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“Albertans already pay for the most expensive health system of any province in Canada. Yet they receive results that lag the results being achieved by the best-performing health systems in other jurisdictions. Albertans are paying for the best. Why would they not demand the best?”
-The Auditor General of Alberta, in 2017
Alberta spends about $22 billion a year of taxpayers’ money on health every year, or $2.5 million an hour.1 Of that, Alberta Health Service spends $15.2 billion, accounting nearly 25 per cent of the total provincial budget.2
The Canadian Institute for Health Information (CIHI) reported that for 2018, Alberta’s health care spending was the highest, per capita, of any province. CIHI also found that after adjusting for age and sex, Alberta spends over 38 per cent more person than neighbouring British Columbia and 33 per cent more than the national average.3
Despite the best efforts of our world-class health care professionals, Albertans have seen key outcomes of our healthcare system decline under the NDP.4 Patients face longer emergency room wait times, worse emergency room outcomes, declining outcomes for youth mental health care, longer wait times for hospital beds, longer continuing care wait times, and more people are waiting for continuing care placement.
- Open-heart surgery wait-times have increased by nearly 50 percent, from 14.9 weeks to 22.2 weeks, between 2014/15 and 2017/18.
- Cataract surgery wait-times have increased by nearly 30 percent, from 29.9 weeks to 38.4 weeks, between 2014/15 and 2017/18.
- Hip replacement wait-times have increased by nearly 30 percent, from 28.7 weeks to 36.7 weeks, between 2014/15 and 2017/18.
- Knee replacement wait-times have increased by 23 percent, from 33 weeks to 40.7 weeks, between 2014/15 and 2017/18.
- The percentage of patients from the Emergency Department (ED) treated and admitted to hospital within eight hours, has declined from 46 percent to 43.9 percent between 2014/15 and 2017/18.
- The percentage of patients treated and discharged in ED within four hours has fallen from 78.5 percent to 76 percent, between 2014/15 and 2017/18.
- The percentage of children receiving required scheduled mental health treatments has declined from 82 percent in 2014/15, to just 67 percent in 2017/18.
- The average wait-time in acute/subacute care hospital beds for continuing-care placement, has increased from 42 days to 51 days between 2014/15 and 2017/18.
- The total number of people waiting for continuing-care placement increased from 1,544 to 1,937, between 2014/15 and 2017/18.
- The percentage of clients placed in continuing-care within 30 days of assessment, has gone down from 60 percent to 52 percent, between 2014/15 and 2017/18.
- Only 52 percent of clients are placed in a continuing-care facility within 30 days of assessment. This falls short of the NDP’s target of 65 percent. The number has dropped from 60 percent in 2014/15, and 69 percent in 2013/14.
- 17.4% of patients in expensive acute care hospital beds could have their needs better met by an alternative level of care (ALC). That number has grown from 12.2 percent four years ago.
Under the NDP, patients face longer emergency room wait times, worse emergency room outcomes, declining outcomes for youth mental health care, longer wait times for hospital beds, longer continuing care wait times, and more people are waiting for continuing care placement.
A United Conservative government would reduce surgical wait times by:
Reduce surgical wait times to no more than four months in four years by replicating elements of the highly successful Saskatchewan model for health care reform, the Saskatchewan Surgical Initiative (SSI)
At the start of the SSI in 2010, 27,500 residents were waiting for surgery and over 15,000 waited three months or more. Four years later, only 3,800 patients waiting more than three months for surgery, a 75% reduction.5
Former Saskatchewan NDP Finance Minister Dr. Janice Mackinnon studied the success of the SSI, concluding that it succeeded because it put patients, rather than providers, at the heart of the system, and because strong leadership held the system accountable to achieving a three month wait time for most surgeries.6
Her findings have been echoed by research conducted by the Canadian Institute of Health Research7 and a 2015 Wait Times Alliance report, which found that “in five years the number of (Saskatchewan) patients waiting more than six months for surgery had dropped by 96%.”8
The Supreme Court of Canada ruled in its 2005 Chaoulli decision that “access to a waiting list is not access to health care,” and that unreasonable surgical wait times imposed by governments may constitute a violation of the “security of the person.”9
Thousands of Albertans are forced to wait for a year or longer for various surgical procedures, often in pain as their physical condition deteriorates. Alberta’s system is the most expensive health care system in Canada, and one of the most expensive publicly insured systems in the world. And this is despite the NDP increasing health spending by $3 billion, while wait times have continued to climb under their watch.
A United Conservative government would respect the spirit of the Chaoulli decision (which legally only applies to Quebec) by establishing an ambitious goal of reducing those waiting for more than three months for surgery by 75% by the end our first term.
