Fixing Health Care: A Phased Approach

8/6/2019 Fixing Health Care: A Phased Approach

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Fixing Health CareA Phased Approach


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IntroductionEveryone wants to be healthy. Everyone wants their loved ones to be healthy.Albertans want to eel con dent that their public health care system will be therewhen they need it.

Right now, that con dence is being sorely tested by long wait times in emergencyrooms and or elective surgery, a shortage o doctors and nurses, and stories aboutneglect o seniors in extended care.

A province as prosperous as ours shouldnt have problems like these. It should haveone o the best health care systems in the world.

But years o mismanagement have le t public health care in disarray. Be oreAlbertas health care system can reach its true potential, we have to return tobasics. Health care can be revitalized i we:

1. Return control o delivery o health care to the regional level.

2. Ensure everyone has access to a amily doctor.

3. Ensure public delivery o quality, a ordable continuing/long-term care.

4. Revitalize prevention programs or healthier citizens and long-termcost savings.

This document outlines a common-sense, realistic plan to accomplish those ourinitial goals and lay the oundation o a restored and revitalized public health caresystem one that nally works or all Albertans. Well take care ully measuredsteps to immediately address the worst problems acing the system while preparing

or more sweeping improvements in the medium to long term. Well make steadybut signi cant improvements in the ve major acets o health care: how thesystem works, hospitals and clinics, access, doctors and nurses , and keepingyou healthy.

Health is a Matter of Principles

When properly managed, publicly unded and publiclydelivered health care is the most e ective and e fcientapproach. The Alberta Liberal Caucus is undamentallycommitted to the principles o the Canada HealthAct: accessibility, universality, portability, publicadministration, and comprehensiveness. An AlbertaLiberal government would not only ollow the lettero the Act, but the spirit o it; as one o the richestjurisdictions in the world, we have the ability to providethe very best health care.

We want Alberta to have the lowest in ant mortalityrate in the country. The highest li e expectancy. Thelowest rates o transmissible diseases. The lowestworkplace injury and car crash rates. The highest percapita organ donations. The lowest rates o cancer,asthma and heart disease. The best mental healthoutcomes. The lowest obesity levels and smokingrates. The healthiest health care workers. And acost-e ective public health care system, one thatssustainable or the long term.

All this is possible. But it wont it cant happenovernight. An Alberta Liberal government would take a

phased, step-by-step approach to dramatically improveaccess, quality and cost-e ectiveness o public healthcare in Alberta.


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How the System WorksAlbertans who have tried to use the health care system since the Alberta Health

Services Board (AHSB) was created know that it doesnt respond to the local needso their communities. Attempting to run services ranging rom remote nursingstations to heart transplants to pharmaceuticals to electronic health records out oone centralized body has proven an administrative nightmare.

Thats why an Alberta Liberal government would, in consultation with rontlinehealth care pro essionals and the public, transition rom AHS to ve new health caredelivery zones: Northern Alberta, Southern Alberta, Central Alberta, Edmonton, andCalgary. The ve health care delivery zones will be governed by their own boards,with hal o the board members appointed and hal elected. This division ensuresthat health care experts will provide the necessary expertise to direct health care

delivery, while the elected board members will return democracy and accountabilityto the public health care system.

This plan will maintain some o the bene ts o centralization: central managemento policies, standards, data collection, and nancial monitoring. These tasks will behandled by the Ministry o Health and Wellness, so that health care pro essionals inthe eld can ocus on patients, not paperwork.

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Phase One

De ne Alberta Health and Wellness roles and responsibilities and shiftdelivery o services rom AHSB to ve new health care delivery zones:

Northern Alberta, Southern Alberta, Central Alberta, Edmonton, and Calgary.

Direct the Health Quality Council of Alberta to monitor access, quality andcost-e ectiveness during this transition.

Reinstate the Alberta Cancer Board and the Alberta Mental Health Board(including Addictions). Establish their roles and responsibilities relative to thenew zonal boards and Alberta Health and Wellness.

Expand the powers of the Health Quality Council of Alberta, giving them theauthority and the unding to investigate issues relating to sa ety and qualityo health services. Make them a more independent body, reporting to the

Alberta Legislature rather than the Minister o Health.

Transition to local health care delivery in northern and southern Alberta rst communities with primary and secondary hospitals. Monitor the transition toensure that health care delivery isnt disrupted, be ore continuing the processin larger centres.

