What have the UCP been up to since forming government in April 2019? Since forming government, the UCP has relentlessly reminded Albertans they they will deliver on their platform, in which privatization of our public health is clearly underlined. This continues to be of great concern for those of us who believe that health care should be available to all, based on need and not ability to pay.
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MARCH 23, 2020: PHYSICIAN BILLING CODES
Following weeks of ongoing calls from physicians, the government announced new temporary physician billing codes so that doctors can be compensated for providing virtual care, just as they would for an in-person visit - and at the same rate Telus Babylon already receives. The change is very important in allowing patients to receive care from their family doctor at home, and limiting the spread of COVID-19. However, physicians have expressed concern with the limitations of the billing code, particularly that patients must initiate the virtual appointment.
MARCH 19, 2020: TELUS BABYLON APP
On March 17, 558 Alberta physicians sent an open letter to Premier Jason Kenney, urging them to change billing codes - including telehealth - to better allow them to treat COVID-19, and limit the spread of the virus. Days later, the Alberta government announced a partnership with Telus Health, through which health care is delivered via app, and paid for through an alternative relationship plan (ARP). Rather than implementing public solutions as per recommendations of front-line physicians about their professional needs, and the health needs of Albertans, the government instead chose to unilaterally institute a private service that will further fragment Albertans' access to primary care, and compromise their medical privacy.
MARCH 17: EXPEDITED BUDGET
Amid an ongoing and worsening pandemic, the government pushed through it's 2020 budget. Despite garnering much criticism for the heavy-handed cuts contained in the austerity budget since it's initial release, and calls from Albertans to reverse cuts in light of the COVID-19 outbreak, the government instead chose to leverage the political, economic, and health uncertainty garnered by the pandemic to expedite the passing of the budget. None of the typical committees for health or other ministry estimates were held, and the budget was passed Tuesday evening.
MARCH 15: COVID-19 FUNDING
Premier Jason Kenney announced today that he would be providing an additional $500 million to Alberta's health budget, in response to health costs associated with COVID-19.
This funding however, still leaves Alberta $200 million short of the minimum $700 million necessary just to meet inflation and population growth in 2020. Given the damage that has already been done in the form of funding cuts, staff cuts, and program closures, it is no more than a band-aid over an ongoing and growing problem – even before we take into account COVID-19 health care needs.
MARCH 13, 2020: STAFF CUTS ON HOLD
Health Minister Tyler Shandro has announced that plans to cut the number of front-line health care workers in Alberta would be paused for the duration of the COVID-19 pandemic. While this is absolutely the necessary move to make while our health care system is under additional stress due to this outbreak, the minister's announcement does not provide any assurance to the dedicated health care workers who continue to work tirelessly to ensure our safety during this difficult time, that their workplaces will remain adequately staffed once this pandemic is over.
MARCH 9, 2020: iOAT PROGRAM
Following the release of the SCS review committee report, the Alberta government will be cutting funding for injectable opioid agonist treatment (iOAT) as of March 31, 2021. The program provides doses of hydromorphone to people with chronic opioid dependency under supervision of a nurse. Currently, there are 65 patients in the program, who have one year to transition to other health services after funding ends.
MARCH 5, 2020: SCS REVIEW COMMITTEE REPORT
The committee appointed by the government to review the "socioeconomic impacts" of Alberta's existing supervised consumption services (SCS) has released it's final report, following months of online and townhall consultation with Albertans. Already, the report has been panned as biased or inaccurate by nurses, doctors, academics, criminologists, Edmonton Police Service, and City Councillors, among others. Shockingly, members of this committee chose to undermine the life-saving measures taken at these sites to revive individuals suffering what was referred to as “adverse effects.” To downplay the precautionary interventions of the qualified health care providers on staff at SCS facilities demonstrates ignorance when it comes to responding to an overdose, and calls into question the very basis of this panel.
Premier Kenney made comment in January that SCS may be "closed or relocated" as a result of this panel's findings, but Associate Minister of Mental Health and Addictions Jason Luan has yet to conclusively say whether sites will be closed.