According to former NDP Minister Mackinnon, one of the key reasons for the success of the SSI was that it invited specialized private day surgical clinics to bid on providing government insured surgeries. The data demonstrates that these clinics completed surgeries for 26% less than government hospitals on average, meaning more patients got treated at lower cost, reducing the number of people waiting in pain for surgery.10
In doing so, the SSI ensured that:
- third-party delivery must support a patient-first approach to health care through improving access, quality, and choice for patients and their families;
- third-party delivery must fully comply with the Canada Health Act, and all relevant provincial legislation and regulations;
- third-party delivery must be fully integrated within the publicly funded, publicly administered health system;
- third-party delivery must meet all necessary health system safety and quality standards;
- third-party delivery must be implemented through an open, consistent, equitable, and fully transparent selection process;
- third-party delivery must be financially responsible and the cost of the services must be equal to, or less than, what is offered by the publicly delivered health system.
Greater use of third-party delivery by a UCP government to reduce surgical wait times would comply with these criteria.
Former NDP Minister Mackinnon’s analysis of the SSI concludes that “Since patients would not be allowed to pay directly for the services, there was no queue jumping. There were no violations of the Canada Health Act: for example, the Act provided only that Medicare services had to be publicly administered and there was no requirement that they be delivered by public-sector employees in publicly owned facilities.”
A United Conservative government will pursue greater efficiency in achieving results for patients by:
This $1 million annual investment will establish more measurements and increase health care quality outcomes for patients.
A United Conservative government would increase the number and scope of Nurse Practitioners practicing in Alberta and allow Nurse Practitioners the ability to bill directly to Alberta Health. We will also expand the scope of practice of other health professionals, such as opticians and paramedics.
Many expectant mothers would like to choose midwifery services for childbirth, but the NDP has capped access to the service. Increased midwifery services in Alberta would both reduce costs for the health care system, and increase the standard of care.
Alberta’s opioid Crisis is a Public Health Crisis
Alberta’s Opioid Crisis is real, and it’s not going away. Addiction to painkillers, including codeine, oxycodone, methadone, hydromorphone, and fentanyl has risen sharply in recent years. Pharmaceutical-grade opioids are prescribed by physicians and surgeons. Prescription opioids are also available for illegal sale on the street, often “cut” or tainted with other compounds, including fentanyl.
Under pressure from the Opposition, the Government of Alberta declared the opioid crisis to be a public health crisis.11 There were 569 opioid-related deaths in 2017, and another 500 deaths in the first three quarters of 2018 alone.12 More than 1,700 people have suffered fatal opioid overdoses since Jan. 1, 2016.
In May of 2017, the Government of Alberta created the Minister’s Opioid Emergency Response Commission13, under the Opioid Emergency Response Regulation in the Public Health Act. The commission was charged with overseeing actions focused in six strategic areas: Harm-reduction, Treatment, Prevention, Enforcement and Supply Control, Collaboration, and Surveillance and Analytics14
Statistics compiled show that on average, two individuals die every day in Alberta as a result of an apparent accidental opioid overdose.17 From April 1, 2018 to June 30, 2018, 86 per cent of deaths occurred in larger urban municipalities (Edmonton, Calgary, Red Deer, Grande Prairie, Fort McMurray, Lethbridge, Medicine Hat).
In the first quarter of 2018, there were 2,830 emergency and urgent care visits related to opioids and other substances of misuse. In the previous quarter, there were 2,619 emergency and urgent care visits related to opioids and other substances of misuse.
Across Alberta, in 2018, community pharmacies dispensed an average of 1,577 naloxone kits per month. The Calgary Zone has had the largest volume of naloxone kits dispensed from community pharmacies, with an average of 589 kits per month. The Edmonton Zone dispensed the next highest volume with an average of 568 kits per month.
In July, 2018, the Minister’s Opioid Emergency Response Commission produced 32 recommendations for the government.18 The recommendations are overwhelmingly focused on “harm reduction” including more supervised consumption sites, more operational funding for supervised consumption sites, and more overdose prevention sites. Far fewer recommendation concerns treatment or enforcement. The government is acting on many of the recommendations including approving new overdose prevention sites in Red Deer and Medicine Hat.
However, The UCP has heard from law enforcement and health-related stakeholders that more urgency is required to address the opioid crisis, particularly with regard to strategies that are focused on treatment, recovery, and enforcement.
A United Conservative Government will launch an opioid response strategy including:
The Minister will work with other levels of government, across provincial ministries, and non-profit organizations to coordinate the government’s strategy to deal with the crisis. The Province of British Columbia also has a Minister responsible for Mental Health and Addictions.19
United Conservatives will provide $10 million per year for three years to expand access to drug treatment programming – $2.5 million for Calgary, $2.5 million for Edmonton, $2.5 million for the rest of the province, and $2.5 million to expand the Virtual Opioid Dependency Program. These funds build on an October 2017 one-time infusion of $4.6 million by the provincial government to deal with ongoing wait times at the drug treatment centres.20
The Virtual Opioid Dependency Program, as well as increased use of mobile detox programs, is designed to provide increased support to opioid addicts everywhere in the province.
