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Smith said with one major piece of legislation passed in the fall sitting, the restructuring effort "is pretty much done."

New health agencies now govern hospital care, continuing care, mental health and addiction, and primary health — under the direction of Smith’s four health ministries.

"So now it's a matter of each one of those areas optimizing," Smith said.

The premier acknowledged the challenges. She promised a new public-facing dashboard that would show decreasing wait times for emergency rooms, ambulance rides and surgeries, along with 1,500 new spaces per year in continuing care.

"People will start being able to watch and see — on all of those fronts — the progress that we're making."

She said her government's move to allow more nurse practitioners to open practices in the province is part of why fewer Albertans are now unattached to a primary-care provider.

Smith has long been critical of what she called the bureaucratic bloat of AHS, promising during her successful UCP leadership campaign to clean house.

When asked if her government will take full accountability for health care once the pieces fall into place, the premier nodded.

"Yeah, and we'll hold our providers to account as well," she said, noting the agency still accounts for the lion’s share of the health budget.

She also pushed back at the idea that she had used the organization as a scapegoat.

"Is it a scapegoat to say that people expect to have better service? I'm not the one delivering the service at the hospital."

Smith's ongoing effort to re-make, re-assemble and re-animate the pieces of the system hasn't been her only challenge this past year. It began under the cloud of tariff threats from U.S. President Donald Trump.

Smith took flak for posing for photos with Trump amid a surge of ºÃÉ«tv patriotism, but stood by her diplomatic approach.

"I think it has worked for us. We ended up with 97 per cent of our goods going across the border tariff free," she said while acknowledging those provinces reliant on steel, aluminum, vehicle or lumber exports did not fare as well as Alberta's oil and gas industry.

After months of making demands of Prime Minister Mark Carney, she inked a preliminary agreement with Ottawa to work toward building a new oil pipeline to the West Coast.

Smith also made her mark on democratic norms.

Her government invoked the Charter's notwithstanding clause four times in the fall sitting, forcing striking teachers back to work and shielding from court challenge her government's laws affecting transgender and gender-diverse Albertans.

Critics, including Alberta’s Opposition NDP, have said Smith's use of the clause runs roughshod over the courts, the rule of law and democracy.

But Smith said her government needed to act in exceptional circumstances to protect the children in Alberta.

Smith's UCP twice changed the law to help pave the way for citizen-led referendums, including a ballot question on pulling Alberta out of Confederation.

Her drive for more direct democracy gave voice to another kind of discontent, as she and many in her caucus are facing recall petition campaigns that will drag well into the New Year.

All the while, Smith’s government has been dogged by allegations of corruption in health-care spending and Opposition NDP demands for a public inquiry.

One of Smith's own cabinet ministers, Peter Guthrie, resigned in the spring over the government's handling of the scandal.

Guthrie soon found himself booted out of caucus and is now organizing to build up a rival progressive conservative political party.

Opposition NDP Leader Naheed Nenshi said Guthrie's exit from the UCP was the beginning of intense instability in a government that has lost sight of Albertans' priorities.

He said stoking the fires of separatism only spurred more than 400,000 Albertans to sign a petition in favour of staying in Confederation.

"Everything they try to bring back their popularity has backfired on them," he said.

Nenshi said he believes the premier has a tendency to lash out at those who disagree — from what Smith calls "activist courts" to citizens angry enough to try to recall government members.

On health care, Nenshi said every worker in the sector will tell you the "chaos" of restructuring isn’t helping them do their jobs.

"There is not an Albertan who believes the system works better now than it did six years ago. There's not one."

He said despite Smith’s promise to hold AHS to account, she runs AHS and has since she took office.

"This is all her, and she cannot any longer get away with this."

This report by ºÃÉ«tvwas first published Dec. 30, 2025.