MARCH 4, 2020: SURGICAL WAIT TIMES INITIATIVE
The government announced a $500 million investment as part of the Alberta Surgical Wait Times Initiative, and earmarked just $100 million of this amount to provide capital funding to upgrade and renovate surgical rooms and equipment and expand surgical capacity within the public system. But this announcement posed more questions than answers.
They have yet to indicate how their initiative will improve on the ultimate failure of the Saskatchewan Surgical Initiative, on which Alberta's initiative was modeled. Little clarity was provided as to which surgeries were considered lower or higher risk, and thus would be designated to different facilities, in different communities. And while they indicated there would be a "modest increase" in surgical staff, their budget made clear that staffing would be reduced across Alberta's public sector. Most importantly, we have yet to fully understand the seemingly major role that private surgical facilities will play in this $500 million overhaul of our surgical system.
MARCH 3, 2020: DOCTORS SIGN OPEN LETTER TO MINISTER
Nearly 600 physicians across the province have signed a letter warning that governments' "short-sighted decisions can inflict untold, avoidable harm to Albertans that get injured, sick, need surgery, have a mental health problem, develop an addiction, on the farm or in the city, or have a family member that does." The letter follows letters from the province's ER physicians and psychiatrists, and a petition with nearly 15,000 signatures, calling on Minister Shandro to return to negotiations with the Alberta Medical Association.
As of March 2, Minister Shandro said he is unaware of the letter, and chalked concerns up to "misunderstanding among our health professionals in the province about what has changed."
FEBRUARY 27, 2020: ALBERTA BUDGET
The budget sees a flatlining of the health care budget for 2020, with a spending increase of a mere 0.3% over the next three fiscal years. A minimum of 2.9% additional funding is necessary to keep Alberta's health care spending in line with inflation and population growth each year – the spending freeze through 2023, as outlined in today's budget, will mean fewer public dollars spent in the health care system. In terms of the impact on Albertans, the spending freeze will amount to a 9% reduction in health care spending in the next three years.
• Fewer family physicians and reduced rural care;
• Fewer front-line workers to provide care services;
• Privatization of surgeries and non-medical services like laundry, housekeeping, and food services;
• The reintroduction of the Affordable Supported Living Initiative (ASLI), which will see Albertans subsidize private for-profit facilities in favor of public ones, and the proliferation of the privatization of seniors’ care, and;
• No mention of continued funding to life-saving, evidence-based supervised consumption services.
FEBRUARY 20, 2020: TERMINATION OF AMA CONTRACT
Health Minister Shandro announced that his government would be terminating the long-standing contract between the Alberta government and the Alberta Medical Association (AMA), and, as per the MacKinnon Report, using “legislative options” to make changes to physician compensation. The government is implementing a new physician funding framework as of March 31, 2020, and physicians will be encouraged to move to a Clinical Alternative Relation Plan (ARP) payment model. This decision to unilaterally end its long-standing master agreement with Alberta’s doctors represents a dangerous precedent in the manner in which this government is willing to push forward their agenda.
They also outlined 11 consultation proposals that will not only negatively impact the financial bottom line for family physicians, but also for Albertans themselves. Some of changes include: Seniors' Driver Medical Exams will now be paid out-of-pocket, as will referrals for diagnostic imaging from practitioners like chiropractors, audiologists and physiotherapists; physicians will no longer be able to submit good faith claims for patients who can't provide ID; an end to clinical stipends, impacting rural care especially. Already, Alberta doctors are anticipating that they will have to close their practices or even leave the province due to the changes imposed by this government.
FEBRUARY 3, 2020: AHS PERFORMANCE REVIEW
Ernst & Young (EY), was contracted for $2 million to conduct a review of Alberta Health Services, with a focus on economics, rather than best health outcomes for Albertans. They released a report containing 57 recommendations that could result in an estimated $1.9 billion savings, though Health Minister Shandro indicated that not all recommendations were feasible, or would be implemented.
The recommendations outlined in this report ultimately have the potential to turn over our resources, health care dollars and staff to private companies that will be subsidized by public health care dollars, rather than put towards improving our existing public health care system.
