In the early 1980s, the Quebec government implemented the Essential Services Council, restricting the rights of public service providers, specifically in the health field, to reduce the supply of care through a strike or other work stoppage. This council, when the renewal of collective agreements approached, met with the unions to “negotiate” the minimum services to be provided if a labor dispute arose.
Posted at 10:00 a.m.
It will come as no surprise that over the years, the services required as essential often proved to be superior to those generally offered, given the staffing shortages. While faced with a conflict, leaders cover themselves with a white cloak of wisdom and probity and brandish the specter of penalties if the decisions of the Essential Services Council – today the Administrative Labor Tribunal – are not respected, it seems that this whole concept of essentiality diminishes when the same leaders are at fault, not having had the foresight to plan the services to be offered to the population and urging the network to be more productive, even by applying budget cuts without consideration for the results.
Productivity is an elastic concept that greatly depends on the objectives to be achieved. Economically, it is the ability to generate goods or services, to sell them and to generate a profit with the proportionally lowest possible investment, ensuring the greatest enrichment. In health, productivity can be measured in the number of patients treated, in the quality of interventions, in life expectancy, in compliance with scientific standards.
The investment per capita to achieve the desired objectives must be adjusted according to variables such as the median age of the population, emerging diseases and health and scientific criteria. We just need to have clear goals, which is frankly lacking in government health management.
Thus, defining the essential is even more nebulous and is often restricted to equivalent essential to existing care.
In addition, many economists denounce health spending, pointing in particular to the salaries of doctors and the cost of drugs. These are arguments that deserve discussion, but which cannot be brandished solely for strictly political and corporate interests in times of shortage. It should be noted that these are not the only parts of the budget that are clearly progressing in health.
The cost of drugs is a constantly growing health budget item and represents an increasingly significant percentage of health costs. And we must note the dependence on pharmaceutical companies, which is a consequence of the abandonment by governments of their role in the development of new and innovative care, contenting themselves with imposing increasingly heavy regulations.
My point is not to justify the cost of drugs, far from it, but there is reason to comment on the fact that leaders are looking for subterfuge to get out of their duty to provide services that have become essential in general and specialized medication. . We reiterate that the medication file cannot be evaluated in isolation, since oral and intravenous treatments are part of the arsenal necessary to provide consistent and competent care.
Let us not lose sight of the undue delays imposed by the authorities to approve new treatments. A renewed, neutral Essential Services Council capable of free will would be able to determine whether Quebec is acting diligently and with sufficient resources to make available treatments deemed relevant by scientific literature and expert recommendations.
With regard to the monetary mass allocated to the medical profession, the majority of it represents the cost of professional expertise, which is increasingly diluted by demands for justification and bureaucratic milestones. Here again, a Council for essential services with a broader mandate and with independent analysis and interpretation could rule on the relevance of the sums allocated according to the supply of care expected by the government, while recognizing the accountability and the notion of direct responsibility which are acute, expected and constraining in medical practice.
In addition, the migration of the practice requires an increasingly specialized specialization and duty to maintain competence, which also have a value to be monetized. Even though the government wishes to define levels of accountability for the leaders of the network to absolve itself, it remains the sole decision-maker of the budgets allocated to health.
In times of COVID-19, since this disease endangered social and economic integrity, it seems that no expenditure was superfluous in health, going as far as paying an additional $1 billion for personal protective equipment. , not to mention the amounts to treat patients with COVID-19 with expensive drugs quickly developed and approved.
Suddenly, “investing” in health becomes profitable again and is no longer the expense that economists decry.
As we emerge from the period of health emergency, the inventory of the priorities of the network leads to worrying observations on all that is essential, compromised, left behind. As far as my field of expertise is concerned, the resources in oncology are clearly not in line with the needs, and patients are waiting, sometimes without resolution, for diagnoses, treatments, well beyond scientific standards.
An independent Essential Services Council would be able to report breaches without simply relying on opinion pieces like this one, and knowing how to disentangle truth from government announcements.
What I am proposing here is part of what I have been asking for a long time, namely to make health an agency independent of political influence, able to determine what is possible according to the resources allocated, excluding gratuitous attacks on professionals seeking to impute fault in order to free themselves from their own responsibility. The revamped Council for Essential Services could, however, quickly activate to define the most glaring shortcomings and force to define whether, for example, access to chemotherapy treatment is essential and must be provided by the State with the appropriate drugs. and in a timely manner.
While most people think the COVID-19 crisis is a thing of the past in healthcare, it’s just exploding differently, expressing itself in demands to restore emergencies, while continuing to absorb the fact COVID -19.
“Yesterday’s crisis is tomorrow’s joke,” said Herbert George Wells. Nothing could be further from the truth in health. The current lack of care has clear repercussions on tomorrow and on the desire of health professionals to continue to get involved and to put their vocation and their professionalism at stake to respond to base political demands.