If you’ve ever wondered why Albertans keep asking their government for one thing but end up with something completely different it’s because the battery on your *stealth alert* device is running low. How do the PCs use stealth to push through policies that might not sit well with the public? Let’s do a case study: the use of Family Care Clinics to open up healthcare delivery to the private sector.
Imagine the breathless headline—Alberta Health & Wellness and Alberta Healths Services strengthen Primary Care Networks by creating Family Care Clinics! Huh? Would it help if I told you that you wanted these Family Care Clinics and Redford’s Tories are patting themselves on the back for delivering them to you? No, then we’ll take it one step at a time. I’ll add a *stealth alert* where appropriate.
Primary Care Networks (PCNs) were created in 2003 when the Alberta Medical Association, the government and the 9 regional health authorities, now all rolled up into Alberta Health Services (affectionately referred to as the Superboard) signed an 8 year agreement governing doctors’ pay.
PCNs were billed as an innovative new model that delivered healthcare by a team of professionals—doctors, nurses, nurse practitioners, pharmacists, mental health workers, psychologists, etc—for a fee of $50 a head for every patient in the PCN.* Patients and doctors quickly adopted the PCN model and now there are 40 PCNs in Alberta.
*stealth alert* Everything was fine until Dec 2011 when Health Minister Horne dropped the Family Care Clinic bomb—billed as “an innovative new” model to deliver healthcare to Albertans. Doctors were stunned. The public was confused. Details were non-existent. When Dr Slocombe, President of the Alberta Medical Association, pressed Minister Horne for more information she was told that “…neither the locations nor the operational details were known”.** There’s no need to worry your pretty little head about that my dear.
*stealth alert* Ms Redford told the Legislature “Family care clinics will include doctors, licensed practical nurses, and other health practitioners who can provide support to moms and dads who want to make sure that they can get access for their kids not in an emergency room at 11 o’clock at night but in their own community”.***
That made FCCs sound like a solution to ER overcrowding but didn’t answer the critical question: How are FCCs different from PCNs? And how will the government ensure that FCCs don’t cannibalize the family practices supported by PCNs.
It took more than 3 months of playing cat and mouse with the government to confirm that (1) both FCCs and PCNs provide healthcare through the same team of healthcare professionals, (2) both FCCs and PCNs give patients direct access to other health professionals without a doctor’s referral,** and (3) both FCCs and PCNs provide extended access to healthcare.
*stealth alert* Then on Mar 7, 2012, the political fog cleared and the true purpose of FCCs was revealed. While defending the Health Department budget, Mr Horne mentioned in passing that the pilot FCCs are owned and operated by the government, however “…opportunities do exist…for the FCCs to be community owned in the future and to be physician owned. That is a distinct difference from the current [PCNs].”****
Premier Redford and Minister Horne have been talking about FCCs for 3 months, both in the press and at the Health Care town hall meetings. Not once did they mention that the only “distinct difference” between the existing Primary Care Networks and the Family Care Clinics was the fact that FCCs could be privately owned and operated.
*stealth alert* In fact Horne’s response to very pointed questions about FCCs at the town hall meetings was this: (1) FCCs are not private delivery models but rather publicly funded models to deliver healthcare to smaller communities and (2) FCCs will enhance PCNs, not cannibalize them.
The proof is in the pudding. On Mar 23, 2012 Mr Horne announced the opening of a FCC in Calgary (not exactly a “smaller community”). It opened right next door to a PCN, forcing the PCN to close its doors. (One down 39 more to go). The PCN which cost $1 million to operate will be replaced by a FCC which costs 5 times as much. The response of the AHS…? Oops. “It was never our intent when we planned this clinic for the [PCN] to move out”.*****
*stealth alert* To add insult to injury, Premier Redford is on record as saying “Family care clinics are what Albertans want.”** I don’t know about you, but I’m drawing a blank when it comes to asking the government to use Family Care Clinics to drive Public Care Networks out of business, at 5 times the cost to the tax payer!
Premier Redford extols the value of transparency and authenticity in government. However her actions do not line up with her words. No surprise really, that’s what “stealth” is—a secretive act designed to make detection difficult if not impossible.
WARNING: You’ve entered the political fog, when you step into the voting booth on April 23, please ensure that your *stealth alert* device is on and fully charged.
*This was increased to $62 a head in Ms Redford’s effort to head off the bad PR created by the doctors’ insistence on a public inquiry into physician intimidation. Albertans were relieved when the AMA didn’t roll over in return for the $12/head increase.
**AMA President’s Letter Dec 23, 2011
***Hansard, Mar 20, 2012, p 665
****Hansard, Mar 7, 2012, 383
*****Calgary Herald, March 23, 2012, B1.
Susan on the Soapbox 
A superb analysis of how the good ship Lollipop is taking on water. Will she sink on April 23?
Phil, I certainly hope so! You, me and the rest of the merry band out here are working like dogs to make it happen!
