This new map shows the extent of Alberta's rural health-care problems — and this old report may hold solutions
Recommendations released in 2015 still relevant in 2023, says former MLA who led rural health-care review
Closed emergency rooms. Unstaffed acute-care beds. On-again, off-again obstetrics.
At any given moment, there are dozens of issues like these at rural hospitals across Alberta.
It's no secret that rural health-care is struggling. But the scale and extent of the problems may not be obvious, especially if you live in Calgary or Edmonton.
Urban folks may hear one-off news stories about the recent emergency-room closure in Milk River, or the lack of maternity care in Pincher Creek, or the "temporary" closure of the ER in Hardisty — which has now stretched on for more than three years.
But these one-off stories barely scratch the surface.
A lack of access to medical care is a daily reality in many rural areas. It's not a new problem, nor is it unique to this province. Similar challenges exist across Canada and around the world.
It was nearly a decade ago that then-premier Jim Prentice ordered a review of rural health care in Alberta. The review committee spent months speaking with residents of more than 100 communities and put forward 56 specific recommendations to help solve what it described as systemic issues.
But its final report was released just before the the 2015 election and largely overshadowed as the PCs lost their 43-year grip on power to the NDP.
Richard Starke, who oversaw that review and has since retired from politics, says subsequent governments — both NDP and UCP — have largely ignored the report's recommendations. But he believes they remain relevant today, as rural hospitals continue to struggle with staffing challenges and consistent delivery of basic care.
"We heard a lot about the desire of rural Albertans to be able to live their entire lives in the community — from birth through until death," Starke said.
That's often not possible, however, given the service disruptions at so many small-town hospitals.
Just how widespread are the issues? It's hard to express in words.
Rather, a visualization might help.
Visualizing 2 years of disruptions at rural hospitals
Alberta Health Services (AHS) has a dedicated website outlining the medical-service disruptions across all its facilities, which is updated twice a week.
Occasionally, a hospital in Calgary or Edmonton shows up, but typically the list is comprised entirely of rural facilities.
The list is archived, dating back to August 2021. CBC News has combed through that archive, extracting and compiling the data on all the closures and service reductions over the past two years, up to July 2023.
All that data is visualized in the animated map below.
Each disruption appears as a dot on the map. The dots are colour-coded by the type of medical service that was affected.
The timeline at the bottom "plays" from August 2021 to July 2023. As a disruption begins, it appears as a dot on the map. When the disruption ends, the dot disappears.
The number of disruptions at any given moment, by type, are enumerated along the left side of the map and charted along the timeline at the bottom.
You can zoom in and out and scroll around the map to take a closer look at specific regions.
You can also "pause" the timeline and click or tap on any of the dots to get specific information about a particular service disruption.
The nature of the disruptions
Some of the dots flicker, indicating an on-again, off-again availability of service.
The emergency room in Cold Lake, for instance, has seen more than two dozen separate disruptions over the past couple of years. Some lasted only a day or two, others for several weeks.
The ER in Hardisty, by contrast, appears as a solid dot throughout the entire timeline. It initially closed at the beginning of the COVID-19 pandemic on what was supposed to be a "temporary" basis. More than three years later, it has yet to reopen because of ongoing staffing challenges.
Similarly, the solid dot in Sundre indicates a lack of obstetrics service that has persisted for several years. Staffing issues at the town's Myron Thompson Health Centre predate the pandemic and have yet to be solved.
Obstetrics are a common type of service disruption in other parts of the province, too, typically due to a lack of physicians or available anesthesia, forcing many rural Albertans to travel long distances to give birth.
Acute care reductions are also common.
The Beaverlodge Municipal Hospital has been unable to staff about a third of its acute care beds for years now. In Fort Vermillion, about half of the beds at the St. Theresa General Hospital have been unstaffed since December.
It's a similar story in Manning. And Oyen. And Peace River. The list goes on.
In Boyle, all 15 acute care beds have been out of service since July 2022 due to a lack of staff, while the emergency room has been closed every night from 9 p.m. until 9 a.m. the next day.