Establish a budget monitoring and accountability process for the new zonal boards.

Phase Two

Complete the transition to zonal health care delivery in Calgary, Edmontonand central Alberta, home to most o Albertas complex tertiary hospitals.Continue monitoring the transition.

Review hospital budgets to improve ef ciency, managing costs whileensuring equitable health care delivery across Alberta.

Phase Three

Continue strategic planning for the future of the public health care system,

including prevention and wellness promotion.

Perform a cost-bene t analysis to determine the merits of a universalpharmacare program and advocate or national bulk purchasing opharmaceuticals, bringing costs down or both patients and government.

The Health Quality Council of Alberta

The Health Quality Council o Alberta (HQCA), whichplays an important role in promoting patient sa etyand quality delivery o health services, will also havea greater role to play in the health care system underan Alberta Liberal government. Currently the councilcan only investigate matters o patient sa ety andthe quality o health service delivery at the requesto either the Minister o Health or Alberta HealthServices. This leaves the process vulnerable to politicalinter erence, so an Alberta Liberal government wouldexpand the powers o the HQCA.

Types of Hospitals(and other medical services)

Primary: Hospitals and Primary Care Networks (PCNs)that o er primary, urgent and emergent care, routinecheckups, vaccinations, health education, maintenance

or chronic conditions, normal maternal-child care andre erral to secondary or tertiary hospitals

Secondary: acute care acilities that o er specializedtreatments such as complex surgery, cardiology,urology, dermatology, occupational therapy and so on

Tertiary: hospitals with advanced acilities such asspecialized surgery, transplants, cancer clinics and

Magnetic Resonance Imaging (MRI) scanners, o tenlinked to post-secondary institutions


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Hospitals and ClinicsWhy are our emergency rooms and hospitals so overcrowded? The answer issimple: we dont have enough hospital beds, primary care clinics, home care andlong-term care acilities. Hospitals are clogged with patients who shouldnt be inhospitals, but in publicly unded, publicly delivered long-term care acilities. Albertamust build new acilities to meet our growing population.

But which communities need new or expanded hospitals, clinics, and long-termcare acilities? An Alberta Liberal government will create a transparent process withhealth service experts to ensure that communities that need health care acilitiesget them in a timely manner, without political games.

An Alberta Liberal government would per orm an immediate audit to determinecommunity needs and then take the necessary steps to provide that capacity. Whenper orming this audit, we will take into consideration the approximately 700 acutecare beds throughout the province that are occupied by those waiting or continuingcare. Its ar more cost-e ective to serve long-term care patients in dedicated long-term care acilities. Its also better or the patient!

On top o the demand or long-term care by people who are waiting in hospitalbeds, there are currently over 1000 people in the community waiting orlong-term care.

An Alberta Liberal government would immediately commit to creating the neededlong-term care spaces as quickly as possible across the province, ensuring thateveryone in the province can stay reasonably close to home even a ter moving tolong-term care.

The Need by the Numbers

Hospitals in Edmonton and Calgary are operating nearor over 100% capacity. That means that there are morepatients in the hospitals than there are beds available,the result o years o rollercoaster unding, bed cuts,and mismanagement.

Acute Care Beds by the Numbers

Because the Tories blew up or sold o several

hospitals, Alberta lags about 25 percent behind thenational average when it comes to per-capita acutecare beds.

Alberta has 2.1 beds per 1,000 people; the Canadianaverage is 2.7 beds per 1,000 people.

Hospitals work best when somewhere between 85-90percent o beds are flled. This prevents emergencydepartments rom clogging up with patients, reducesmistakes and sta burnout, and protects patientdignity. It also leaves room or hospitals to deal withlarger emergencies such as disease epidemics or

natural disasters.


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Phase One

Determine the needs of the hundreds of Albertans currently being treatedin hospitals while waiting or long-term and continuing care. Identi y existing

alternate spaces and construct long-term care capacity to provide or theAlbertans who are currently waiting in acute care beds.

Open more Primary Care Networks in communities with the greatest needor primary health care and community based services.

Establish palliative care as a core health service throughout Alberta.

Phase Two

Build specialized surgical centres (for bone and joint surgery, for example) toreduce administrative costs and deliver superior treatment.

Phase Three

Continue to either expand hospitals or build new ones where theyre neededmost.