United Conservatives will provide $2.5 million per year to launch this team within the RCMP’s ALERT. ALERT was established in 2006 to combat organized and serious crime. Currently, under ALERT, more than 300 municipal police and RCMP officers work together to investigate everything from drug trafficking to child exploitation to gang violence. There are specific teams dedicated to Organized Crime and Gangs, Internet Child Exploitation, Law Enforcement Training, Threat & Risk Assessment, and Criminal Intelligence.21 However, there is no team dedicated solely to opioids enforcement. ALERT’s total budget is about $29 million per year. This additional $2.5 million for this priority alone will represent a nearly 10 per cent increase in ALERT funding.
United Conservatives will provide $5 million to establish these courts, which will allow non-violent offenders to avoid prison by successfully completing a drug treatment program. Calgary and Edmonton currently have such courts. This funding fulfills a recommendation of the Opioid Emergency Response Commission to expand these courts in other regions of the province.18
A significant portion of Alberta’s opioid crisis is driven by foreign traffickers. Alberta’s RCMP and others have identified China as the principal source.22 The UCP will on the federal to increase resources to the Canada Border Services Agency to more aggressively interdict the importation of fentanyl and other deadly drugs. In addition, the Trudeau government has committed to eliminating mandatory minimum sentences for drug traffickers at a time when court decisions have further eroded law enforcement’s ability to protect society from those who are trafficking in opioids.23 A UCP government would build a coalition of like-minded provinces to press the federal government to maintain mandatory minimum prison sentences for drug traffickers.
Provincial funding related to substance abuse and other social challenges should be awarded to the best, most effective community-based models. A United Conservative government will ensure that successful faith-based models are and remain eligible for funding.
The Associate Minister (along with the Health Minister) will be tasked with reaching out to physician groups and other stakeholders to minimize the risks of drug prescriptions.
A United Conservative Government will Enact a New Multi-Year Mental Health and Addiction Strategy
The United Conservatives that the evidence that the opioid and addiction crisis is highly corelated to mental health.
That is why a UCP government will enact a new multi-year Mental Health and Addiction Strategy, based in part on the recommendations of the Report of the Alberta Mental Health Review Committee, and provide $100 million in additional funding over four years, on top of existing government funding: an extra $10-million in year one, then $20 million, then $30 million and $40 million by year four.
- Increasing earlier access to addiction and mental health services through primary care centers;
- Expanding home care to support those who identify addiction and mental health as a primary concern;
- Supporting Albertans in crisis by expanding programs to more communities including Police and Crisis Teams, Provincial Family Violence Treatment Programs, diversion programs and drug treatment courts, and by developing mental health court models;
- Increasing access to mental health services, and reduce recidivism and use of emergency departments for those in contact with the criminal justice system; and
- Supporting First Nations, Métis, and Inuit people and communities by establishing a continuum of addiction and mental health services, ensuring service provision is not disrupted by jurisdictional disputes, and increasing access to services to manage the impact of Indian Residential Schools on mental health.
Drug Injection Sites: A Sensible and Compassionate Approach
Drug injection and overdose sites are causing concern among Albertans for multiple reasons: discarded needles,24 the deterioration of communities and neighbourhoods,25 the attraction of drug dealers,26 and increased crime in surrounding neighbourhoods.
At the same time, Albertans want those living with addictions to be treated with compassion. Simply put, Albertans want those with addictions to be helped but they also want their parks, neighbourhoods and communities to be safe.
- Only endorse new supervised consumption sites if there have been extensive consultations with affected communities, including residents and business owners, and if there is a robust evidence-based analysis of the socio-economic impact of a potential drug consumption site.
- Only endorse new Overdose Prevention Sites if they have clear plans to provide treatment services.
- Conduct evidence-based socio-economic impact of analysis of existing drug consumptions sites.
- Consult with local communities, police, municipalities and others on the location of existing sites to determine if they are optimal, or if better locations could be found that would reduce the impact of crime, discarded needles, and other negative social and economic impacts on local neighbourhoods.
A United Conservative Government will strengthen palliative care
Albertans are living longer and experiencing increased incidence of chronic disease. Providing timely access to palliative care for those experiencing life-limiting illness is key to ensuring health system sustainability and quality of life for all Albertans.
The 2016 legalization of assisted suicide underscores an urgent need to educate Albertans about palliative care, why it matters, and which services are available. Now more than ever, the health care system needs to ensure access to high quality palliative care to alleviate suffering.
