Well-played political game by premier and health minister

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Premier Danielle Smith and Health Minister Adriana LaGrange, along with their staff, must be commended for their mastery of political tactics. Health care is expensive, with a huge payroll. Even small increases for these services are costly. The UCP backers want the government to be “good stewards of resources,” which seems to mean keeping taxes down by not spending. The minister must face great pressure in cabinet to restrain spending plans.

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Yet the government must be seen to do something during a time of health-care crisis.

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Population growth but falling nurse staffing, backed up emergency departments and rising procedure waiting lists are exacerbated by family doctors leaving the province for better conditions and support.

While other provinces have recognized problems and made immediate decisions to resolve their crises, Alberta is barely moving. The longer the delay, the greater the savings. Every week before new expenditures is a bonus — though the UCP can move quickly when public anger is major, as shown by cancellation of the Dynalife laboratory service, even at a high cost.

The greatest challenge is appropriately paying doctors. Here the minister’s delays are masterful.

Negotiating defuses anger, so she has established a committee for discussion with the Alberta Medical Association.

More than a year ago, the previous minister, Jason Copping, engaged physicians in creating a plan. That plan is now being discussed further, to then contribute to budget discussion, excusing doing nothing till April. After that, more time will be taken. It is unlikely any changes will occur before mid-2024.

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In the absence of real decisions, a series of announcements divert attention. The premier announced a reorganization of the health service. This will take months, more likely years, so no one can identify its failures till then.

They announced a plan to fund nurse practitioners in their own primary care practices. This will also take time, since there are few unemployed nurse practitioners ready to start immediately. Opening an independent practice requires complex planning. It requires faith that the system will continue supporting the practice for several years into the future. Only the most dedicated will take that plunge.

This promise was a low-cost outlay that generated favourable publicity from rural councils. It also stirred up inter-professional conflicts about the role of nurse practitioners and whether they should compete with family physicians or collaborate with them.

Talking to naturopaths also generated publicity and diverted attention, stirring the vexatious issues of their validity and role.

There are periodic announcements of doctors and other health-care staff being brought into local health services, but they are fewer than needed to build back to full services. And unless the conditions that drove away their predecessors improve, they, too, are likely to leave after a few years. But that will be the next minister’s problem.

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Much of the health-care system in Alberta has been underfunded for a long time. Specialist care in the cities is supported well, so the people who get to those services receive world-class care. The wealthy funders of the UCP who live in the cities get what they need. However, there are major deficits in primary care (especially rural care), psychiatric care, emergency medicine and specialist care outside the major cities. UCP voters live there, but since they are unlikely to turn against the party, they can be ignored.

Alberta could copy the best features of plans in other provinces that are attracting Alberta staff. To turn the tide, substantial funding must be announced immediately, for increased EMS staffing, emergency room staff and boosts to physician remuneration, especially in rural areas. Such announcements will give hope for longer-term improvements. Fine tuning can occur later.

Can Smith and LaGrange change their approach and use some of the $5.5-billion expected budget surplus for a Christmas present to Alberta, to encourage retention and real expansion of the health-care workforce?

Dr. James Dickinson is a professor in the departments of Family Medicine and Community Health Sciences at the University of Calgary.

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