PUTTING PEOPLE FIRST PART ONE RECOMMENDATIONS FOR AN ALBERTA HEALTH ACT September 2010 LEGISLATIVE ASSEMBLY ALBERTA Fred Horne, MLA Edmonton-Rutherford September 15, 2010 The Honourable Gene Zwozdesky Minister of Health and Wellness Government of Alberta Dear Minister: Last September, I had the privilege of serving as co-chair of the Minister’s Advisory Committee on Health (MACH). On January 20, 2010, our report, A Foundation for Alberta’s Health System, was submitted to you. The Committee made four recommendations: • articulate a set of principles that must be sustained and maintained throughout Alberta’s health system; • legislate an Alberta Health Act for the future; • ensure ongoing citizen engagement in the development of legislation, regulation and policy including the development of a patient charter; and, • develop clear directions to guide legislative, regulatory, policy and program delivery changes across the health system. Government subsequently accepted the Committee’s recommendations, and on February 5, 2010, you appointed me to lead a province-wide consultation process regarding the proposed Alberta Health Act, other MACH recommendations, and to recommend next steps based on the feedback received from Albertans. An Advisory Committee was appointed to assist with this process. At this time, I am pleased to submit my report, Putting People First. The report is presented in two parts. Part One, Recommendations for An Alberta Health Act, offers 15 recommendations based on feedback received from Albertans. This report and recommendations were developed in consultation with, and are supported by the Advisory Committee. Recommendations address specific components of the proposed legislation, including principles, a health charter for Alberta, and public engagement with respect to future changes in legislation, regulation, and policy. In addition, a recommendation is included with regard to the development of an independent entity to support evidence-based decision-making. A possible framework for ongoing public engagement on broader health system issues is also included. LEGISLATURE OFFICE: 721 Legislature Annex, Edmonton, AB T5K 1E4 Tel: (780) 427-2235 Fax: (780) 422-1671 CONSTITUENCY OFFICE: 308 Saddleback Road, Edmonton, AB T6J 4R7 Tel: (780) 414-1311 Fax: (780) 414-1314 [email protected] www.assembly.ab.ca Part Two, Summary of Views, is devoted entirely to an overview of the diverse input received from Albertans through the consultation process. Input was gathered through 29 community workshops held in 23 communities across the province, with a combined total of over 1300 participants. We also conducted a public survey to which over 1500 Albertans responded, received over 85 written submissions, and held many meetings with stakeholder organizations. I am indebted to the members of the Advisory Committee who assisted with the design of the consultation process, detailed review of Albertans’ input, and development of this report and its recommendations. My thanks also to staff of Alberta Health and Wellness, Alberta Health Services, and so many others who assisted with the process. But most of all, I am indebted to Albertans who devoted many hours and a great deal of effort to carefully thinking through the issues and presenting thoughtful, insightful feedback on questions critical to the health and health care of Albertans, now and for generations to follow. On behalf of the Advisory Committee, thank you for the privilege of leading this important initiative. Sincerely, Fred Horne, MLA Edmonton - Rutherford Putting People First, Part 1 Recommendations for an Alberta Health Act DEDICATION This report is dedicated to Gary McPherson, who pursued the goal of wellness with zest and incredible determination throughout his life. The passion, wisdom and insight Gary brought to the Minister’s Advisory Committee on Health was instrumental in development of the Committee’s recommendations to improve the health of Albertans and build a stronger health care system for today and tomorrow. “Inourculture,responsibilityforpersonalhealthhasbeenabdicatedtothe professionals.Forreformtotakeplace,theindividualmustbecomethefocal pointofa“systemofhealth”.” WithEveryBreathITake.GaryMcPherson.2000 Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act ACKNOWLEDGEMENTS The valuable contributions made by the following individuals and organizations in shaping, informing and formulating this report are gratefully acknowledged: • All participants in the consultation process, for their open, honest, frank and heartfelt views. • Members of the Advisory Committee, who contributed their time, expertise and valuable insight: Mr. Greer Black, Past President, Alberta Continuing Care Association Dr. John Cowell, CEO, Health Quality Council of Alberta Mr. Greg Eberhart, Registrar, Alberta College of Pharmacists Dr. Tom Feasby, Dean, Faculty of Medicine University of Calgary Mr. Dan MacLennan, Former President, Alberta Union of Provincial Employees Ms. Deborah E. Prowse, Chair, provincial Patient and Family Safety Panel, HQCA, former co-chair, Minister’s Advisory Committee on Health Ms. Mary-Anne Robinson, Chief Executive Officer, College and Association of Registered Nurses of Alberta Dr. Trevor Theman, Registrar, College of Physicians and Surgeons of Alberta Members of Alberta’s 12 Health Advisory Councils, for their tremendous efforts in promoting and hosting community workshops in their regions to gather Albertans’ input for this report. • The communities of Airdrie, Athabasca, Brooks, Calgary, Camrose, Delia, Edmonton, Fort McMurray, Fort Saskatchewan, Grande Prairie, High Level, High Prairie, Hinton, La Crete, Lethbridge, Medicine Hat, Nanton, Peace River, Red Deer, Slave Lake, Spruce Grove, St. Paul, and Vermilion, for their gracious hospitality and warm Alberta welcome. • Employees of Alberta Health and Wellness and Alberta Health Services, who provided research and other support throughout the process. Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act TAbLE Of CONTENTS EXECUTIVE SUMMARY 4 Key Recommendations . . . . . . . . . . . . . . . . . . . . . . . . .4 The Components of the Alberta Health Act . . . . . . . . . . . . . .4 Realizing the Aims of the Alberta Health Act . . . . . . . . . . . . .6 Beyond the Alberta Health Act: Albertans’ Priorities For Action . . .7 Proposed Actions for Implementing the Recommendations . . . . .7 ROLE Of LEGISLATION AND PURPOSE Of THE ALbERTA HEALTH ACT 8 bUILDING THE ALbERTA HEALTH ACT, TOGETHER WITH ALbERTANS 12 fRAMING THE DISCUSSION 13 A fRAMEWORK fOR OUR HEALTH fUTURE 14 Recommended Components of the Alberta Health Act . . . . . . . 14 Realizing the Aims of the Alberta Health Act . . . . . . . . . . . . 19 Beyond the Alberta Health Act: Albertans’ Priorities for Action . . . 20 PROPOSED ACTIONS fOR IMPLEMENTING THE RECOMMENDATIONS 28 fINAL THOUGHTS 30 APPENDIX I – PROPOSED PUbLIC ENGAGEMENT fRAMEWORK 31 DRAFT PRINCIPLES TO GUIDE PUBLIC ENGAGEMENT . . . . . . 31 APPENDIX II – ROLES AND RESPONSIbILITIES WITHIN ALbERTA’S HEALTH SYSTEM 32 | 1 Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act CHAIR’S LETTER TO ALbERTANS “Thereisahumanstoryinthe HealthAct.” In September 2009, the Government of Alberta through the Minister’s Calgary Advisory Committee on Health (MACH) began a new conversation with Albertans about the future of Alberta’s health system and how Alberta’s health legislation should support that system. This spring, we continued that conversation. From May through August 2010, stakeholders and members of the public were asked to share their views on the Alberta Health Act, its proposed components and its implications for the health system. We travelled to 23 communities and conducted 29 workshops with a combined total of over 1,300 participants. We also had the benefit of over 85 written submissions from stakeholders and the participation of nearly 1,500 respondents to an Internet-based survey. An Advisory Committee of health professionals, stakeholders and members of the public assisted in these consultations and in the formulation of this report. This report is based on those extensive conversations. We heard a lot about what people are experiencing in their health system and what they want to see happen in the future. Overall, Albertans believe their health system works well for them when they need it. They supported creating an Alberta Health Act, which would set out clear principles as a framework for future decision-making. They provided a range of views on how to ensure the Act is effective and meaningful in promoting better health and better decision-making in the health system. They talked about how a health charter could contribute to better health experiences and how it needed to take into account the social, spiritual, health and economic realities faced by people. Albertans want a system that puts patients and people first. The Alberta Health Act, as Albertans envisioned it, has the potential to be the cornerstone of Alberta’s health system. It will give our province a principle- based framework that drives greater assurance and accountability. It will provide Albertans with a clearer understanding of what they can expect from their health system and support them in taking an active role as health citizens – not just as patients, but as people actively engaged in their health and the future of the health system. And it will help us move from conflict to dialogue through meaningful, ongoing public engagement. Albertans were also very clear with respect to changes to other existing legislation that governs our health system. 2 | Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act They told us to put the Alberta Health Act in place, then pause and reflect before opening up Alberta’s health legislation further. They identified the need to make deliberate decisions about the health system, its future direction, and policies to support that direction before changing what is there now. And, they said, involve us in that decision-making, because we’re proud of our publicly-funded health system and we want to work with government to ensure it is there for us in the future. Albertans want to know they are being heard, and have a constructive conversation that leads to meaningful input about the health system. In short, Albertans told us they want dialogue. They told us they want a health system that recognizes health as more than medical care and engages a multitude of community partners to support the physical, emotional, spiritual and social health of Albertans. They want a health system responsive to the needs of individuals, families and communities, rather than facilities, institutions and processes. Albertans described the need for a system that promotes wellness, and anticipates the changing needs of Alberta’s aging population. They talked about a system with stable, predictable funding that allows us