Susan an excellent analysis of the Redford ‘stealth’ in pulling Family Care Clinics out of their political bag of tricks and mis-representing them as a solution emerging from both Albertans’ wishes and health professionals support. Another fitting term would be ‘denial’ – denial of her commitment to pilot test and evaluate them first; her denial that they would cost more and open private delivery options; denial that there is any political motivation here; denial that they will poach professoinals from the existing PCN’s; and denial that the AMA concerns are valid. This is the legacy of entitlement that accompanies 41 years of majority government.
David, your characterization of Redford’s behavior as denial is bang on. Sadly stealth, denial and misdirection appears to be the order of the day. I expected better of a Premier who billed herself as “authentic”. We’re depending on you and your Liberal, NDP and WR colleagues in the opposition to keep her honest!
The stealth alert model in Alberta should come equipped with flashing lights, beeping sounds and capable of producing rude smells for the next 20 odd days. PC’s are now “communicating” with us (as compared to the previous model of talking just to themselves). It appears that they, and especially the Premier, are trying to second guess or third guess what we are really wanting to hear and are depending on how the media and the polls are judging their stories to see if they need modifying. The notion of principled discussion, of community engagement and of working together to make a better province is not part of the PC culture, and we Albertans have to decide if we want to be treated this way for another four years. I do not!
Hopefully this election period will bring some laser sharp reporting (just like your blog) to the stories and myths we are being told. Then as people start to see the stealth alert in its full glory, they can come to the realization that the flashing lights and the beeping sounds means that a defunct party past its expiry date can be wiped off our landscape on April 23.
When the PCs started the privatization in 1993 I was part of that process. At the time, there were never any concerns about what was more efficient or less costly. The objective was that the number of public employees was going down, despite the fact that we were paid from the same bank account. The process was as disturbing as the pink slip. The kind of privatization you describe today is the so called by proxy. If you dig deeper you will find that someone in those FCCs is a dear friend and donor of the PC party. At that time, the media was totally enthralled with the process and had no qualms calling those losing their jobs ‘check grabbers’ and ‘do nothings’. Interestingly enough as soon as the crisis hit the media industry they were the first to cry out for handouts and that something had to be done to save newspapers. It did not surprise me they got very little support from the public.
What you describe today is amazing of course but not surprising. This is what has been happening in the last 30 years. The blind implementation of an ideology that means nothing to most of us.
A week has gone by and I still have no idea what Danielle Smith health care policies are. She is way more concerned responding to a Tweeter attack by a PC campaign member. Like a teenager she had to justify why she does not have kids. Let me get this, a 45 year old married professional woman aspiring to be premier of this province trying to justify why she does not have kids. Really? Who cares? Either because of infertility or choice is something that is private to her and her husband and whoever cares. That she finds necessary to justify is really mind boggling.
Thank you for letting us know about the Family Clinics. Interesting subject. I have to confess I had a very good feeling when they first talked about this concept. I am no longer sure.
Carlos, you mentioned the possibility that behind the FCCs we’ll find someone who is connected to the PC party in one way or another. This is my suspicion as well. The fact that Health Minister Horne kept the Alberta Medical Association in the dark while at the same time negotiating with certain doctors to set up the 3 pilot FCCs which opened on Apr 2 demonstrates that the process was not open or transparent. It also supports the notion that these FCCs will be privately owned very soon, otherwise there would be no need for secret negotiations. Please note, I’m not making any comment about the quality of care we’ll received from medical practitioners working in FCCs, just commenting on the lack of transparency and honesty demonstrated by the government in getting us there.
Carlos, thanks for sharing your experiences from the 1990’s. It really is time for a change!
Roy your point about the strength of the PCs policies being dependent on the opinion polls is a well taken. Redford’s flip flop over whether the MLAs should pay back the compensation they received for not attending the no-meet meetings was a classic example. First she decreed that the MLAs had to return their compensation, but only for the period of time that she was in office, then when the public didn’t buy that she decided that the MLAs would return their no-meet pay from the date that the no-meet committee was formed in 2008.
To paraphrase Greg Clark AP candidate running against Alison Redford, if it’s the right thing to do five days into an election campaign, it was the right thing to do a month ago, and it was the right thing to do two years ago,” Greg was talking about the funding for the Calgary drop in centre but his point is equally valid here.
This a very important election, I’ll see you at the polling station!
Thanks, Susan – a timely alert!
Actually, I think there ought to be a “stealth alert” for the PCNs, as well. They’re based on the UK NHS Trusts, and I think the general plan is that if you give a management board the health care funding, they will organize how to spend it. In the case of the PCNs, that non-profit board is self-selected local doctors, who operate basically in secret, with secret funding and accountability contracts with AHW and/or AHS, deciding what the community needs and what it gets as well as who gets what funding for what purpose.
From an article published in the Capital Health Quarterly Spring 2003, I gather that the PCNs got start-up grants possibly in addition to the per capita operating funding – and the “alternate payments” for the docs. It would be nice to know… and it would also be nice to know how the community is involved in the decision-making about what services are needed, and which services are achieving some stated goal, and….
All this is just a step away from an entrepreneur who can offer management services and….