JANUARY 31, 2020: SURGICAL SERVICES
AHS released a Request for Expression of Interest (REOI) for surgical services in Alberta. The request follows a government announcement of a new initiative to contract out surgical services. The REOI was not limited to hip, knee, and cataract surgeries as areas that will see further privatization, but also listed several potential procedures as areas of expansion for private surgeries, including gynecology and general surgeries, ie. hernia repair, mastectomy, and cholecystectomy.
We know that private delivery of surgical services costs more than public delivery, and we know that contracting out means that public loses our right to see what AHS pays for services from private suppliers, and is denied any input on how to provide or change services. Yet, the government is doubling down on their costly, risky plan to privatize Alberta's surgical services.
JANUARY 21, 2020: SUPERVISED CONSUMPTION SERVICES
DECEMBER 12, 2019: ALBERTA SURGICAL WAIT-TIMES INITIATIVE
In a press conference, Health Minister Tyler Shandro announced the government’s plan to reduce surgical wait times in Alberta. The minister confirmed that the planning for the surgical initiative was informed by the Saskatchewan Surgical Initiative (which ultimately failed to solve wait-time issues in Saskatchewan) but was unable to clarify the lessons that this government is taking from its failure. The announcement came with no monetary figures, no timelines, and no details, but made it clear that they would be increasing contracts to Non-Hospital Surgical Facilities, providing public funding to private practitioners.
NOVEMBER 29, 2019: FIRST CUTS TO FRONT LINE STAFF
On Black Friday, Albertans learned of the impending loss of well over 5,100 front-line health care jobs and another 2,500 public sector jobs, via the release of letters addressed to union officials from Alberta Health Services and the Government of Alberta. United Nursed of Alberta estimate the loss of 750 registered nurses and registered psychiatric nurses in the next three years. More job losses are anticipated following the commencement of the government’s review of Alberta Health Services (AHS). These announcements came alongside notice that AHS will be considering future contracting out initiatives, and the privatization of emergency, non-emergency and hospital transfer ambulance services.
NOVEMBER 14, 2019: PHYSICIAN BILLING
The UCP proposed that physicians stop billing for patients without valid Alberta health cards. This change would disproportionately impact vulnerable Albertans, and individuals experiencing homelessness in particular. Other proposed changes would alter the rates at which doctors can bill, including cutting funding for complex care plans, and restricting doctor pay for 25-minute visits to the same as for 15-minute visits. They have also proposed that the Alberta Medical association charge seniors for their mandatory renewal driving tests. Bill 21: the Ensuring Fiscal Sustainability Act will also limit the number of physicians allowed to practice in a given area of the province, as well as the number of physicians allowed per practice type or specialty.
Family doctors in particular, and especially rural doctors, have expressed worry about the impacts this would have on their ability to provide the care that their patients need. The Alberta Medical Association has called the proposed changes "troubling."
NOVEMBER 7, 2019: BILL 207
Peace River MLA Dan Williams introduced Bill 207: Conscience Rights (Health Care Providers) Protection Act. The bill passed first reading and was referred to the Standing Committee on Private Bills and Private Members Public Bills. Although the Charter of Rights and Freedoms already protects doctors and health care providers’ ability to refuse to provide health services or procedures to which they morally object, Bill 207 sought to allow health providers to refuse to even refer patients to an alternate health provider. This bill would impact Albertans' access to legal health care services, especially reproductive rights, medical assistance in dying (MAID), and LGBTQ2S+ health care - and particularly for individuals in rural areas.
Following much opposition from Friends of Medicare, other advocacy organizations, the official opposition party, and medical professionals, the bill was shut down at committee level. However, after MLA Mike Ellis tabled the committee's final report, MLA Dan Williams indicated that he wished to speak to the motion for concurrence, and so debate was scheduled for December 2. This debate was interrupted by a tragic incident outside the legislature, in which a man took his own life to bring attention to the issue of MAID access.
Instead of reopening debate once the house resumed, the bill was left to fail on the order paper.
NOVEMBER 4, 2019: MENTAL HEALTH AND ADDICTIONS ADVISORY COUNCIL
The UCP appointed a new 23-member panel to address access to mental health and addictions services. The panel replaces the NDP-appointed Minister’s Opioid Emergency Response Commission, which the UCP claims was too focused on a harm reduction approach. One of the panel's co-chairs is Pat Nixon, father to two sitting UCP MLAs.
