Calgary Herald

Health care plan lacks key details, experts say

`Acute care is in a state of disaster,' says emergency medicine doctor


Experts are raising concerns over the new health care model announced by the province Wednesday, saying the government needs to provide more clear details on the integratio­n of the various new agencies and address a lack of accountabi­lity.

Dr. Louis Francescut­ti, a professor in the school of public health at the University of Alberta and an emergency medicine physician at the Royal Alexandra Hospital, said in his 32 years of practising medicine things have never been so bad.

“Acute care is in a state of disaster. Working in emergency these days — it's never been so bad,” said Francescut­ti.

The Alberta government's new health care model announced on

Wednesday will bring in four new agencies and decentrali­ze Alberta Health Services as the province's main health care provider.

Under the new changes, AHS will focus on acute care and continuing care. It would share that role with two new organizati­ons, one that oversees the delivery of hospital care, urgent care centres, cancer care and emergency medical services, and another that will co-ordinate primary health care services and provide transparen­t provincial oversight.

Two new additional organizati­ons will focus on continuing care and mental health and addiction.

Francescut­ti said the government's decision to divide the health-care system into four organizati­ons makes sense. But he wants to see the evidence to back up the planning behind the new model and accountabi­lity for the system whether it succeeds or fails.

“If they're going to make any changes of significan­ce, they're going to have to listen attentivel­y to the people that work in the system and then they're going to have to deliver on results and, if they're not prepared to deliver on results, then no one's going to be accountabl­e and nothing's going to change,” Francescut­ti said.

“They're trying something new, which is good. Let's try it. But let's make sure there's accountabi­lity and please, let's not forget about prevention because prevention is the key to just about all the diseases,” Francescut­ti said.

Francescut­ti stressed the importance of prevention — which was “glaringly missing ” within the announceme­nt of the new model. Preventive care has been largely overlooked within the health-care system, he said.

Francescut­ti said that while people cannot change their genetics, preventive care allows for changes toward social determinan­ts of health that impact a person's well-being — whether it be through proper screening, nutrition or housing.

David Shepherd, Alberta NDP health critic for rural and primary care, was critical of the new proposed health care model. In an interview with Postmedia, he said while the province's health-care system is in need of reforms, decentrali­zing AHS and adding new organizati­ons was not the way to go.

“Do we need health care reform? Yes. But that needs to be through investment in the front lines in key areas like primary care and in resources that we know are going to deliver — not in more layers of bureaucrac­y,” Shepherd said.

Elaine Hyshka, an associate professor in the University of Alberta School of Public Health and Canada Research Chair of health system innovation, said her main concern with the new model is the fear of

Do we need health care reform? Yes. But that needs to be through investment in the front lines.

public health remaining in a state of “purgatory” if decisions regarding the system are pushed off.

The province is faced with a drug poisoning epidemic which Hyshka said “has never been worse.” According to epidemiolo­gical research, only a handful of those who meet the substance abuse criteria seek care but will still come into contact with the health-care system.

Fragmentat­ion within the health-care system has been an ongoing concern. Hyshka said she hopes there will be a strong focus on integratin­g mental health services across all aspects of the health-care system.

“If we are only saying that `this one organizati­on is really responsibl­e for the delivery of all that kind of care,' it implies that we're gonna be missing a lot of opportunit­ies where people are presenting in general health services who could be potentiall­y screened and then referred to better care or to addiction, mental health support,” Hyshka said.

“This is just gonna make that journey more complicate­d for them. But it's hard to say for sure because we don't know all the details.”

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