Carol
Click to access chqspring2003.pdf
Valid point Carol, I was just getting ready to dive into the link (in a pathetic attempt to see if I could figure out this byzantine system of PCNs, “alternative payments”, FCCs, $12 more per head), when I heard Alison Redford’s latest campaign pledge. She’s promised to build 140 FCCs over the next 3 years. This was on Apr 2. the same day that the FCC “pilot” project kicked off! The Alberta Medical Association was supposed to be part of the advisory committee tasked with evaluating and monitoring the pilot project. What’s the point of a “pilot” project if you have no intention of evaluating and monitoring it? Now that’s stealth…or the sign of a government that is completely out of control. Thanks for your comments Carol…enlightening as ever.
10 Days into the election campaign and the party that wants to be government has talked about fertility and Danny bucks. Very isnpiring indeed. Health Care will be on the last day so that no one can discuss it. It will be as confusing as possible and no one will know if it means privatization or not. Very Sad
No Wonder really
http://thetyee.ca/News/2012/04/05/Low-Oil-Sands-Royalties/
Carlos, if the PCs have any political smarts they’ll do just what you suspect and hold off discussing Health Care until the last day of the campaign (if ever). Redford’s announcement shows extreme disrespect for the Alberta’s doctors who were told they’d have a chance to evaluate the FCC pilot project–instead they were blindsided by Redford’s announcement that she was steaming ahead with 140 more FCCs..
The Alberta Medical Association says that (1) adding 140 FCCs in 3 years will mean massive change at a time when the system needs stability not upheaval, (2) the overall integrity of the health care system will be strained (eg. where are the staff coming from?) and (3) there was absolutely no engagement of family physicians and and the health care teams in the 40 primary care networks (PCNs) which provide care to 2.8 million Albertans and involve 90% of all family doctors. This is critical because Redford says the funding for the new FCCs will come out of the existing budget for the PCNs.
Instead of working with the Alberta Medical Association, the PCs sent a “cease and desist” letter to them for daring to tell the public where they stand on the need for a judicial inquiry into physician intimidation. I am dismayed at what this government has come to. One can only guess at how far they will go over the next two weeks to stay in power.
Thanks for your comments Carlos and the very helpful link to the Tyee article.
Susan I absolutely agree with you. I could not even believe that in a time when our Health Care System is going through some very unstable times, that she would announce only 140 around the province. This is idiotic to say the least and makes me wonder whether there is a total lack of responsibility and reality not only with the government but the population in general. In a time when it is basically impossible to get doctors to the rural areas we are going to build clinics?
I have to say that last year I basically lost all confidence in the political system in Alberta and now I am really concerned that we may have a very serious political crisis as well. I frankly do not believe these people are at the minimum level required to run a province like Alberta. They certainly think so but I personally do not agree. Danielle Smith will be a disaster for this province in the long term. Alison Redford reminds me of Alison in Wonderland. I am very sad about this situation. Never thought that a province like ours, with great educational institutions and many resources would get to this impasse. It is starting to be a subject for jokes all over Canada. There are some interesting visions coming from the Liberal and the NDP but it is astonishing that these people sit 4 years waiting for the next election and are incapable of coming up with plans that are detailed and that clearly would disarm the government. Everything is just words without much background or serious research on how change can be brought about. It all sounds like they are all individually fighting for power and the the gold hansdshakes that it brings even at the end of just 2 cycles. It is very sad indeed. In the meantime the progressive parties (not so sure about this) cannot talk to each other at all. Individualism is king and will slowly destroy our capacity to do well in a complex world.
First of all, PCN stands for Primary Care Network not Public Health Network. Second, FCC’s are not a private take over of Health Care they are a government take over so that clinic services will be controlled directly by the government. (please see the package for starting an FCC). Third, most Physicians offices are Private yes Private. As a Physician the only way we are going to save Health Care is to contract out service delivery but keep the funding public. Right now there are huge lab and xray companies providing Private delivery but with Public funding. The private lab and xray services are far more efficient than the public ones.
Our clinic of fourteen Physicians runs a total operational budget of $750,000/yr. A five doctor FCC with union workers costs 4 million a year to run with a much lower through-put.
What Redford wants, is for the same people that provide such excellent management of the ERs and the hospitals (sarcasm) to run the Family Doctor’s office and have the Family Doctor as a direct employee. (again read the document sent to us).
FCC’s are far more expensive to operate and the current PCN’s are a very inefficient way to deliver the services they offer.
Just saying.
This is important feedback from someone in the system. Everything I’ve read supports the comment that FCCs are ridiculously more expensive than PCNs. What I’d like to learn more about is the inefficiency of PCNs and why this is the case. Thank you for your comment FS&GS.
On this sentence
‘Our clinic of fourteen Physicians runs a total operational budget of $750,000/yr. A five doctor FCC with union workers costs 4 million a year to run with a much lower through-put.’
Well I would like to understand why this difference – you put the emphasis on the union workers so does that mean the reduction of costs is because you use non-union workers and pay whatever you want? I am sure the doctors are not making less. I have seen this type of sentence over and over but I have not seen any explanation. Does this mean that the fourteen doctors do less than the five in your clinic? Mind boggling really.