Continue building long-term facilities to reduce the number of seniors whoare waiting in acute care hospitals or long-term care.

Support PCNs and specialized surgical centers to address the most pressing needs.

Restore stable funding and long-term planning to mental health care,including a renewed emphasis on income, employment and housingsupports, crisis response and community-based treatment, in addition torevitalized institutional care.

AccessWhen youre sick or injured, the last thing you want to do is wait hours, weeks or

even months or treatment. While most Albertans are pleased by the quality otreatment at our clinics and hospitals once admitted, timely access to this treatmenthas become our number one concern. I we take the necessary measures now, itwont be long be ore Albertans enjoy much aster access to health care, with ewercomplications and lower cost!

Furthermore, an Alberta Liberal government would stand by this principle: thatregardless o income or infuence, all Albertans must have equal access to medicallynecessary laboratory tests and imaging, including MRI or CT scans. No one shouldgo broke paying or a potentially li e-saving scan.

In 1989 Alberta had a total o 13,300 acute care beds.Two decades later, we have only 7,800 acute care beds,

while the population has increased by approximately700,000 people.

Primary Care Networks

Primary Care Networks o er frst-level care services,public health services, mental health and addictionstreatment, and some have a day-time emergencyservice. An Alberta Liberal government would committo increasing the number o PCNs across the province,where the need is greatest. Such centres will increasethe number o Albertans with a amily doctor and serveas the frst stop or people with everyday health issues.

The High Cost of Albertas Lackof Long-Term Care Facilities

Every day, over 700 acute care hospital beds areoccupied by people waiting or long-term care. Thisis like losing an entire major acute care hospital. Theaverage cost o operating an acute care bed or oneyear is $150,000. The average cost o a nursing homebed per year is $57,000. Every year, Alberta wastes$105 million because people who should be in long-term care have no place to stay, and must there orebe cared or in hospitals. By providing these Albertanswith publicly delivered long-term care, we would saveover $65 million per year.

Specialized Surgical Centres

Publically unded and publicly delivered specializedclinics ocus on specifc medical procedures deliveringsuperior quality treatment with reduced administrativecosts. The Alberta Bone and Joint Institutes hip andknee replacement pilot project reduced surgery waittimes by 90 percent and consultation wait times by80 percent. This method could also be applied toother surgery, including eye and abdominal surgery.A network o specialized clinics to handle the mostcommon and/or most challenging or expensiveprocedures would reduce costs and provide ar betterpatient outcomes.


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Phase One

Organize and fund enough procedures to clear the current backlog ofelective surgeries (including heart surgery, cataract surgery and hip and kneereplacements), reducing costs to the system and, more importantly, helpingthousands o Albertans live better lives.

Expand the use of bed management coordinators to facilitate the patient owinto and out o hospital.

Increase funding for home care, allowing patients to leave acute carehospitals sooner (or stay in their homes longer), reducing costs and improvingpatient outcomes.

Restore pastoral care services.

Phase Two

Ensure equal access to diagnostic scans by expanding hours of service.

Bed Management Coordinators

Bed management coordinators manage the distributiono available beds to ease some o the backlog whilewaiting or new beds to be created. An AlbertaLiberal administration would expand the use o bedmanagement coordinators so that the patient ow intoand out o hospital is made as seamless as possible.The advantage to the patient is better continuityo care, and the advantage to the system is a moree fcient use o capacity.


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Doctors and Nurses and Allied HealthProfessionalsEvery Albertan deserves a amily doctor and a primary care team. But a chronicshortage o health care pro essionals has made that increasingly di cult.The amily doctor acts as the point o entry to the health care system, and amilydoctors play an important role in ensuring that Albertans stay healthy and manage

their chronic illnesses. This will also ensure the most e cient use o hospitals andmedical services.

The shortage o health care pro essionals has also created long wait times oremergency care and surgeries. It has driven overworked pro essionals intoretirement or away rom Alberta. And it has created undue levels o stress andanxiety within the health care pro ession, resulting in inevitable degradation ocare. We will rely on consultation with our universities and medical, nursing andallied pro essional associations to ensure appropriate planning. Well provide thenecessary unding or post-secondary institutions to expand their programs and trainmore doctors, nurses, lab technicians and other pro essionals.

750,000Albertans - approximately 20 percent of us

dont have access to a family doctor .