A 2018 report by Canadian Institute of Health Information on access to palliative care finds that only 1 in 6 Canadians utilize palliative home care in their last year of life. A 2013 study indicated 61% of Canadians died in hospital, while only 15% died at home. And a 2016 IPSOS poll revealed that only 50% of Canadians were somewhat familiar with the term “palliative care.”27
A United Conservative government would strengthen awareness of and availability to high quality palliative care, in part by:
- Continuing to shift from hospital to community-based home and hospice care. Albertans have indicated they want palliative care earlier in their health care journey and that they want this care in the home. Studies indicate that increased spending on residential hospices and home care generated equivalent savings in hospitals.
- Establishing and implementing palliative care education, training and standards for health professionals. One barrier to ensuring access to quality palliative care is a lack of appropriately trained professionals. Ensuring an adequate supply of health providers with competence in palliative care could dramatically improve access.
- Developing effective caregiver supports to support patients in their homes and community. Over 32,000 Albertans die each year which can include being supported by as many as five caregivers in the last year or two of life—with one in ten providing more than 30 hours of support a week; and one-third of caregivers report feeling distress. Maintaining the health and wellbeing of both patient and caregivers is vital to the entire health system.
- Raising public awareness of palliative care and how and when to access it. Nine out of 10 Canadians have expressed the need for improved knowledge of palliative care.27 Health promotion is needed to ensure Albertans with life-limiting illness understand palliative care and access the services to effectively address their health needs and maintain good quality of life.
Alberta is already home to a number of innovations in health care reform. One example is the Crowfoot Village Family Practice, a “wrap-around”, “medical home” care model which is a physician-owned family clinic and part of the Calgary Foothills Primary Care Network.
The Health Quality Council of Alberta studied ten-year outcome data from Crowfoot and found that:
- Crowfoot’s patients visited the emergency department 13% less than the Calgary average, and were admitted to hospital 17% less than the provincial average
- Crowfoot achieved same-day/next-day access for patients in the year it reviewed (2013).
- Crowfoot’s physicians see an average of 1,650 patients compared with the provincial average of 1,200 patients.
- 20 per cent of patient encounters were provided by multidisciplinary teams.
A United Conservative Government will eliminate waste in the healthcare system
“We need to make the most of every dollar spent in our $22 billion health care system, always with a focus on patient care.”
– UCP Leader Jason Kenney
United Conservatives have already announced plans to save taxpayers $590 million by cancelling the proposed Edmonton Laboratory Clinical Hub, known as the “Superlab,” and reversing the NDP’s $50 million payment to Dynalife to further nationalize lab services.28
A United Conservative government would also stop the NDP’s plan to waste $200 million on purchasing new laundry machines as part of its effort to create a government monopoly on the provision of laundry services to the Alberta hospitals.
In addition to improved efficiency, there are significant opportunities to identify and eliminate wasteful spending in healthcare. A United Conservative government will:
- Review the Connect Care contract and My Health Care Records to reduce potential duplication of services and ensure maximum effectiveness. E-Health records are critical for a safer and more efficient health care system. A United Conservative government will review progress on the front to ensure the best possible outcomes for the public money committed.
- Modernize paper health care cards to be combined with either driver’s licenses or provincial photo ID cards as a multi-use Personal Identification Card. In 2004, the Auditor General estimated fraud from using others’ health care cards at up to $80 million annually.29 The transition to secure Personal Identification Cards would cost about $50 million.
- Alberta Historical Fiscal Summary 2018-2021, http://bit.ly/2SpQMjM, 156.
- https://open.alberta.ca/dataset/8beb5614-43ff-4c01-8d3b-f1057c24c50b/resource/68283b86-c086-4b36-a159-600bcac3bc57/download/2018-21-fiscal-plan.pdf, 21.
- Alberta Health Annual Report, 2017/18, https://open.alberta.ca/dataset/4bb6bc99-ab59-47fd-a633-dfc27d7a049e/resource/94b95989-e03a-4acc-8bf9-f080f911abf0/download/health-annual-report-2017-2018.pdf
- Canadian Institute for Health Information (2015), Wait Times for Priority Procedures in Canada (April): 7
- Wait Time Alliance (2015), Eliminating Code Gridlock in Canada’s Health Care System: 2015 Wait Time Alliance Report Card: 2.
- Tables 1 and 2, Learning from the Saskatchewan Surgical Initiative, Janice Mackinnon, 2015 https://www.fraserinstitute.org/sites/default/files/learning-from-the-saskatchewan-surgical-initiative-to-improve-wait-times-in-canada.pdf
- Members of the commission are here: https://www.alberta.ca/opioid-emergency-response-commission.aspx.
- The minutes are here: https://www.alberta.ca/opioid-emergency-response-commission.aspx.