Meanwhile, the existing supervised consumption site review panel has yet to report to the government. The findings of the report, expected by year's end, will inform the government's decision about whether or not to continue to fund Alberta's existing sites beyond March 2020.
OCTOBER 28, 2019: ALBERTA PRECISION LABS (APL)
Existing leadership of Alberta Public Laboratories was suddenly removed and the name changed to Alberta Precision Laboratories. The name change and the removal of the word ‘public’ signals a move towards privatization in Alberta's medical labs, as is consistent with the recommendations of the McKinnon Report. The future of lab services in this province continues to be uncertain.
OCTOBER 24, 2019: BUDGET 2019
Budget 2019 saw a slight increase in spending in health care in 2019, and a flat-line in health spending for the following three years. The 1% increase in 2019 far from meets inflation and population growth (3.5%), and over 4 years the spending freeze will amount to a 15% reduction in health care spending.
Some notable changes:
• The South Edmonton Hospital has been delayed four years
• The Child and Adolescent Mental Health building has been delayed indefinitely
• Assured Income for the Severely Handicapped (AISH) will no longer be indexed to inflation, impacting more than 66,000 recipients
• The reintroduction of ASLI means that privatization is ramping up in the continuing care sector
• $11 million cut from ambulance services
• Changes to the Alberta Seniors Benefit Drug Program could mean up to 46,000 people will lose their drug coverage
OCTOBER 17, 2019: EXPANDING LPN SCOPE
Health Minister Tyler Shandro revealed that the government would be widening the practicing scope of licensed practical nurses (LPNs). With an appropriate utilization strategy, an expansion to the role of LPNs could alleviate under-staffing in care settings and optimize the continuity of patient care, however, with the release of the provincial budget, the government confirmed that this move is intended to "lower the number of Registered Nurse (RN) funded hours per weighted resident day." Despite their assertion that this will have "no impact on residents’ quality of care," the government has the responsibility to establish an effective workforce strategy that includes the right mix of health care professionals in a variety of care settings, so that Albertans can be assured that staffing decisions are based on best patient outcome, not on budgets.
OCTOBER 15, 2019: LAWSUIT AGAINST OPIOID MANUFACTURERS
The Alberta government announced it would be joining BC a class-action lawsuit against opioid manufacturers, and seek to recoup health care costs connected to opioid over-distribution. Meanwhile, Albertans wait to see what measures the government will be taking to reduce the number of lives lost each day due to the overdose crisis, and to see what their Opioid Response Strategy will entail.
OCTOBER 11, 2019: LAB EQUIPMENT FUNDS ON HOLD
OCTOBER 10, 2019: VEGREVILLE SUPPORTIVE LIVING WORKERS LAID OFF
After all 53 workers at the Vegreville Century Park supportive living centre learned they would see their employment terminated, the Health Minister made clear that he would not be intervening. The Health Minister's press secretary, Steve Buick, said in a statement: "He sympathizes with the staff and understands the new operator intends to hire mainly from the existing staff, and that there are other jobs available in Vegreville and area, so he hopes most or all the staff will have jobs at the end of the transition."
In early October, BC-based private operator Optima Living, issued layoff notices to the workers following the decision to contract their work out to Pro-Vita, a privately-held company also based out of BC. Optima Living receives receives operational funding from Alberta Health Services to hire and retain staff, and will now be contracting out staffing to save money for shareholders. Starting November 1, the employees have the opportunity to re-apply for similar positions, but at $8 to $10 an hour less than what they were previously making.
SEPTEMBER 3, 2019: BLUE RIBBON PANEL REPORT
The UCP appointed Janice MacKinnon to chair the Blue Ribbon Panel, and to look into our province’s expenditures. The panel was given a very narrow mandate to examine expenses but not revenues, and was tasked with recommending a path to a balanced budget by the year 2022-23, without raising taxes. The panel released its report on September 3, and the recommendations included massive cuts to public services, which will directly inform the UCP's upcoming budget.
In the area of health care, the panel recommended "transformational change in the way health care services are delivered and health care professionals are compensated." Most concerning was the recommendation that the government expand the role of private health care in Alberta.