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We would ensure that any expansion o post-secondary medical programs isaccompanied by a corresponding increase in residency and practicum positions.Educating young Albertans who want to enter a health pro ession but ailingto provide them with a place to nish their training just drives them out o the

province. Recruiting pro essionals is one part o our task; keeping them is anotherequally important acet o sustainable health care planning.

Phase One

Establish a manpower planning group to ensure proper consultationand planning to create an accurate projection o how many health carepro essionals we need over the next 25 years, and how much we canreasonably expand post-secondary institutions to train these pro essionals.

Support creative programs such as ex time, on-site child care and alternate

payment models to improve workplace health and morale and keep healthcare pro essionals working in Alberta.

Increase post-secondary education spaces for medical, nursing and otherhealth care pro essions.

Offer comprehensive incentives to attract family physicians and other healthpro essionals to rural Alberta.

Add more residencies and training for international medical graduates,including the hundreds already living in Alberta.

Promote Alternate Relationship Plans (ARP) as a form of physiciancompensation and explore other innovative ways o paying physicians thatsatis y both physicians and the public.

Promote health care to high school students as a viable career option.

Phase Two

Monitor the impact of medical school expansion on the current and projecteddemand or health care pro essionals, and ensure that the supply o residencyand practicum positions is matched with the number o educational positions.

Consider tuition reimbursement to new Alberta-trained doctors and nurseswho agree to serve our years in regions that have the greatest need orthese pro essionals.

Phase Three

Continue planning and monitoring the number of professionals to meetpresent and uture needs.

Primary Care Networks

A primary care network is composed o amily doctorswho work with a team o other health pro essionalssuch as nurse practitioners, midwives, nurses, socialworkers, dieticians, and psychiatric pro essionals toimprove quality o care, manage chronic illness andincrease access or primary care.


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Keeping You HealthyIts the oldest clich in medicine: an ounce o prevention is worth a pound o cure.

Education, income and employment have a pro ound infuence on human health.Governments have an important role in ensuring these basic elements are in placeto give children and adults their best chance at a long and healthy li e.

In addition, health education and regulations that ensure sa e environments, such asmeasures to reduce accidents, keep people healthy and save millions o dollars. AnAlberta Liberal administration would restore and expand the prevention and healthpromotion programs previous governments have allowed to stagnate.

Phase One

Establish a Prevention and Health Promotion Council with other governmentand non-government organizations such as the Alberta Public HealthAssociation and poverty groups to review, implement and monitor bestpractices or health o the entire population.

Ban trans-fats to reduce chronic health problems such as heart disease,diabetes, cancer and liver disease.

Improve access for people with mental illnesses (see sidebar) .

Health Impact Assessments

All major government policy and unding decisionswill undergo a Health Impact Assessment to examinea policys e ect on a wide range o actors (such asincome, poverty, education, and environment) thatinuence the health o our society. Such assessmentswould require the government to keep health issuesat the ore ront o decision-making. Its more sensibleto encourage healthy public policy than to deal withthe problems created by side e ects that werentconsidered when public policy was being developed.

School Nutrition

Undernourished children and there are tens othousands o them in Alberta are more likely to getsick, have shorter attention spans than normal anddont per orm as well as they could in the classroom.Hunger increases health care costs, because poornutrition is linked to a wide range o preventablehealth problems. For a tiny raction o Albertas budget about $2 per student per day an Alberta Liberalgovernment would provide lunch or all children at risko malnutrition in Alberta.


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Promote the importance of vaccinations. Vaccinations are a cost-effectivemeans o dealing with many illnesses.

Continue to support the Alberta Centre for Injury Control and Research andpropose injury prevention laws. For example, require ATV riders and bicyclistso all ages to wear helmets; reduce workplace injuries, motor vehiclecollisions, childrens injuries and domestic abuse.

Improve access to health care services by Albertans of limited means ormobility by either providing mobile services (such as mobile dialysis units orMRI scanners) or by designing an a ordable, e cient transportation.

Phase Two

Review evidence and make appropriate changes where evidence indicates

urther cost-e ective policies.

Provide reduced-cost access to recreation for low-income families.

Ban smoking in vehicles carrying children.

Establish a provincial school nutrition program to provide meals for all childrenat risk in Alberta.

Phase Three

Use tax revenue from tobacco sales to create a $200 million Community

Wellness Fund supporting wellness initiatives and quit-smoking programs.

