Presentation by the Alberta Health Advocate
Excel Society, Edmonton, May 14, 2014
Thank you very much for giving me the opportunity to speak with you today about the new
Health Advocate’s Office. 50 years of service deserves to be celebrated and I’m very honoured
to be able to join you today and talk about Alberta’s new Health Advocate and what the Office
can mean for Albertans going forward.
The Health Advocate was created by the Alberta Health Act, which came into force on
January 1, 2014. So we’re a very new Office and a new idea for Canada, but not for other parts
of the world, where Health Advocates have been part of the health system for decades.
When the Health Act was introduced in 2010, it was written to capture the ideas and
aspirations put forward by people within the health system and from all across Alberta – what
they said was important for the health system going forward.
There was an extensive consultation process with
over 30 presentations by stakeholders and as
many written submissions, followed by 29
workshops in 23 communities across the
province. At the end of the day, Albertans said
they wanted to see clear principles to guide the
system. They wanted to have a system that
responds to the needs of individuals, families and
communities, rather than facilities, institutions
and processes. In the words of the Minister’s Advisory Committee on Health at the time, the
Health Act was to shape a “new, clearly defined understanding or ‘compact’ with Albertans
about their health, and their health care…” (A Foundation for Alberta’s Health System, p.2)
That’s why the Alberta Health Act begins by stating the fundamental principles that
underpin our expectations for the health system, including quality health services, reasonable
access based on need and not ability to pay, and an acknowledgement that our health services
need to recognize the needs of individuals, families and communities.
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The Alberta Health Act also creates the Health
Charter, which is intended to help build a shared
understanding about what people receiving care
and services can expect from the health system
and providers, our responsibilities as patients
and families, and how our expectations and
responsibilities balance with those of providers
and funders. I will talk more about the specific
provisions in the Charter a little later on - you
also should have a copy of the Charter at your table. Generally, though, the Health Charter
attempts to put into words the expectations and responsibilities that people have, but which
are sometimes taken for granted. Not just that, but often these are the expectations that we
think all people understand, but they don’t know about them. And that can include immigrants,
the disadvantaged and people marginalized by poverty or health status.
The creation of the Health Charter is directly related to the other big change introduced
by the Alberta Health Act - the creation of the Health Advocate. The position of Health
Advocate is intended to make the Charter more than words on a page. By putting the Advocate
in place, the Health Act gives Albertans a way to raise their concerns about the services they
receive and a place to go to when they need help getting their concerns addressed.
At the time that the legislation was passed, the then Minister of Health and Wellness
spoke in the Alberta Legislature about the role of the Health Advocate. I want to read you some
of what he said:

“Albertans told us that once a health charter is created, they want meaningful ways
of raising concerns about how the charter is applied. …

[The Health Act] provides for the appointment of a health advocate, who will be
accessible to the public, responsible for receiving complaints relating to the charter,
and who will have the ability to address these complaints.

If the health advocate finds that a person has not honoured the charter, the
advocate will have the authority to make recommendations as required to address
the issue…
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
… the health advocate must report annually to the minister, and the minister is
required to table this report in the Assembly, similar to the current reporting
structure of the Mental Health Patient Advocate….”
He went on to say that the Health Advocate is based on the Mental Health Patient
Advocate model, which he described as very successful. He also made it clear that the health
advocate will work at arm’s length from government, the same as the Mental Health Patient
Advocate.
Why is this arms-length relationship important?
Albertans need to be able to trust that the Health
Advocate is able to work without government
interference in its mandate. It is based on the
same "arm's length" model as the Mental Health
Patient Advocate, which has served the Mental
Health Patient Advocate Office very well. That
Office has credibility with stakeholders including
patients, providers and the public.
The MHPA is appointed by the Lieutenant Governor in Council, and is independent of
politics and government priorities that can change. It takes its mandate from the governing
legislation that outlines the powers and duties of both the MHPA and the Health Advocate
including mandate, confidentiality, disclosure etc. The Advocate reports directly to the Minister
of Health. The Mental Health Patient Advocate works without government interference, and
any decision of the MHPA is final. There is no right of appeal – its decisions are final.
Over the years, the MHPA has developed an independent operational plan, and retained
independent legal counsel. This arm's length relationship has enhanced the credibility of the
Office and facilitated open and frank discussions with stakeholders about concerns with how
the system is working for people. As a result of this experience the MHPA has been able to
provide helpful advice and input into legislative developments affecting patients and their
families. The Mental Health Patient Advocate has appeared before Legislative Committees, and
this participation has been welcomed and encouraged.
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The MHPA demonstrates accountability by reporting on activities in the Annual Report.
The Annual Report is submitted to the Minister and it must be tabled in the legislature. The
determination as to the final contents of the Annual Report rests with the Mental Health
Patient Advocate. In that way, the legislature and Albertans are confident that they are hearing
an independent message regarding the Advocate's mandate.
This successful model will be used by the Health Advocate to establish an arm's length
office that will fulfill the important tasks that have been given to the Office.
The Health Advocate is created by statute. As
such, the role of the Health Advocate is set out
in the Alberta Health Act, and the Health
Advocate Regulation. It is important to examine
those provisions carefully in order to understand
the full scope of the Health Advocate’s duties.
The legislated responsibilities of the Health
Advocate include:

Reviewing complaints that a person failed to act in a manner consistent with the Charter

Initiating complaints that a person failed to act in a manner consistent with the Charter

Making recommendations and reporting to the Minister if recommendations not acted
upon

Providing education on the Charter

Assisting people in finding appropriate resolution mechanisms to have their concerns
addressed and resolved

Informing people about existing health related programs and resources

Preparing annual reports for the Minister and the Legislative Assembly
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So what happens when the Health Advocate
receives a complaint that a person or
organization has failed to act in a manner
consistent with the Charter?
 Who can make a complaint?
 Who can be the subject of the complaint?
 What can the complaint be about?
 When can the Health Advocate conduct a
review?
Who can make a complaint?
The legislation does not require that complainants be personally affected in order to make
complaints. In this respect, the Alberta Health Act is significantly different than other legislative
schemes like the Ombudsman Act. The Ombudsman Act requires that the complainants must
be affected in their personal capacity.
Who can be the subject of the complaint?
The Health Charter guides the actions of Alberta Health Services, operators, health providers,
professional colleges, Albertans, and others specified in the regulations. As such, any of these
may be the subject of complaints.
What can the complaint be about?
The complaint must be about failure to comply with the Health Charter. And the Charter covers
much if not all that can happen within the health system.
The Health Charter includes the following
expectations: having health status, social and
economic circumstances and personal beliefs
and values acknowledged; being treated with
respect and dignity; having access to team-based
primary care services; having timely and
reasonable access to safe, high quality health
services and care; and having the opportunity to
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raise concerns and receive a timely response without fear of retribution or an impact on health
services and care.
As well, the Health Charter includes
responsibilities and individuals understand that
they will be asked to: respect the rights of other
patients and health providers; ask questions and
work with providers to understand the
information being provided; treat health services
as a valuable public resource; learn how to better
access health services; and make healthy choices.
Finally, the Health Charter contains an
expectation that when economic, fiscal and
social policies are being developed by the Alberta
government, their impact on public health,
wellness and prevention is considered and steps
taken to ensure that public policy is healthy
policy. This was included to emphasize the
importance of the social determinants of health
and the impact that all policy has on our health.
When can the Health Advocate conduct a review?
The Health Advocate can undertake a review when it receives a complaint from anyone about a
Charter breach. There are a number of limitations on that for example, the Health Advocate
must refer complaints to another person or body where the complaint relates to a matter that
is within the jurisdiction of that person or body.
As well, the Health Advocate has a number of discretionary grounds for refusing to
conduct a review. For example, the Health Advocate may refuse to conduct a review or cease
conducting a review:
(a) if the matter is the subject of an ongoing investigation by a law enforcement agency,
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(b) if the complainant refuses to provide information requested by the Health Advocate to
substantiate or support the complaint, or
(c) if, in the opinion of the Health Advocate,
(i) having regard to all of the circumstances, no
review is necessary or practicable,
(ii) the issue complained of has already been
addressed, or
iii) the complainant has had knowledge of the
issue for more than 6 months before the
complaint is received by the Health Advocate.
Still, all complaints received by the Health Advocate will be reviewed and if we can’t
investigate, we will help find out who and where people need to go to in order to have their
concerns dealt with. We are already finding that this navigation and referral process is proving
valuable and that a call from the Office of the Health Advocate on someone’s issue is both
being well received and getting attention. Sometimes, that’s the only assistance that people
need.
The Health Advocate also has the ability to
initiate and conduct a review without receiving a
complaint where the Health Advocate has reason
to believe that a person or organization fails to
act in a manner consistent with the Charter.
These types of reviews are often referred to as
“own motion” reviews. The Health Advocate will
be developing criteria for determining when an
own motion is the right course of action.
Some possible criteria are:

The number of complaints received by the Health Advocate – if the same issue seems to
be arising again and again;

The likely public interest in the identified issue of concern – how important is this to
people;
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
The number of people likely to be affected;

Whether other reviews of the issue have been done recently or are in progress;

The potential for the review to improve compliance with the Health Charter; and

Whether investigation of the chosen topic is the best and most efficient use of the
Health Advocate’s resources.
So at the end of a review, the Health Advocate is
able to make recommendations. The
recommendations may relate to any aspect of
compliance with the Health Charter. If the
recommendations are not implemented, the
Health Advocate may report to the Minister.
Ultimately the Minister may make an order
regarding compliance with the Health Charter.
Experience in other jurisdictions shows that recommendations are usually acted upon and, as
such, it would be very unusual for the Health Advocate to report to the Minister on failure to
comply with a recommendation.
Two other very important responsibilities are navigation and education. I referred to the
navigation responsibility earlier. People are coming to the Health Advocate, not knowing how
to have their concerns addressed and resolved. The Office helps people find the appropriate
resolution mechanisms to have their concerns addressed and resolved.
There is a great deal of complexity in existing resolution mechanisms. The Health Advocate will
become a specialized resource in existing resolution mechanisms, and will be able to assist
Albertans in finding the most appropriate place for dealing with their concerns. The Office will
also be helping people find out more about health related programs and resources.
Education is another key role for the Health Advocate. There are a number of ways that
the Health Advocate may provide education on the Charter, such as public presentations,
information on the Health Advocate’s web site, and articles. Another way is to publish reports
regarding the Health Advocate’s experience when applying the Charter to different situations.
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As mentioned earlier, the annual reports will be a key part of the Health Advocate’s
accountability to Albertans.
So, how will this all work in practice? After six
weeks of operation, we know there is a demand
for the services of the Office of the Advocates –
the Health Advocate, the Seniors’ Advocate and
the Mental Health Patient Advocate. I’ve spoken
mainly about the Health Advocate, but the
Seniors’ Advocate is another new role within the
system and is tasked with looking into concerns,
providing public education on seniors issues, and
giving people information and referrals to programs and services. Carol Robertson Baker will
speak to you next on the Mental Health Patient Advocate.
We are working hard to provide a seamless entry point for people to contact us about
their concerns – we have one number for all three Advocates, so that when people call, they
don’t have to sort out who should be looking into their concerns – we will sort that out
afterwards. We have a temporary website with some basic information on it and will be
working to build a site where people can come
for information, education and referrals. We are
also going to be working with the Health Quality
Council, Alberta Health and Alberta Health
Services to ensure that our information and
referral systems are aligned and supporting each
other.
The people who worked on the Alberta Health
Act and recommended that there be an Advocate and a Charter, the Albertans who looked at
the Charter and spoke to government about what they wanted to see – and didn’t want to see
happen to the health system – all had a hand in shaping the legislation. The Act, the Health
Charter and the Health Advocate are all part of the work that has been done over the last 20
years in Alberta to shift to a patient-focused and patient-centered system that is there for
individuals, families and communities. The Health Charter sets out what we all expect from the
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system; it sets out what we should be aspiring to if we are to be true partners in our care. The
Health Advocate is there to help people find their voice and express their concerns in
constructive ways that can make a difference.
We’ve talked a long time about shifting from a sickness system to a wellness system;
from a system focused on building and professions to one centered around people and
communities. We’ve talked about healthy policy and the importance of education and social
programs like housing to our health for years. The Alberta Health Act, the Health Charter and
the Health Advocate are part of a legislated framework that is going to support those changes
and ideas going forward.
We have all been around long enough to know that change is a process that takes time.
This is no different. It will take time for people to get to know the Health Charter. It’s going to
take time for the Health Advocate’s Office to work out exactly how to best undertake its
responsibilities. But Alberta has important new tools for change within the system and people
and families have a new guide for taking ownership of their health and care. This is a significant
and exciting change that I believe will make a difference.
Thank you.
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