Independent and arm’s-length public bodies play a critical role in high-functioning, publicly administered health systems. They provide expertise-driven and non-partisan inputs into the system, while maintaining continuity of vital functions between election cycles and changes in government. They can also help to counteract regulatory capture by shielding certain activities from political interference and rent seeking. In many health systems, the responsibilities assigned to these institutions include the regulation of health professionals and oversight of certain aspects of patient safety and health service quality improvement. 

On July 6, Alberta’s Health Minister Tyler Shandro introduced Bill 30 in the legislative assembly (Legislative Assembly of Alberta 2020). The bill makes significant changes –including facilitating the privatization of surgical services – paving the way for corporate involvement in the delivery of health services, and altering the manner in which doctors can be paid. While these aspects of Bill 30 have garnered significant public attention, other important amendments have flown largely under the radar. For example, there are concerns that the proposed legislation will compromise the independence, objectivity and expertise of key healthcare institutions, including the colleges responsible for regulating and disciplining health professionals and the Health Quality Council of Alberta (HQCA), a provincial agency responsible for pursuing opportunities to improve patient safety and health service quality.

Bill 30 will amend the Health Professions Act to increase public representation in the colleges from 25% to 50%. Public participation can bring more diversity to the oversight of health professionals, make colleges more reflective of the populations they serve and improve public trust and confidence in professional self-regulation. With the government being responsible for appointing the public members, this may, however, be seen as a guise to exert control over health professionals and to advance the government’s policy agenda by appointing individuals with whom they are politically aligned. This is a possibility, given several recent reports suggesting that the government tends to favour cronyism (Graney 2019; Rusnell 2020a). 

The government is currently engaged in a protracted compensation dispute with the Alberta Medical Association, with several doctors recently changing their practices or leaving the province. In response, the minister of health directed the College of Physicians and Surgeons of Alberta (CPSA) to change their practice standards in a manner that will make it very difficult for some doctors to close or leave their practices (Rusnell 2020b). Because of the government’s feud with doctors and its directives to the CPSA, increased public representation or more government appointees may be more about solidifying control over health professionals and suppressing opposition than about enhancing public trust and diversifying the composition of these bodies.

Bill 30 also impinges on the HQCA’s independence and objectivity. Under the Health Quality Council of Alberta Act, the council is an arm’s-length partner to the government and other health system stakeholders. The Lieutenant Governor in Council is responsible for appointing the HQCA’s board and directing its operation in conjunction with the legislative assembly. By contrast, the health minister’s role is administrative and consists of approving by-laws and CEO compensation, and requesting assessments and reports. The proposed amendments significantly expand ministerial control, thereby setting up the HQCA to help advance the government’s policy agenda. Under Bill 30, the health minister will be responsible for appointing the HQCA’s board, approving its annual plan and issuing directives to the HQCA. Other changes will permit the deputy minister of health to attend HQCA board meetings and require the HQCA to report to the minister of health rather than the legislative assembly. The council’s objective will shift from a leading role in health system monitoring and improvement to merely assisting in information and evidence gathering.  

Given that HQCA recommendations will not always be consistent with the government’s political agenda, eroding its independence will compromise the HQCA’s ability to advance evidence-based solutions. Evaluating and improving the quality of health services is a long-term, ongoing process that transcends election cycles and should not be influenced by the whims of the government of the day. In order to ensure the uptake of the HQCA’s outputs, it is essential to maintain the trust of health professionals and other partners in the system, which will not be the case if they are perceived as partisan. 

While the erosion of independence and expertise, and the exertion of government control is concerning, the government does have an important role to play in these bodies in terms of oversight and collaboration. However, this can be achieved through formal and informal administrative mechanisms, such as information exchange and reporting requirements.

There are deep concerns with the direction Alberta’s health system is going to take following the introduction of Bill 30. The stated goals of the amendments to the colleges and the HQCA are to “give Albertans a stronger voice and greater role in professional oversight” and to increase “coordination and accountability” (Government of Alberta 2020). However, given the considerable opposition to Bill 30’s privatization reforms and the government’s public feud with doctors, its true purpose seems to be increasing government control to advance a political agenda, weakening the structures that hold elected officials accountable and suppressing institutions that may act as barriers to the government’s political goals. 

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