The Alberta Health Act, Health Charter, Health Advocate Regulation and Office of the Health Advocates By:Mary Marshall, Interim Health Advocate To:Alberta Federation of Regulated Health Professions May 5,

Chronology September 1, 2009: Minister of Health and Wellness establishes the Minister’s Advisory Committee on Health with a mandate to “focus on a framework for legislation” January 20, 2010: Minister’s Advisory Committee on Health releases “A Foundation for Alberta’s Health System” February 4, 2010: Speech from the Throne states that the government will act on the recommendations of the Minister’s Advisory Committee on Health February 5, 2010: Minister of Health and Wellness appoints MLA Fred mechanisms for ongoing consultation and dialogue with the public.” Horne to “coordinate an inclusionary consultation process with Albertans regarding overarching principles to be included in the Alberta Health Act, the proposed patient charter, evidence-based decision- making, and 2

Chronology September 16, 2010: Putting People First is released October 28, 2010: The Alberta Health Act (“AHA”) receives First Reading December 2, 2010: The AHA receives Royal Assent (coming into force on proclamation) January 1, 2014: The AHA is proclaimed into force January 30, 2014: The draft Health Advocate Regulation (the Regulation) under the AHA and the Health Charter are released for comment 3

Chronology March 3, 2014: The feedback period closed for comments on the draft Regulation and Charter. There were 56 submissions received; the feedback is posted on the Alberta Health website. The government fulfilled its commitment to open the Health Advocate’s Office by April 1, 2014 and moved forward with the original versions of the Health Advocate Regulation and Health Charter. 4

Chronology March 19, 2014: Order-in-Council 089/2014 established the Health Advocate Regulation, coming into force on April 1, March 20, 2014: Ministerial Order 20/2014 established the Health Charter effective April 1, April 1, 2014: The Office of the Alberta Health Advocates opened. The Health Advocate has been asked to provide a report to the Minister of Health by the end of June 2014 on preliminary findings about how the office is functioning. Stakeholders’ comments about the Regulation and Health Charter will be considered along with my initial observations on how the office is operating when determining amendments to the Health Advocate Regulation and Health Charter. 5

Alberta Health Act – Contents Preamble contains what “Albertans acknowledge” and principles to guide, measure and sustain “policies, organization, operations and decisions about Alberta’s health system” Establishes “Health Advocate” Establishes “Health Charter” Sets out Roles and Responsibilities of regional health authorities, provincial health boards, professional colleges, and the Minister of Health and Wellness Sets out process for public input into Regulations 6

Health Charter - Purpose Guides the actions of regional health authorities, provincial health boards, operators, health providers, professional colleges, Albertans, and other persons specified in the Regulations 7

Health Charter – Contents Must recognize that health is a partnership among individuals, families, communities, health providers, organizations that deliver health services, and Government of Alberta Must acknowledge the impact of an individual’s health status and other circumstances on the individual’s capacity to interact with the health system Must not be used to limit access Minister must review Health Charter at least once every 5 years 8

Health Charter – Enforcement Person may complain to the Health Advocate regarding a failure to “act in a manner consistent with the Health Charter” Health Advocate may review such a complaint, or shall refer complaints that are within the jurisdiction of other bodies Health Advocate may submit a report to the Minister if a person fails to comply with a recommendation Health Advocate’s annual reports are submitted to the Legislative Assembly 9

Health Charter - Enforcement Subject to the Regulations, Minister may, by order, direct a regional health authority, health provider, professional college or operator or any other person involved in the provision of a health service to: Comply with the Charter Develop and adopt a charter consistent with the Charter Modify bylaws, codes of conduct or other documents to make them consistent with the Charter 10

Health Charter - Enforcement Failure of a person to act in a manner consistent with the Charter “does not in itself give rise to: a cause of action or other enforceable claim, OR proceedings in any court or before any body or person having the power to make a decision under an enactment”. Consultation showed that the majority of the people didn’t want a “rights-based Charter of Rights and Freedoms type document, not a way to enable more litigation and more conflict in the health care system, but a health charter to chart the course for the future…” (Hansard, Minister of Health and Wellness, Nov. 30, 2010, page 1734) 11

Alberta Health Act Regulations The Lieutenant Governor in Council may make Regulations: Respecting the establishment and review of the Health Charter Respecting the powers and duties of the Health Advocate Respecting complaints to the Health Advocate 12

Development of Regulations Process for obtaining public input – s. 14 Minister publishes a notice that includes: a summary of the proposed regulation and the proposed text; time period and format for submission of written comments Minister reports to the Executive Council on any changes The Minister or the Lieutenant Governor in Council “without further notice may make the proposed regulation” 13

Health Charter Health Charter is based on feedback that occurred during the earlier consultations Draft Charter wa s proposed in Putting People First 14

