The Alberta health-care workers union is challenging the provincial government’s claims that Alberta Health Services is no longer in crisis and is offering recommendations on how the province can more transparently track response times and improvements and be held accountable.
“Despite what we’re being told, the crisis in health care is not over,” said Mike Parker, president of the Health Sciences Association of Alberta (HSAA). “We’re concerned about the oversimplification of the crisis in health care and these proposed solutions.”
The HSAA is the trade union that represents approximately 29,000 paramedical technical, professional and general support employees in the public and private health-care sectors of Alberta.
“If Albertans are being told EMS is being fixed, they need to know three things: EMS is fully staffed, that we’re taking care of the people who take care of us and paramedics will be there when we need them,” Parker said Wednesday.
“HSAA is recommending response times be measured on a call-to-door (basis) to better reflect the patient experience, (that AHS) release the numbers showing unfilled shifts and dropped ambulances — because AHS officials get these numbers twice a day — and show proof that working conditions are improving and decreased injury rates would be a good start,” Parker said.
On Feb. 27, Premier Danielle Smith was joined by Health Minister Jason Copping and AHS administrator John Cowell to provide an update on Cowell’s first 90 days as head of AHS.
Cowell was hired after Smith fired the AHS governing board in November 2022, citing poor performance during the COVID-19 pandemic.
Cowell said the system is seeing incremental but measurable improvements in key stress areas.
“AHS is not in crisis and is not broken,” he said Feb. 27. “I believe you should have renewed confidence in AHS.”
He said emergency response wait times are now averaging 17 minutes rather than almost 22 minutes, and the wait time to see a doctor in an emergency ward has fallen by about 10 per cent.
Cowell said the number of patients waiting longer than the critically recommended times has decreased by more than nine per cent.
He credited the improvements to more staff, more ambulances and triaging 911 emergency calls to other health providers to free up paramedics for the most urgent cases.
“We’ve still got more work to do,” Cowell said.
AHS said EMS response times are improving despite a sustained 30 per cent increase in call volumes across Alberta. Comparing November 2022 to January 2023, EMS response times for the most urgent calls are down from 36 to 34.9 minutes in rural communities with fewer than 3,000 people and down from 63.9 to 57.5 minutes in remote communities.
Smith said that before she made changes to AHS, health workers were saying the system “was on the brink of collapse.” She said there’s been “significant progress in 90 days.”
“People now have confidence” in the senior executive team and in the system, the premier said.
“We’ve made so much process, we should just keep going.”
“They’ve moved it from 21 minutes to 17 minutes,” Parker countered. “These paramedics used to be at your door in less than eight.
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“They’re celebrating this three-minute improvement to 17 minutes, which has gone from a ‘critically ill condition’ to a ‘really bad situation,’ instead of improvements that actually get paramedics to your door in an appropriate amount of time.”
The HSAA presented some solutions: improving working conditions to retain the EMS workers Alberta has, recruiting new paramedics and emergency communications officers and reducing call volumes by tackling the opioid crisis “through harm-reduction services instead of a misguided abstinence-only approach.”
Parker added the front-line emergency response workers he represents haven’t seen anything change over the 90 days.
“There’s a disconnect because what we’re hearing on one side is government saying that help is on the way, the crisis has been fixed.
“But in their front-line daily jobs, they’re still seeing long response times, triage delays at hospitals, no coverage, code reds — these are all still happening today. Nothing has changed from that level,” he said.
Parker also thinks the improvements on paper the government reported are the result of changing the way response times are measured rather than actually improving response times. He said that response time used to be measured from the time the person called 911 to the time paramedics arrived.
“(Cowell) said response times for EMS are down but what he didn’t say is AHS is now measuring response times from the moment an ambulance is dispatched to the moment it arrives at the door.”
Parker gave an example.
“This week a call came in and it was determined the patient needed paramedics but there were none available to respond because the system was code red again. So the calls sat stacked for just over two hours before an ambulance was dispatched to respond.”
In addition to recommending “call-to-door” response time measurements, HSAA is also urging the government to release daily numbers of unfilled shifts and dropped ambulances, as well as evidence that working conditions are improving.
AHS spokesperson Kerry Williamson told Global News that AHS EMS “has always measured response time from the time the call is received at EMS Communications Centre to the time an EMS resource arrives on scene, and we are not changing that.”
According to an October 2022 AHS document, EMS response time is the time elapsed from when a 911 call is received at an EMS dispatch centre until the first ambulance arrives on scene.
Dispatch prioritizes all calls based on severity. Response time is calculated based on events thought to be life-threatening.
For metro/urban areas, AHS EMS has a median target response time for life-threatening calls of eight minutes. However, it is currently focused on responding in the 90th percentile, which is 12 minutes. In communities smaller than 3,000 people, that median target is 10 minutes (90th percentile is 15 minutes). In rural areas, that median target is 20 minutes (90th percentile is 40 minutes).
The 90th percentile means the response times for 90 per cent of activity.
In his statement, Williamson said the EMS shift-filling process is constant and can’t be measured by a single figure.
“Because of this, we cannot pinpoint a single comparative figure for volume of shifts unfilled, year over year; however qualitatively, we do know that the number of unfilled shift daily seems to be reducing, though still highly variable.”
Alberta’s UCP government has said health care, especially access to health care, is a top priority, and has allocated funding for more ambulances across the province, as well as millions of dollars to improve health-care facilities.
The 2023 budget included an extra $243 million over three years for primary health care to help reduce bottlenecks for those trying to see a family doctor.
Copping said that investment will include $40 million previously committed in a new agreement with the Alberta Medical Association.
The bulk of the money — $125 million — is to be used to implement recommendations currently being studied by advisory panels, such as the Modernizing Alberta’s Primary Health Care System (MAPS) panel, on how best to improve the system.
“Last week, the AHS administrator also told Albertans 19 new ambulances had been added to the service,” Parker said. “Ambulances do not provide emergency health care; paramedics do.
“We do not have enough paramedics and emergency communications officers (ECOs) to staff the shifts that are already funded. Announcing new units in this way is simply a sleight of hand.”
In 2022, 457 new EMS staff — including 341 paramedics — were hired in the province, AHS said. That’s been part of the 11.2-per cent increase in paramedics since 2019.
The Opposition NDP said the numbers aren’t painting a true picture of a health system that remains in dire straits.
“The truth is the UCP have starved and attacked our health-care system for almost four years,” said Lori Sigurdson, who is the NDP’s seniors, housing mental health and addictions critic.
The NDP also said that hearing the premier say “AHS is not in crisis” shows how “out of touch with Albertans she really is.”
–– with files from The Canadian Press
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