to take a long-term view…a system that pursues innovation, continuously adapts and learns and ensures that Alberta has the health workforce it needs for the future. Albertans told us a key role of their government is to provide assurance about the performance of the health system – in terms of quality, safety, and the achievement of desired health outcomes. They said the broader determinants of health need to be recognized across the Government of Alberta and that this should be clearly evident in how policy and decisions are made. Their wisdom has been heard and this report represents the culmination of our conversation so far. The process that was undertaken built on the excellent work of the MACH last fall and has restarted the conversation about health between government and Albertans. It has involved a lot of listening and learning, and its results can help restore trust and confidence. I would like to thank all Albertans who participated in helping set out this principled framework for Alberta’s health system. It is stronger because of your input. Thank you. Fred Horne, MLA, Edmonton Rutherford | 3 Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act EXECUTIVE SUMMARY This report makes recommendations regarding the key components that should be included in the Alberta Health Act based on input received from Albertans. The report also proposes measures that should be taken to ensure the Act operates as intended. In addition, the report sets out priorities that Albertans have identified for action as Alberta proceeds to clarify outcomes, develop policies, revise legislation and make decisions for the future of its health system. Finally, the report recommends next steps for the Government of Alberta in pursuing further work on Alberta’s health legislation. Key Recommendations The Components of the Alberta Health Act Include principles to guide the health system. 1. Set out the aspirations Albertans have for their health system. Legislative language in the preamble to the Act should recognize Alberta’s commitment to the principles of the Canada Health Act. 2. Include overarching principles in the preamble that “put people first” and will guide policies, organization, operations and decisions throughout the health system. These principles should further define how our beliefs are to be reflected in the health system and guide our approach to health, including a view of health that gives greater focus to wellness. Establish a responsive and transparent public engagement framework to gather input from Albertans on an ongoing basis, and legislate requirements for engagement on future legislative and regulatory changes. 3. Establish a requirement within the Act that public notice be provided “Havehealthprofessional when regulations under the Act are proposed, with a specific notice period peopletravelandbemobile– to provide adequate time for public input. that’sthewayitusedtobe.” 4. Establish a requirement within the Act that any feedback received in an SlaveLake engagement process must be considered by the Minister prior to making proposed regulations. 4 | Alberta Health Act Consultation Report September 15, 2010 Putting People First, Part 1 Recommendations for an Alberta Health Act Provide for a Health Charter. Wellness“shouldstandonits 5. Require the establishment of a Health Charter and make it explicit in the own”asacorevalueofthe Act that the Health Charter will: healthsystem. Edmonton • Recognize that health is a partnership among individuals, families, communities, health professionals, organizations that deliver health care and services, and the Alberta government; • Acknowledge the impact of a person’s health status and other circumstances on their capacity to interact with the health system; • Not be used to limit access to health services; • Not be subject to or be the basis of litigation within the court system. “Wellnessandpublichealth 6. The Health Charter should specifically commit that all Albertans have havetospeaktoprevention. access to primary care services through primary care teams. Dealingwithissuesbeforethey becomeaproblemwillsave 7. Establish a requirement within the Act for a Health Advocate who reports thesysteminthelongrun.” to the Minister of Health and Wellness. The Health Advocate should be Vermillion mandated to do the following: • Provide education on the Health Charter and what it means for people and the health system; • Help people determine the appropriate resolution mechanism through which they can have their concerns addressed and resolved; • Provide assistance to Albertans in accessing appropriate resolution mechanisms in the health system through the use of education, guidance and referral; • Advocate on behalf of citizens who bring forward concerns under the Health Charter; • Review and report on individual Health Charter-related issues that are not addressed by current resolution mechanisms; • Report annually to Albertans. 8. Stipulate within the Act a specific time frame for periodic review of the Health Charter. 9. Include a requirement that professional colleges and other entities regulated under key pieces of health legislation, such as the Health Professions Act and the Regional Health Authorities Act, ensure their bylaws, codes of conduct and operating guidelines are consistent with the Health Charter, as well as complying with the principles contained within the Act. | 5 Alberta Health Act Consultation Report September 15, 2010