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Bill 43 - Emergency Health Services Act

November 6, 2008 - Second Reading

Ms Blakeman: Thank you very much, Mr. Speaker. I’m pleased to be able to rise in second reading and speak to Bill 43, the Emergency Health Services Act. Oh, this was a long time in coming, wasn’t it? I’m thinking back to when I was critic for Health and Wellness, and we had that amazing turn of events where the government told all the municipalities that they were going to take over responsibility for ambulance delivery and that they should reallocate the money in their municipal budgets for ambulance provision immediately and that they were going to take it over on April 1, and I think 30 days before that it was announced that, well, literally, all bets were off and that it wasn’t going to happen and that the municipalities were to continue to provide the service.

It was a bit of a shock to a lot of those municipalities. Frankly, it cost them quite a bit of money because most of them, being pinched for money, as I’ve raised many times in this Assembly, of course immediately reallocated the money when the province told them they could. Now it was reallocated. It was spent. It was gone. It was happening for other projects. Trying to scramble and find that money to put it back in there I’m sure was a huge headache to a lot of municipalities.

Time has gone on. We’ve had a lot of to-ing and fro-ing about who’s really responsible and who should really pay for it and who should be responsible for delivering it, and I gather that Bill 43 is the end of that. We now have the responsibility for delivering emergency health services taken from the municipalities and going to the Ministry of Health and Wellness. Now, based on what I heard the minister say earlier today, I’m assuming, then, that this service delivery will go in his line versus policy model under the line and will in fact fall under the superboard for managing that service delivery.

I know that most of the municipalities are very happy to have this happen because they’re not going to have to pay for this anymore. Frankly, from what I’ve heard from both the front-line workers and people either serving as elected officials or staff working for the municipalities, they think that ambulances are a part of health care. I think that where it gets confusing to everybody is where the ambulance transportation is not, strictly speaking, health care. It’s transportation. Once again we start to wade into murky waters there. I am not sure that this bill clarifies that sufficiently for my purposes, but I’ll need to go back and double-check the remarks of the sponsoring member to see if that’s been covered satisfactorily.

I’m sure others have raised the issue, but it’s an obvious one to me because there are a few locations in Alberta where we have integrated services for ambulance and fire. Yeah, it’s mostly fire and ambulance, I think. The municipalities had paid to put all of that in place. So is there going to be some financial recognition back to the municipalities for their efforts? You know, even joint buildings where both services could be delivered from the same building: are those to be pulled apart now and housed separately if they’re still housed together? Who pays for what? How do you decide that? If I could get some clarity around how it’s anticipated that that will happen because I’m sure you’ve worked out that question.

There are lots of possibilities here for privatization, the question of whether it’s appropriate for ambulances to be a private business and paid for with public dollars. Then there are the ambulance services that are paid for with auxiliary insurance dollars, which is your Blue Cross, for example. I’m not sure that all of those questions are answered in this bill either. I guess my question is: does the government care? Do they have a preference one way or another? If it’s not the municipalities anymore, then there’s nothing to say that it’s going to be a public service delivery. So do they care if it’s private? And how does that work?

Again, my concern is going to be where we’ve got assets – assets like buildings, the trucks, the ambulances themselves, the gurneys, and all of the other equipment that goes with it – that have been paid for by a municipality, and now that is taken over by the province and handed over to a private company. That’s inappropriate. If you’re going to play in that marketplace, play in that marketplace from scratch. So either those private providers should be compensating the municipalities or the government should. But what’s the deal there? How is that going to work? I’d like that on the record, please.

I also want to know how this affects the unions that are involved here, how it affects their collective bargaining agreement, and how they are affected by the provision that we had in the spring that mandated that emergency medical service personnel were – what’s the phrase I’m looking for?

Mr. MacDonald: Essential services.

Ms Blakeman: Essential services. Thank you.

I want to know how that’s going to affect the ambulance operators. Are they considered part of that or not? Does that now roll them in there without any additional choice on their part? In other words, does the passage of this legislation make that instantaneous?

I’m sure that I’m not the only person that has asked these questions because they’re the obvious ones to ask around this particular legislation. But I’m aware, for all of my cautions, that the municipalities have been looking for this one for a while. It’s got to be three years, anyway. This has been up in the air that long.

I guess my last question is: who ends up being where the buck stops? Does the buck stop on ambulance service delivery with the superboard, or is it under the department with the minister? Who is ultimately responsible? Of course, with that my question always goes: who is monitoring the performance and delivery of this, and how is enforcement handled if things are not going right?

What are we worried about here? Okay. Let’s say it gets privatized, and people are being, you know, asked for their credit card before they’re picked up, something inappropriate or what the public would view as inappropriate. Who makes the decisions about that? Where does the buck stop? How much control do they have over it?

Mr. MacDonald: That’s a good question.

Ms Blakeman: Yep.

Is there a transition period that’s anticipated with this bill? You know, what sort of financial and administrative assistance will be given for the transition?

As I said, I’m essentially supportive of what is happening here if for no other reason than the fact that we got certainty out of something that hadn’t been certain. I’m more or less happy to support it.

Mr. MacDonald: Oversight. Who is it going to be? Is it Alberta Health Services?

Ms Blakeman: Yes. Just to clarify, then. I’m looking for the oversight of the transition but also the oversight of the operation of this transfer to Alberta Health Services. Following this, I’m assuming that the oversight is the board, but where does the buck stop with the board? You know, who do you yell at if you’ve got a problem with them? Is somebody going to be able to find someone that will ultimately be responsible for saying yes or no, or does it sort of go around and around? I have to say that that’s one of my long-range complaints about the government. They set up delegated administrative organizations, which frankly is what the superboard is, and then when you ask the government questions, they say: oh, it’s not our problem; it’s the superboard’s. But you go to the superboard, and they say: well, we’re set up with…I totally lost my train of thought. Sorry about that. I’ll have to let that one go.

Those are the questions that I want to leave on the record in second reading. I’ll be looking forward to the responses when we get into Committee of the Whole. Thank you very much for the opportunity. Oh, that’s right; we had someone else who wanted to speak to this.

At this point I should move adjournment of debate for Bill 43.