Beyond Phase ThreeThe plan outlined here represents only the beginning o health care re orm andrevitalization in Alberta. Once these initial steps are complete and results areanalyzed, the people o Alberta will have the tools to hold the revitalized publichealth care system and the new Alberta Liberal government accountable. Whenthey see the improvements weve made, were con dent that well be able tomove orward with more ambitious re orms. Such re orms might include:

Stable Funding for the Long Term

Since 1993, the biggest problem disrupting public health care has been unstablebudgets. Shi ting political winds have caused health care unding to bounce up anddown with oil prices. An Alberta Liberal government would cra t legislation settingminimum and maximum GDP percentages for health care budgets, giving politiciansand health boards some predictability and ample time and knowledge to plan or thelong term.

Access to Mental Health Care

Mental illness will a ect one in fve Canadians in theirli etime. New knowledge about early intervention andprevention o mental illness can save much su eringand costly health services later. Pre-natal nutrition,counselling, proper management o individual and

amily crisis helps the whole community.

Albertans who need mental health treatment o tenend up in hospitals because there is no other place

or them. And people with mental illness are morelikely to be readmitted to hospital, because their frststay wasnt long enough to stabilize a serious mentalillness. This puts an additional strain on our alreadycrowded hospitals.

Alberta lacks both community mental health careand inpatient treatment capacity. An Alberta Liberalgovernment will consult with community stakeholders,patients and service groups in the best position tohelp government address mental health concerns

more e fciently and identi y which areas need morespace and sta to address the needs o the population.We will also reinstate the Alberta Mental HealthBoard, improving our planning and capacity or earlyidentifcation and treatment o those with mentalillnesses to improve outcomes and reduce costs.

Proper supports or mental health extend beyondthe health care system. The Ministry o Health andWellness will cooperate with other governmentdepartments to ensure that housing, employment,nutrition and other supports are available to helpAlbertans cope with their illnesses.

Through education programs that target both schoolchildren and the adult population, an Alberta Liberaladministration will raise awareness o the reality omental illness.

Some Albertans have li elong mental illnesses andneed li elong support. But there are transitionalmoments in li e childhood to adolescence,adolescence to adulthood when gaps in supportappear. Sometimes people all through the cracksduring these times o transition because the hoopsthey need to jump through to retain support are toocon using or complicated to deal with. And sometimessupport is cut o or arbitrary reasons. An AlbertaLiberal government will ensure that mentally illAlbertans get the help they need, whatever transitionstheyre going through.

Supports provided to Albertans with mental illnesses

will be tailored to their needs and experiences.For example, supports tailored to the aboriginalexperience provide avenues to recovery thatrecognize aboriginal culture and new Canadians. Andusing the latest technology, tele-mental health servicesensure that patients can access supports at a distance

rom specialists.


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The Road to a Public Health Care System That Works

Alberta has the people, the resources and the tools to build a public health caresystem, publically unded and publically delivered, that works or all Albertans. The

election o a more responsible government, one that understands the importanceo an e ective and e ciently unctioning public health system, is only the rst stepon that road. The rst our years o an Alberta Liberal government will see us takingthe next steps. ER wait times will come down. Access to elective surgery andimportant diagnostics will improve. Costs will come down...and most importantly,Albertans will get healthier.

Its a journey that we can and must make together. Theres a better way.

Dignity for the Dying

Coverage or palliative care varies across the province;

in some areas its covered, while in others dyingpatients or their amilies pay huge costs. When aperson needs palliative care, what they need is aconsistent, compassionate system, not bureaucratichurdles. The unding o services can o ten changeas someone transitions rom an acute care settingto assisted living or home care. An Alberta Liberalgovernment will consider palliative care a core healthservice, provided without cost to the patient.

More to Come

This document is one in a series o new policies romthe Alberta Liberal Caucus. Revitalizing Oil and Gas,Clean Air, Clean Land, Clean Water, Cutting Carbon:Restoring and Protecting our Environment and The Clean Government Initiative are available now atwww.albertaliberalcaucus.com .

The Alberta Liberal Caucus #201, Legislature Annex9718 107 StreetEdmonton, AB T5K 1E4

Phone: (780) 427-2292Fax: (780) 427-3697www.alberta liberal caucus.com

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Fixing Health Care: A Phased Approach

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