A provincial review of rural health care is recommending a return to more local input.
The recommendations were among 56 released on Wednesday by the Rural Health Care Services Review Committee. The committee was created last September by Premier Jim Prentice to review the delivery of health care in under-serviced rural and remote areas.
Rural Alberta’s intense frustration with the top-down management approach of Alberta Health Services has led to a provincial recommendation to “re-launch AHS” and return health-care delivery to “locally autonomous districts,” the report states.
The review was conducted by a committee chaired by Vermilion Conservative MLA Richard Starke.
The report recommends eight to 10 operational districts to be established by AHS, respecting historical travel and trading patterns. It also recommends they be in place by July 1. The districts would be responsible for delivering local health services and meeting performance objectives. They would meet quarterly.
AHS says centralized decision-making would continue for new capital builds, the introduction of new technology, and corporate functions including finance, budgeting, human resources and communications.
Each operational district would have a local advisory committee made up of 10 to 15 members to provide local input from community leaders, Health Advisory Council and AHS representatives, patients and families.
In 2008, the province eliminated nine regional health boards and created Alberta Health Services to streamline the system.
Health Minister Stephen Mandel said the new health districts will push decision making down to the local level and reduce overhead costs.
“It’s more effective, more efficient, and more responsible to the local level to deliver the health-care services,” Mandel said during a news conference on the committee’s report in Edmonton on Wednesday.
“Each district will be responsible for establishing a patient-first program. This is something we heard at many different meetings. We need to be a patient-centric system, not a provider-centric system.”
When it came to AHS, rural Albertans ranked the need for more local decision making as a top priority.
According to the report:
—“Communities expressed frustration and resentment about how decisions with profound effects on their health facilities and programs were made in ‘ivory towers’ in Edmonton or Calgary by people who had no knowledge of their communities’ needs. Some presenters expressed anger that decision makers had never been to their community, never met with residents, and doubted they if they even knew where their town was located.”
—“The committee repeatedly heard about simple and routine maintenance tasks (changing light bulbs, fixing toilets, and installing new equipment) that were delayed by months and even years while awaiting approvals from ‘up the ladder.’ ”
Mandel said districts will be able to address the rural doctor shortage by working as integrated units and by reaching out to primary care networks to expand.
Another recommendation to increase the use of nurse practitioners, physician assistants or clinical assistants will also help.
Mandel said it will be up to the districts to determine how they use their facilities. For example, Red Deer Regional Hospital Centre has already moved some surgeries to other hospitals in the region and may decide to do more of that.
Other recommendations to improve rural health care focus on EMS by allowing ambulance crews to discharge their patients within one hour of arrival at an emergency department, and permitting rural ambulances to return to their home communities and not be diverted for calls outside their region.
Michael Dawe, who sat on the Red Deer Regional Hospital board, followed by time on the David Thompson Health Region board, called information released on the district advisory committees vague, and questioned its reliability coming on the eve of an election.
“There’s nothing that compels Alberta Health Services or Alberta Health, for that matter, to listen to the advice of these committees. They can offer it, but it can be equally ignored,” said Dawe, who will run as an independent candidate for Red Deer North in the next provincial election.
And if the province chooses who sits on the committees, how can it be called public input, he asked.
“I welcome anything that brings in greater local input. I guess we can be optimistic and hope that it means something.”
But Dawe said he has “files and files and files” of government reports on health care collected over the years, some containing good advice, that were also ignored.