Hospital capacity plans questioned as UCP aims to lean on private clinics
Public health advocates and UCP MLAs found a rare common ground on the need to expand hospital capacity and be more transparent about funding, but the fault lines of where blame and solutions lie when it comes to the ongoing fourth wave still divides them.
In order to expand capacity in the province’s ICUs amid strain caused by sky-high Covid cases, surgeries have been cancelled, worsening a long-standing backlog.
Health Minister Jason Copping has outlined a plan to permanently expand hospital capacity, which Premier Jason Kenney confirmed includes ramping up publicly funded private care.
But health-care advocates worry about that direction. Sandra Azocar, executive director of Friends of Medicare, said in an interview with AB Today that well-funded public care is critical to making it through a crisis.
“I hate to think that we have politicians that will allow Albertans to die so that they can further their political agenda,” Azocar said. “To me, that’s just immoral. But, in a lot of ways, what we have seen throughout the history of this province is that’s the modus operandi of governments that seek to privatized our public health care — basically underfund, understaff and undermine our public health-care system and then bring in the private sector as the only solution.”
Last month, UCP MLA Shane Getson took heat for questioning AHS president and CEO Dr. Verna Yiu’s salary, as well as why the baseline capacity of ICU beds was so low. He later apologized, saying he shouldn’t have singled out any single AHS employee, but rather questioned overall management.
The government had pledged to cut a minimum of 100 AHS management positions following a UCP-commissioned Ernst & Young review of the health authority in 2019, but the implementation of those recommendations was postponed due to the pandemic.
UCP MLA Jason Stephan also wrote an open letter questioning why the health-care system hasn’t expanded to meet demand.
Azocar said it is fair to ask why the province’s baseline level of ICU beds isn’t high enough but noted much of the mystery around where money goes lies in the fact public dollars are funnelled to private operators, which are not obligated to disclose finances.
Patients in the crossfire
In order to expand ICU capacity, thousands of operations have been postponed — ranging from cancer surgeries to pediatric procedures.
Approximately 8,500 surgeries were delayed between September 13 and October 3, including 805 pediatric surgeries, Alberta Health Services spokesperson Kerry Williamson told AB Today.
In the same time period, AHS completed 9,100 surgeries. Of those, 3,500 were emergency surgeries and 1,100 were cancer surgeries.
Jen Wood’s 16-month-old daughter Robin has hypotonia and hyperekplexia. Her body burns through calories faster than typical children her age and she weighs only as much as an average six-month-old. After exhausting other methods — feeding formulas and a nasal gastric feeding tube — she was approved for gastronomy tube surgery, which had been scheduled for September 27. On September 16, doctors called to postpone it, and two weeks later, there is still no news.
Robin fiddles with a toy while sitting on her mom’s lap in their Fort Saskatchewan home. The same instincts of grabbing and pulling at her toy show why the interim solution of a feeding tube was not developmentally appropriate while she awaits her delayed surgery.
“We have one and she pulls it out every single day,” Wood said. “And so we have to put it back in every day. Well, she’s screaming and crying. And there’s more issues in terms of irritation and inflammation.”
Wood called on elected officials and unvaccinated Albertans to do their part to fix the problem.
“The decisions of this government, the decisions of those who are eligible to be vaccinated but haven’t — they have real world implications for my baby girl and so many others who rely on our health-care system to be there when they need it,” Wood said.
NDP Leader Rachel Notley called on the government to release daily updates to surgical delays alongside Covid numbers.
“These surgical cancellations count, and demographic information should be released alongside all the daily Covid information because it is every bit as important as the daily case number,” she said. “We are in a crisis. We need transparency, accountability and real, substantial action to get through it.”
In the short term, Notley is not opposed to private clinics providing surgeries to address the backlog on an emergency basis. But she said the government must release a long-term plan to reschedule all surgeries.
Where’s the money?
Surgical wait times were on the UCP’s radar before the pandemic plunged the world into chaos.
As part of a campaign commitment, the UCP pledged to study efficiency in the health-care system and find ways to cut back spending to ensure its sustainability. The party also promised to tackle the backlog through the surgical wait times initiative.
Along with the EY report, which contained 57 recommendations and 72 savings opportunities, the UCP government commissioned the MacKinnon panel study on the province’s overall finances in 2019. The latter recommended a variety of cuts, including in the health sector, to help the government reduce spending.
One area of focus for the government was moving patients to more appropriate levels of care.
“Hospitals are the biggest expense in the health-care system and the costliest place to treat and care for patients, the MacKinnon panel report stated. “In 2018/19, Alberta spent $8.7 billion on hospitals, which represents 42.6 per cent of Health’s operating expense.”
On the eve of the pandemic in February 2020, the UCP rejected a suggestion in EY’s AHS review to close rural hospitals and consolidate urban emergency departments. Instead, the government’s surgical wait times initiative involved funding alternative surgical facilities — privately run clinics funded entirely through the public system.
Azocar said the efficiency of that model is unknown because those private facilities are hidden under commercial confidentiality agreements. She said staffing is a finite resource and staff from the public system are lost to private providers.
The private sector takes on easier to handle, lower-risk surgeries — and when anything goes wrong, those surgeries go back to the public system, she added.
“We’re not really doing anything to improve the system,” she said. “We’re just basically passing the buck around and passing that riskier surgeries back onto the shoulders of the public system.”
Impact of 1990s austerity
The lack of ICU spaces goes back to decisions made decades ago — Monday marked the anniversary of then-Premier Ralph Klein blowing up the Calgary General Hospital, the facility he was born in.
Azocar said when the pandemic hit in March 2020, the province was still working to catch up from the lingering impacts of health-care cuts in the 1990s, following labour strife in the 1980s.
In addition to facility closures, the Klein government’s “billion dollar” health-care reform sought wage rollbacks, leading many health-care workers to flee the province.
“We lost an entire generation of nurses in the 1990s,” she said.
Subsequent governments brought in incentive programs over the following decades in an effort to build back the workforce. The UCP government cut many of those incentives when it unilaterally tore up the physicians agreement last year, only to walk back some of those cuts. It is still trying to cut pay for nurses, albeit with a lighter hand than a few months ago.
Azocar urged Albertans to pay attention to the long-term consequences of these decisions.
“We’re living in a critical situation where we’re watching our public health-care system fall off the cliff,” she said. “And people really need to be concerned about the politics behind what is driving this and ultimately what they want the outcome to be.”