the news release was apparently not clear to many journalists. It and the news coverage that followed left a lot of readers with the incorrect impression it meant restoration of regional health authorities, which were eliminated in 2008 when AHS was created by the government of premier Ed Stelmach.

The premier and the health minister seemed quite happy to let this impression linger, without actually quite saying it was so. Presumably this is because large numbers of Albertans have been highly critical of AHS, having reached the conclusion its creation was a mistake and its operations are so sclerotic they may be impossible to fix, whether or not that is actually true.

So, in a story headlined "Back to the past: Alberta returns to decentralized health care," the Canadian Press paraphrased the premier as saying "decentralization of health care is the way to go, despite earlier decisions by previous Progressive Conservative governments."

It quoted him as actually stating, "I'm not going to defend what happened in the past, I wasn't the premier at the time," which is not quite the same thing, although it was a great example of his not-my-fault mantra that is growing increasing hilarious with regular repetition.

The Edmonton Sun couldn't resist the same back-to-the-future imagery, although the tabloid's correspondent delivered it more skillfully: "Alberta Health Services is going back to the future," its story began. "AHS will once again be restructured into several different districts as the province moves back to having health decisions made at the local level following years of centralization."

The Sun quoted Mandel as saying: "We hope that this will push decision making down to the local level, which is what the goal is, and will allow each of the particular districts and each of their facilities to deal with budgetary constraints." (Emphasis again added.) Alert readers will notice that this doesn't mean quite the same thing as the paraphrase that accompanied it either.

This led many readers so smoothly to the conclusion a genuine restructuring of AHS is under way that a newspaper in Halifax -- working hard for gold standard of Canadian journalism, known in the trade as "the local angle" -- wrote that "as Nova Scotia's provincial health authority prepares to become operational, the province of Alberta is preparing to dismantle its own super board."

Sorry, Halifax Chronicle Herald, no health authorities will be dismantled in this experiment. Here's what's actually happening:

The "new" districts are merely a renaming and insignificant restructuring of Alberta Health Services' current "zone" system.

AHS will not be broken up. AHS's province-wide management structure will not change. AHS Headquarters will remain on 107th Street in Edmonton. This is an internal restructuring only.

Right now AHS has five zones, including Calgary and Edmonton.

After July 1, it will have eight to 10 districts, including Calgary and Edmonton.

The current three AHS rural zones will be transformed into six to eight AHS rural districts.

What's the difference between a zone and a district? Not much except the addition of local advisory boards, which won't really have much power to do anything except advise.

They may, as Mandel suggested, advise about cuts to local services, thus adding a veneer of insulation for the government from unpopular future decisions. They will have slightly broader scope for local decisions, but this will have to be kept on a tight leash lest someone complain that services are not being distributed equally among zones … I mean districts.

Nothing much else will change, except the rhetoric.

As for AHS, it remains the same, legally the province's single health authority, constructed atop the legal bones of the old Camrose-based East Central Health Authority by the Stelmach Government in 2008.

The old health regions were much the same kind of legal entity as AHS itself is now. They were separate corporations, based in a region, with a CEO, governing board and budget from Alberta Health, the government department that funds and oversees health care in the province.

Splitting the non-metropolitan areas into smaller zones may make rural Albertans feel like they are being listened to by AHS Headquarters in Edmonton. It may even make them feel loved, or at least a little less disconnected and alienated from the centre. But I doubt it will really result in many meaningful decisions that account for local conditions, as the old Ralph Klein Era health regions could do.

Remember, we got the current unwieldy situation because of politics, and a big part of that political equation in 2007 and 2008 was that rural Albertans -- always disproportionately influential because of the way electoral districts are drawn in this province -- were unhappy about service differences between the cities and low-population areas.

So AHS was supposed to ensure that if Calgary or Edmonton offered top-notch services, rural districts must have local access to the exactly same services about the same distance away.

Now these same voters are unhappy because they feel disenfranchised since the province-wide board charged with doling out services fairly is located in one place, which for most of them is inevitably far away.

Well, guess what, people, even if you put AHS Headquarters in Manyberries or Zama City, this ain't gonna change!

If you think this restructuring is going to change everything, just look at the part of the sentence from the news release that I left out with an ellipsis. That is, the part about the other recommendation that's already under way. "…Developing a provincial EMS service delivery model." (The emphasis, as ever, is irresistibly added by your blogger.)

That's not going to improve local service in very many places. It will likely make it much worse in some … in particular, cities.

The bottom line is that the new districts, just like the old zones, are divisions of AHS. There is still direct management control from AHS in Edmonton. That is not going to change. AHS is not going away.

On Wednesday in the Legislature, NDP Leader Rachel Notley asked Mandel: "Why should anyone trust your government on yet another health care reorganization?"

It's a good question, but in this case there's probably not much to worry about. That's because this isn't really much of a reorganization.

This post also appears on David Climenhaga's blog, AlbertaPolitics.ca.

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