Health Charter Expectations When I interact with the health system, I expect I will: Have health status, social and economic circumstances and personal beliefs and values acknowledged. Be treated with respect and dignity. Have access to team-based primary care services. Have confidentiality and privacy of health information respected. Be informed in ways I understand so I may make informed decisions about my health, health care and treatment. Be able to participate fully in my health and health care. Be supported through my care journey and helped to find and access the health services and care I require. Receive information on the health system and education about healthy living and wellness. Have timely and reasonable access to safe, high quality health services and care. Have timely and reasonable access to personal health information. Have opportunity to raise concerns and receive a timely response without fear of retribution or an impact on my health services and care. 15

Health Charter Responsibilities Taking my circumstances into account and to the best of my abilities, when I interact with the health system I understand I 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. Demonstrate I or my guardian or caregivers understand the care plan we have developed together and that steps are being taken to follow the plan. Treat health services as a valuable public resource. Learn how to better access health services. Make healthy choices in my life. 16

Health Charter (continued) As I work to be a healthy citizen within Alberta, I expect that: When economic, fiscal and social policies are being developed by the Alberta Government the impact of those policies on public health, wellness and prevention will be considered and steps taken to ensure that public policy is healthy policy. 17

Office of the Alberta Health Advocates The Office of the Alberta Health Advocates encompasses: Health Advocate (new) Seniors’ Advocate (new) Mental Health Patient Advocate (existing) All Advocates report directly to the Minister of Health. Single entry point of contact for the three Advocates. 18

Responsibilities of Health Advocate Appointed under Alberta Health Act Responsibilities: Education and awareness of the Charter Assist people in finding appropriate resolution mechanisms to have their concerns addressed and resolved Inform people about existing health related programs and resources. Investigate complaints that a person failed to act in a manner consistent with the Charter Make recommendations and report to Minister if recommendations not acted upon 19

Health Advocate (continued) Alberta Health Act and the Health Advocate are “based on the model currently in place for the Mental Health Patient Advocate, a very successful model … As well, the Health Advocate will work at arm’s length from government in the same way that the Mental Health Patient Advocate does today.” (Alberta Hansard, Minister of Health and Wellness, second reading, Nov. 2, 2010, page 1073) 20

Responsibilities of Seniors’ Advocate Appointed by Ministerial Order Responsibilities: Request inspections, investigations, and quality and safety assessments related to care provided in seniors’ facilities. Refer seniors’ concerns and complaints to the appropriate channels. Provide information and referrals to seniors, their families, and caregivers regarding government-funded seniors’ health, continuing care, and social support programs and services. Provide public education on the rights, interests and needs of seniors. 21

Responsibilities of Mental Health Patient Advocate Appointed under the Mental Health Act Responsibilities: Promote and protect the rights of formal or involuntary patients in mental health facilities or persons under community treatment orders. Education and awareness of patients’ rights under the Mental Health Act. Investigate complaints from patients under one or two admission or renewal certificates and persons under community treatment orders. Refer people with non-jurisdictional concerns to other services. 22

Question How will the jurisdiction of the Health Advocate fit with complaint processes in existing legislation, i.e. the Health Professions Act and the Patient Concerns Resolution Process Regulation? 23

Answer The functions of the Health Advocate are to review complaints that a person has failed to act in a manner consistent with the Charter, and to perform any other duties that are set out in the Regulations (s. 3(3) of the Alberta Health Act). Where, in the opinion of the Health Advocate, the complaint relates to a matter within the jurisdiction of another person or body, the Health Advocate shall refer the complaint to that person or body (s. 4(3) of the Act). Complaints will be assessed on a case-by-case basis to determine whether the Health Advocate will refer the complaint to another authority who has jurisdiction, attempt Alternative Complaint Resolution or conduct a review. The Health Advocate’s Office may make informal inquiries/seek advice from professional colleges about Charter-related complaints involving their members to determine whether the matter is a professional conduct issue that should be referred to the professional college. The Health Advocate will follow Charter-related complaints referred to other complaint resolution processes by asking that the outcome be shared with the Health Advocate to monitor compliance with the Charter. If a complainant has completed the review process of another body and wishes to pursue a Charter-related complaint with the Health Advocate, the Health Advocate will then determine on a case-by-case basis whether to conduct a review. 24

Question Why would the Health Advocate review a complaint involving a regulated health profession when complaints can be investigated by the Ombudsman under the Health Professions Act? 25

Answer The Ombudsman and the Health Advocate have different mandates. Both have the power to conduct a review under their respective legislation. The Ombudsman may investigate to ensure there is administrative fairness in a process and decision under the administrative fairness guidelines used by the Ombudsman. The Health Advocate may conduct a review to ensure that a person has not failed to act in a manner consistent with the Charter. 26

Contact Information: Office of the Alberta Health Advocates 12 th Floor, Street Edmonton, Alberta T5J 3E1 Telephone: Toll Free: