Alberta Premier Danielle Smith鈥檚 government recently announced it is eyeing reforms to the structure of Alberta Health Services, better known as AHS. In an editorial posted online last month in the , Health Minister Adriana LaGrange said the AHS had strayed beyond its original mandate to focus on acute care in hospitals. This is false. AHS, from the time it was formally created in 2009, has always had a broad mandate to deliver health care that did not stipulate it stick to hospital-based acute care.
LaGrange stated recent measures to improve health system performance revealed that AHS was working outside its mandate.
LaGrange wrote: 鈥淚t has become clear that Alberta Health Services (AHS) has evolved beyond its original acute-care hospital system mandate. Today, it is a comprehensive health organization that serves Albertans across various settings, from hospitals to clinics, continuing-care facilities, and beyond.
鈥淎s a result, AHS is shouldering a burden it was not intended to carry, and Albertans are facing long wait times and delays to the care they desperately need. This is unacceptable. We need to ensure AHS is able to focus on what they were originally established to do, while also improving care for those needing long-term care, family doctors, and more.鈥
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AHS, a massive sprawling organization of more than 112,000 direct employees, has been tasked since its creation in 2009 with delivering provincewide front-line care on a broad spectrum, from continuing care and midwifery services to acute care in hospitals.
On July 18, Smith directed LaGrange to explore reforms in her to the minister. On July 20, Smith told reporters in Edmonton the review is predicated on a concern that AHS has spread itself too thin and needs to focus on acute care alone. Smith has been sharply critical of AHS, accusing it of failing to rise to the challenge during COVID-19. Last November, she fired its governing board.
AHS original mandate
AHS was the final stage of a 15-year consolidation process that began in 1994, when the province collapsed 200 health boards and regions into 17 health regions. That 17 eventually became nine and in 2008 it was announced the nine would become one superboard, AHS. AHS became a legal entity in its own right on April 1, 2009, overseeing five geographic zones.
The legislation governing the new board was already in place under the existing . Section 5 of the act gave AHS a broad, sweeping mandate to deliver health care, including direction to 鈥渄etermine priorities in the provision of health services in the health region and allocate resources accordingly,鈥 and 鈥減romote the provision of health services in a manner that is responsive to the needs of individuals and communities and supports the integration of services and facilities in the health region.鈥
The legislation also spelled out that while AHS has the independence to pursue care priorities as it sees best, it is answerable at all times to the health minister and to cabinet. The minister鈥檚 authority, notes Section 16 of the act, grants the minster power to 鈥減rovide or arrange for the provision of health services in any area of Alberta, whether or not health services are also being provided in that area by any other government, person or authority, and do any other thing that the Minister considers necessary to promote and ensure the provision of health services in Alberta.鈥
Alberta Health Services acted immediately on its marching orders and continues to do so to this day. In its submitted on July 20, 2010, it recounted initiatives along the health spectrum, including: acute care and ambulance services, community and long-term care, addictions and mental health services, midwifery help, and prevention and protection measures such as a smokers' helpline and sponsored walks to promote weight loss.
Twelve years later, in its latest , AHS spells out how that work continues, 鈥渄elivering a broad range of healthcare on behalf of government, and in accordance with the mandate set by government.鈥
The AHS also submits to government overarching planning documents, titled Health Plans, which must be approved by the government. The latest details a 10-year vision to improve surgery and testing wait times while expanding community-based and home-care options. On page 10, it notes these plans fall within Section 5 of the Regional Health Authorities Act and on Page 6 states that 鈥渢his direction is fully aligned to government priorities and Alberta Health鈥檚 policy direction.鈥
There is an array of other documents from 2009 through the present affirming AHS鈥檚 continuation of its original mandate, including a 2016 agreement on between then-health minister Sarah Hoffman and AHS.
There is no documentation in a survey of reviews or reports that AHS has ever acted beyond its original remit.
On Dec. 31, 2019, third party accounting firm Ernst & Young submitted its findings after a massive, intensive of all AHS operations to determine if it was delivering value for money. Ernst & Young was not asked to conclude whether AHS was operating beyond its original mandate but did not cite in its report concerns that AHS was doing so.
The Alberta Ministry of Health and AHS both did not respond to requests for comment.
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