The disruptions led to a tense community meeting earlier this year, attended by hundreds of area residents, many of whom worried the Boyle Healthcare Centre would close altogether. Officials assured them that was not the case, but so far have been unable to solve the staffing issues.
Issues like these led the Alberta government to undertake the review of rural health care nearly a decade ago, according to the man who oversaw the process.
Report lost in churn of politics
The review committee was chaired by Richard Starke, who served as the Progressive Conservative MLA for Vermilion-Lloydminster at the time.
Starke later ran for the PC leadership but lost to Jason Kenney, who ran on a platform of merging the PCs with the Wildrose Party to create what ultimately became the United Conservative Party.
Starke refused to join the UCP and ended up being the last PC MLA to sit in the legislature, even after the party effectively ceased to exist. He later retired from politics.
In an interview with CBC News last week, Starke said the review committee's recommendations fell by the wayside as Alberta politics churned.
The committee's report was released in March 2015, and many of its recommendations hinged on decentralizing control of health decisions — a major shift away from the centralized model the PC government, itself, created in 2008 when it merged regional health authorities into a single entity, now known as Alberta Health Services.
After receiving the report, Stephen Mandel, who was health minister at the time, immediately announced a plan to break up the health-authority monolith into as many as 10 "operational districts" that would provide more local autonomy when it comes to rural health-care decisions.
But in May 2015, the PC government was defeated in a general election, and the new NDP government scrapped the decentralization plan.
Starke said the new government also ignored other recommendations, with one notable exception: the NDP did follow through on expanding the mandate of the Rural Physician Action Plan, an organization originally focused on helping small communities attract and retain doctors. Its work now includes more than just doctors, and it has been renamed the Rural Health Professions Action Plan.
When the NDP were defeated in 2019, Starke said he found little interest from the new UCP government in the report's recommendations, either, apart from a preliminary conversation with the office of then health minister Tyler Shandro.
"I indicated a willingness to sit down or have a conversation or an interview ... to try to help out," Starke said. "And I was never contacted again."
Where things go next
The 2023 provincial election churned Alberta politics yet again.
The UCP, with its new leader Danielle Smith, won one of the closest elections in provincial history and emerged with a rural-dominated caucus.
In her mandate letter, newly appointed Health Minister Adriana LaGrange has also been tasked with reforming Alberta Health Services "to better decentralize decision-making."
Many of the recommendations in the 2015 report fall along a similar theme. The committee found that, while the problems with rural health-care delivery may be similar from town to town, the solutions in Pincher Creek may look quite different from those in Peace River.
"A 'one size fits all' approach to rural service planning and delivery will not work for rural Alberta," the report reads.
A key recommendation was "to 'unshackle' health service planners from their provincially driven bureaucratic structures and allow them to authentically plan with communities and innovate to meet their unique health-care needs."
Starke recalled the conversations he had with rural Albertans, over and over: "There was a tremendous frustration expressed to us, especially by people who were directly involved in the administration of rural hospitals, about the loss of their ability to control their own facility."
Of course, alternative plans have also been explored that involve closing rural hospitals and consolidating services in larger centres.
That was the route Saskatchewan went in the early 1990s, when the NDP government under premier Roy Romanow controversially closed 52 small rural health facilities. The decision was deeply unpopular and has been used in political attacks against the Saskatchewan NDP for decades since.
Closing or consolidating rural hospitals was also among the recommendations in an Ernst & Young review of Alberta Health Services commissioned by the UCP in 2019, but LaGrange has since said that is not part of the government's current plans.
Asked if LaGrange would consider the 2015 review as part of any future restructuring of health-care delivery in rural Alberta, her press secretary Scott Johnston replied with an email that didn't directly answer the question.
"The government is committed to continuing to improve rural health care," the email reads.
"We are working with local health providers to enhance local decision-making authority so we can improve health care services for all Albertans. We're working to do that by incentivizing regional innovation and increasing our ability to attract and retain the health care workers we need."
Starke says the recommendations in the 2015 report were not based on a particular political ideology and, while they are now more than eight years old, he believes they are still relevant.
"These recommendations are not partisan," he said. "They're not something that belongs to one party or another. These are things that need to be done."
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