The government should give the national director of public health the power to inform the public independently and to communicate his opinions and recommendations in a transparent way, recommends the Commissioner for Health and Welfare (CSBE) in his final report on services for seniors during the first wave of the pandemic.
The document was presented to the media on Wednesday. In particular, he mentions a “paternalistic attitude” on the part of the government towards seniors. In Quebec, “services for the elderly are not recognized as priorities in the governance of the care and social services system”, it is noted. The survey notes on this subject that Quebec leaders have shown “insufficient leadership to bring an ‘elderly lens’ into government decision-making”.
CSBE’s final report, Joanne Castonguay, focuses on the government’s response to the first wave of COVID-19. It does not assess the measures taken to control subsequent waves. His work does not constitute a public inquiry either: rather, it has been approached from a scientific point of view and for this reason grants anonymity to the 104 people who were interviewed.
Quebec recorded 5,718 deaths during the first wave of the pandemic, from February 25 to July 11, 2020. Of the number, 4,836 deaths occurred in living environments for seniors, including 3,675 in CHSLDs.
Quebec “ill-prepared”
At the end of her investigation, Commissioner Castonguay concludes that “it was not possible to control the situation and effectively protect vulnerable populations”.
She identified four main areas in the “vulnerability of the ecosystem of care and services for seniors”: the fact that Quebec was ill-prepared to deal with a pandemic, the state of the care system for seniors at the time of enter into a pandemic, the “failing governance of care and services for the elderly” and the general governance of the health and social services system.
As “fundamental cause of our collective failure during the first wave”, the CSBE identifies the fact that “for a long time, the ministry has not valued its role, however essential, of governance”. Clearly, the Ministry of Health pays particular attention to the operations of the system, and not to the results obtained. “The department is not mobilizing all of its governance levers to improve the performance of the system,” writes Ms. Castonguay.
Above all, she recalls that most of the issues raised by her investigation were already known. “Recommendations have already been made. Decisions did not follow. A change of orientation based on results and on the value of care and services is necessary,” she insists.
Public Health lacks independence
During its investigation, the CSBE noted a “perception of a lack of independence of the national director of public health”. She notes that the roles and responsibilities of public health actors are “unrecognized and imprecise, which can even arouse mistrust”.
Ms. Castonguay thus recommends “developing a culture of transparency in terms of policies and decisions relating to the health of populations”, among other things. This must go through “assertive transparency of the opinions and recommendations of the Public Health Department”, both at national and regional level. The government must also “give explicit power to the national director of public health to inform the public independently”, reads the report.
In general, the CSBE deplores the existence of a “system [de santé] opaque centered on the protection of personal information” and proposes a transition towards an “integrated, open and transparent system that exploits the full potential of data to inform decisions, without compromising privacy”.
More room for seniors
Ms. Castonguay also observed that the reality of seniors’ living environments and needs was under-represented and that this resulted in “the absence of experts on decision-making committees”.
It now suggests offering a “fair funding method” to accommodation services and deploying, through the CISSSs and CIUSSSs, an evaluation system “in all accommodation facilities and resources in their territory”. .
The report also pleads for a strengthening of the strategic role of public health and the setting in motion of a process of reflection “to place public health at the heart of the strategic priorities of the [ministère de la Santé et des Services sociaux] “.
More details will follow.