The Pause Button

That’s it…they’re gone.  On Thursday May 12, 2011 after tributes to Premier Stelmach and Dr David Swann and the usual skirmishes during  question period the Legislature wrapped up the last day of the spring session.  The Legislative Assembly will be on “Pause” until Oct 24, 2011 when the MLAs will return to engage in the work of setting the policies and laws that govern us all.

A quick review of Hansard and the media over the last week demonstrates that the PCs lost some ground, but not much, on the challenge to its ability to manage and deliver healthcare services in Alberta.

While Minister Zwozdesky successfully faced down the call for a public inquiry into the culture of intimidation in healthcare, Alberta Health Services (AHS) quietly put into place an internal patient advocacy committee with the objective of improving a doctor’s ability to advocate for his patients.  Dr Lloyd Maybaum is a member of the committee and one of the many doctors who has been threatened for “inappropriate” patient advocacy.  He noted that the committee will not address any of the past examples of intimidation and reconfirmed his belief that “…only an inquiry can get to the bottom of what has happened.”* 

The PCs also refused to admit that Ron Liepert’s ill-conceived decision to centralize the health regions into the Superboard (aka Alberta Health Services) created nothing but chaos and dysfunction.  Nevertheless, AHS has begun the slow process of decentralization by announcing the creation of 5 management regions in order to bring decision making to a local level.

Earlier in the week Mr Stelmach bristled at the suggestion that the $1.9 billion Superboard decision was misguided.  “Now there’ll be more decision-making at the local level which will deal with very simple situations like when to put a light bulb in a surgical suite, all of those things that will now be taken care of through a common-sense approach”.**

One hopes that he’s kidding about the light bulb.  But recall Dr Duckett, the ousted AHS CEO, insisted on approving all hiring decisions in the 94,000 strong organization and nurses were instructed to supply their own pens as a cost cutting measure, so one can’t be too sure.  Minister Zwozdesky explained the swing to decentralization as a change in capacity:  “What is changing is more capacity for local decision-making because the circumstances today are vastly different than they were two, three years ago.”*** I’m not sure about the increased capacity for local decision making but I am convinced there has been a change in circumstances with respect to decreased morale and an increased demand for results from a better informed public.

These small victories were offset by two disturbing announcements from Jay Ramotar, Health Deputy Minister.  Mr Ramotar will be taking “a hard look” at HealthLink, the 24/7 medical hotline service through which registered nurses provide medical advice by phone.  Mr Ramotar complains that HealthLink nurses send too many people to hospital emergency departments (HealthLink says only 14% of callers are advised to go to ER;  in my view erring on the side of caution in this case is a good thing).  He also thinks that the RNs might be better utilized in busy hospitals.  One can’t help but wonder whether the PCs have found a creative way to reduce the patients waiting in ER by eliminating the HealthLink RNs who send them there.

Mr Ramotar also wants a comprehensive review of the 40 primary care networks (PCNs) in the province.   He admits the PCN concept is a “very very good one” but wonders whether there should be a system to measure the performance of the teams of specialists.  He expects to “tweak” the program so as to avoid increasing the number of family physicians per captia.  He muses:  “Do we have a report that would tell us today about the benefits we’re getting for $109 million?  I would say not”.**** 

In both of these cases Mr Ramotar appears not to have read the his own 5 Year Health Action Plan Not only does it describe HealthLink as a key initiative to improve accessibility to healthcare, it sets an aggressive target of reaching an RN by phone within 1 minute.  Furthermore, the 5 Year Action Plan characterizes PCNs as a significant success story and one of the 5 key strategies (it’s Strategy #3: Strengthen Primary Health Care) to drive further improvements in Alberta’s healthcare system.

Mr Ramotar’s announcements demonstrate the PCs approach to providing healthcare has not changed.  Despite promises to reduce ER wait times by increasing the number of continuing care beds and staffing empty new hospitals, Mr Ramotar is focusing on reducing the referrals to ER made by trained registered nurses on HealthLink.  Rather than increasing accessibility to healthcare by increasing the number of family physicians, he proposes an evaluation of the “effectiveness” of the healthcare workers in the primary care networks in order to do the exact opposite.  The evaluation of these two programs will take 2 years.  I hesitate to speculate on the cost—both in tax payer dollars and ongoing churn in the system.

No wonder Mr Zwozdesky was content to let Mr Ramotar handle this one alone.  But here’s a suggestion, when the MLAs return on Oct 24, 2010, instead of hitting the “Play” button, let’s all hit “Eject” and start fresh.

*Hansard, May 10, 2011, p 1042

**Hansard, May 9, 2011, p 979

***Hansard, May 9, 2011, p 985

****Calgary Herald, May 12, A4

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