JULY 9, 2019: CONTINUATION OF ASLI
On July 9th, 2019, without media releases or formal statements, Health Minister Shandro announced on Twitter that the Affordable Supportive Living Initiative (ASLI) will continue under the UCP government. His announcement was made with a photo op at the Silverado Seniors Village, owned by Park Place Seniors Living. The ASLI program allows the government to provide up to 50% of funding for construction costs, followed by operational costs to run these facilities. Tax payers do not own the buildings, and once the contracts expire tax payers will need to buy the building back at the market price.
JUNE 28, 2019: BILL 9
Introduced Bill 9: Public Sector Wage Arbitration Deferral Act, enabling the government to delay wage arbitration for thousands of public sector employees, including many of the province's front-line health care workers. The government's decision to impose Bill 9 on all public sector workers not only violates their charter rights and breaks a legally binding contract with the employer it also undermines the importance of the vital work they do every day on behalf of all Albertans.
JUNE 26, 2019: BILL 203
Following Friends of Medicare's presentation to the Standing Committee on Private Bills and Private Members' Public Bills on Bill 203: An Act to Protect Public Health Care, the committee — comprised of 4 NDP and 7 UCP MLAs — voted to keep the bill out of full debate in the legislature. The bill would have protected our public health care system by prohibiting two-tier medicine, extra billing and any other form of private payment in relation to insured services, and would have banned queue jumping via cash payments.
This was possible because of a new Standing Order implemented by the UCP government, which allows government MLAs sitting in a position of majority to determine what bills presented by the opposition will proceed forward. As we saw in the case of Bill 203, these 7 MLAs now have the power to decide on behalf of 4 million Albertans whether we have the right to hear our legislators discuss proposed legislation that would impact each and every one of us. In the case of Bill 203, committee members' unwillingness to allow it to proceed to the Assembly for a fulsome debate on the importance of strengthening public health care in this province brings clarity to the direction that we can expect this new government to take.
JUNE 8, 2019: CONVERSION THERAPY
The government failed to take action to ban conversion therapy in Alberta, including refusing to reinstate the Conversion Therapy Working Group, or to commit to supporting their recommendations. Health Minister Tyler Shandro’s office has said that they “don’t think there’s a need to address [conversion therapy] specifically because it’s not a valid health service,” despite the fact that over 250 complaints have been made to Alberta Health from Albertans who have been subjected to the practice.
MAY 31, 2019: SUPERVISED CONSUMPTION SITES
Funding for proposed supervised consumption sites in Medicine Hat, Red Deer, and Calgary is suspended pending “socio-economic analysis” of the impact of the existing sites. The review has halted the development of the three proposed sites, and its results could impact the continued funding of existing sites across the province. Meanwhile, the government has not made clear what is in store when their “comprehensive approach” to substance addiction and misuse is eventually rolled out. What is clear is that Alberta is in the midst of an overdose crisis – a staggering 10,300 Canadians lost their lives between January 2016 and September 2018, with Alberta trailing only British Columbia in rate of overdose deaths. As of February of this year, the 3 existing supervised consumption sites in Edmonton alone have reported 420 overdose reversals and 15,335 referrals to other services and supports.
MAY 30, 2019: AHS REVIEW
As part of their election promises, the UCP said they would be commissioning a performance review of Alberta Health Services, with the intention of finding savings “on the administrative front,” despite the fact that AHS has the lowest administrative costs in Canada. On May 30 they began the review, with the final report on the $15.2 billion public health care agency due December 31. The real savings would be found if we looked at how much of our public health has been contracted out from under the public umbrella especially in home care and seniors’ care.
APRIL 22, 2019: EDMONTON LAB HUB PROJECT
As one of their first moves as government, prior to even being sworn-in, the UCP announced that the $590 million lab hub project would be put on hold until they have the opportunity to “review the project.” Then-Premier elect Jason Kenney claimed that this project “will do nothing to improve patient services,” a claim which is both inaccurate, and patently disrespectful to laboratory workers and the vital work they do for Albertans. Reporting from the Edmonton Journal showed that our current lab system is outdated and overwrought, and without a plan in its stead, this halt to what was to be a major expansion for our public laboratory services puts Albertans’ health care in jeopardy.