In the debate on Minister Christian Dubé’s Bill 15, the unprecedented outing of six former prime ministers raises a red flag on the disappearance, and its negative effects, of the autonomous legal status of hospitals and university institutes. This position has the merit of opening a breach in the universal logic of systemic thinking (magical and bureaucratic) specific to mega-ensembles. “Mammoth,” they say.
The minister and his prime minister suggest that this time, it is “courage” that will change the situation. A “courage” that their predecessors would have lacked. But still !
What reform? The one that adds a fifth leg to the “mammoth”? Or that which would give back to actors, partners, communities and regions the spaces of belonging, deliberation, decision-making, innovation, accountability and responsibility for the achievement of the mission of the Ministry of Health and of Social Services, a mission expressed in as many purposes for establishments and objectives for their services.
The six former prime ministers agreed on a very limited number of contentious issues. Important certainly, but overall marginal. I attended four — five if Robert Bourassa had still been among us — who were inspired by the Castonguay-Nepveu reform, later modernized by Jean Rochon in his important report. This reform focused on the communities, with a plural first line (health, social, community organization) organized in CLSC, under the supervision of a board of directors bringing together representatives of all stakeholders, namely management, staff, partners, community.
Fundamentally, as in the most successful countries in this essential state mission, the Castonguay-Nepveu-Rochon proposal aimed at democratization, decentralization and empowerment of actors with a view to innovative interventions in the environments on the determinants of health. A major shift had to be imposed on a system that was then massively hospital-centric. Marc-Yvan Côté, Minister of Health under the second government of Robert Bourassa, translated this orientation into a remarkable health policy, the implementation of which he entrusted to regional boards of plural composition.
Arriving in office in the middle of a public finance crisis, Jean Rochon did not have the resources or the time that would have been necessary to give further impetus to the rooting of his own reform initiated by his predecessor, Marc -Yvan Côté.
Then arrived Jean Charest, Prime Minister, and Philippe Couillard, Minister of Health and Social Services. Change of direction ! All sails are out to eject civil society from all places of deliberation, innovation and co-construction of public policies, to merge CLSCs with hospital centers, to abolish boards of directors and regional boards, which are more social and democratic, and create more medical and bureaucratic agencies.
Agencies that, later, Philippe Couillard, who became Prime Minister, and Gaétan Barrette, Minister of Health and Social Services, would in turn disappear to centralize everything in the minister’s office.
By disconnecting his unique and mega-agency, Santé Québec, from the political sphere, without counter-power, the “courage” of Minister Dubé is ultimately nothing other than the centralizing, bureaucratic and anti-democratic completion initiated exactly ago twenty years. Thus creating facilitating conditions for more privatization. Which, in all likelihood, is the ultimate goal of this entire operation.