CALGARY, ALBERTA, CANADA – The Alberta government finalized the final legal framework for its new health care system in 2025, and Premier Danielle Smith says she'll be working to prove it was worth it in 2026.
A massive reorganization saw Smith abolish Alberta Health Services as the provincial health authority and transfer it to a hospital services provider.
Smith said that with one major bill passed during the fall session, the restructuring effort is “largely complete.”
The new health agencies now manage hospital care, continuing care, mental health and addictions, and primary care—under the leadership of Smith's four health departments.
“So now it’s about optimizing each of those areas,” Smith said.
The prime minister admitted there were problems. She promised to create a new public dashboard that would show reductions in emergency department wait times, ambulance rides and surgeries, as well as 1,500 new continuing care beds a year.
“People will be able to watch and see—on all of these fronts—the progress that we're making.”
She said her government's decision to allow more nurse practitioners to set up practice in the province is part of why fewer Albertans are now unattached to a primary care provider.
Smith has long been a critic of what she called AHS bureaucratic bloat, promising during her successful UCP leadership campaign to clean up the mess.
When asked whether her government would take full responsibility for health care when things return to normal, the prime minister nodded.
“Yes, and we will also hold our providers accountable,” she said, noting that the agency still accounts for the lion's share of the health care budget.
She also rejected the idea that she was using the organization as a scapegoat.
“Is it scapegoating that people expect better care? I'm not the one providing the services at the hospital.”
Smith's constant efforts to redesign, reassemble and resuscitate parts of the system weren't her only tasks in the past year. This began amid tariff threats from US President Donald Trump.
Smith faced criticism for posing for photos with Trump amid a surge in Canadian patriotism, but stood by her diplomatic approach.
“I think it worked for us. We ended up with 97 per cent of our goods crossing the border tariff-free,” she said, acknowledging that provinces that depend on steel, aluminum, auto or lumber exports aren't doing as well as Alberta's oil and gas industry.
After months of making demands to Prime Minister Mark Carney, she signed a preliminary agreement with Ottawa to work on a new oil pipeline to the West Coast.
Smith also left her mark on democratic norms.
In the fall session, her government invoked the Charter four times, forcing striking teachers to return to work and defending against legal challenges to her government's laws affecting transgender and gender-diverse Albertans.
Critics, including the opposition Alberta NDP, said Smith's use of the clause ran roughshod over the courts, the rule of law and democracy.
But Smith said her government needs to act in exceptional circumstances to protect children in Alberta.
Smith's UCP changed the law twice to pave the way for citizen-led referendums, including whether Alberta would secede from Confederation.
Her push for more direct democracy has sparked another kind of discontent as she and many members of her caucus face recall petition campaigns that will stretch into the New Year.
All this time, Smith's government was dogged by allegations of corruption in the health sector and demands from the opposition NDP for a public inquiry.
One of Smith's cabinet ministers, Peter Guthrie, resigned in the spring over the government's handling of the scandal.
Guthrie soon found himself expelled from the faction, and now he is organizing the creation of a rival Progressive Conservative political party.
Opposition NDP Leader Naheed Nenshi said Guthrie's departure from the UCP was the beginning of great instability in a government that had lost sight of Albertans' priorities.
He said fanning the flames of separatism only prompted more than 400,000 Albertans to sign a petition in favor of remaining in Confederation.
“Everything they are trying to do to regain their popularity has backfired on them,” he said.
Nenshi said he believes the prime minister tends to lash out at those who disagree – from what Smith calls “activist courts” to citizens angry enough to try to recall members of the government.
In health care, Nenshi said every worker in the sector will tell you the “chaos” of restructuring is not helping them do their jobs.
“There's not a single Albertan who believes the system works better now than it did six years ago. Not one.”
He said that despite Smith's promise to hold AHS accountable, she has been in charge of AHS and has led it since she took office.
“It's all her, and she won't get away with it anymore.”
This report by The Canadian Press was first published Dec. 30, 2025.
