Insights (Essays)

Insights (Essays) November 2020

Aggressive Cuts Destabilizing and Irreparably Damaging Alberta’s Healthcare System

Lorian Hardcastle and Ubaka Ogbogu

AUPE 

The government’s plans to cut approximately 11,000 Alberta Health Services (AHS) jobs prompted hundreds of healthcare workers across the province to take job action in October, 2020 (Boothby 2020). The cuts will affect those working in housekeeping, laundry, food services and laboratory services. Health Minister Tyler Shandro mischaracterized these individuals as not being “front-line workers,” despite their essential role in the healthcare system and in combating COVID-19. The first round of cuts is already in motion with AHS releasing a call for proposals to outsource laundry services, which will result in the loss of 428 jobs (AHS 2020b). These and other cuts, and the aggressive pace at which they are being implemented, risk destabilizing the entire healthcare system. 

Workers laid off by AHS may be rehired by private contractors. In healthcare, private sector jobs are often associated with poor working conditions including fewer benefits, precarious hours, less job security, lower compensation and fewer workplace protections. Privatization is also associated with high staff turnover, which, in turn, raises concerns about proper training and adequate staffing levels. Given the composition of the affected workforce, the cuts will disproportionately affect women and racialized populations.

Jobs like laundry and housekeeping are accompanied by considerable risks such as exposure to biohazards and repetitive stress injuries. With privatization comes a risk that corners will be cut to generate profits thereby increasing the incidence of workplace injuries. Studies have also linked outsourced housekeeping to an increase in infections that can be costly to treat (Toffolutti et al. 2017). Privatization is touted as more cost-effective due to lower compensation for workers but it is unclear whether this initiative will generate significant savings for the healthcare system. When services are outsourced, contracts must include a profit margin to provide returns to shareholders. A recent report on the over 100 companies who have lobbied Shandro over the past few months includes two laundry service providers (PressProgress 2020). Some companies operating in this area are international, and thus profits may not stay within Canada.

AHS executives claimed that outsourcing services like laundry will reduce equipment and infrastructure costs. However, private contractors will likely build much of these costs into the price of their services. Furthermore, any borrowing they require to construct facilities or purchase equipment will be at higher interest rates than those available to the government. There is also a risk that while initial contracts may be favourable for AHS, these companies will subsequently increase their costs once AHS is reliant on their services.

The planned cuts prompted strikes at dozens of health facilities across Alberta by members of the Alberta Union of Provincial Employees (AUPE), which represents approximately 60,000 healthcare workers. AHS filed a successful emergency application with the Labour Relations Board to suppress these strikes and threatened noncompliant employees with disciplinary action. Government actions prompting health sector strikes are especially destabilizing as Alberta faces its highest rates of COVID-19 infections to date and a potential surge in hospitalizations. 

Another union, the Health Sciences Association of Alberta (HSAA), stated that it would respect AUPE picket lines. HSAA represents over 27,000 healthcare workers in the province, including pharmacists, respiratory technicians and lab technicians, some of whom are responsible for COVID-19 testing.

Although Minister Shandro promised that planned cuts to nurses will be postponed during the pandemic, when they do occur these cuts will add further turmoil to the healthcare system. The government managed to suppress recent job action but future strikes by one or more of these unions are possible given that their collective agreements with the government have expired.

Along with cutting the health workforce, the government plans to implement many other reforms. Some of these reforms, such as those targeting unnecessary care, consolidating services and ensuring that patients are expeditiously discharged from hospital, are arguably sensible. However, it will be extremely difficult to implement transformative changes to the healthcare system if there is significant tension between AHS and its staff due to aggressive layoffs and other cuts. AHS itself has acknowledged the “negative impact” workforce changes can have on “morale and engagement,” and that workforce changes come with a “future risk of having insufficient workforce to meet needs” (AHS 2020a).

It is clear that the government must achieve cost savings in the health sector. However, the extent and pace of the planned and proposed changes are reminiscent of Premier Klein’s deep cuts, which devastated the health sector and required subsequent governments to revive the system by pouring money into it. Before aggressively proceeding with its cuts, the government ought to carefully consider both their long-term ramifications and immediate consequences, such as weakening the healthcare system during a pandemic and terminating jobs during an economic crisis.

About the Author(s)

Lorian Hardcastle is an associate professor in the faculty of law and Cumming School of Medicine at the University of Calgary in Calgary, AB.

Ubaka Ogbogu is an associate professor in the faculties of law, and pharmacy and pharmaceutical sciences at the University of Alberta in Edmonton, AB, and a Pierre Elliott Trudeau Foundation Fellow.

The opinions expressed here are those of the authors and do not represent those of the Pierre Elliott Trudeau Foundation.

References

Alberta Health Services. 2020a, August 13. AHS Performance Review Proposed Implementation Plan. Retrieved November 15, 2020. <https://open.alberta.ca/dataset/e07fb93b-806f-4d91-bceb-640ea4ba5473/resource/c4890bfa-bc7c-48e2-8c95-e34c9c15f1da/download/health-ahs-review-implementation-plan-2020-08.pdf>.

Alberta Heath Services. 2020b, October 23. Request for Proposal Issued for Third Party Provision of Laundry services. Retrieved November 15, 2020. <https://www.albertahealthservices.ca/news/releases/2020/Page15681.aspx>.

Boothby, L. 2020, October 13. Health Ministry to Cut 11,000 AHS Jobs to Save $600M Annually After Three Years. Calgary Herald. Retrieved November 15, 2020. <https://edmontonjournal.com/news/politics/health-ministry-to-cut-11000-ahs-jobs-to-save-600m-annually-after-three-years>.

PressProgress. 2020, November 12. Over 100 Private Companies Lobbied Alberta’s Ministry of Health in Just the Last Few Months. Retrieved November 15, 2020. <https://pressprogress.ca/over-100-private-companies-lobbied-albertas-ministry-of-health-in-just-the-last-few-months/>.

Toffolutti, V., A. Reeves, M. McKee and D. Stuckler. 2017. Outsourcing Cleaning Services Increases MRSA Incidence: Evidence from 126 English Acute Trusts. Social Science & Medicine 174: 64-69. doi: 10.1016/j.socscimed.2016.12.015. 

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