Honorable Minister of Health of Quebec,
Concerned about the social inequalities in health that COVID-19 has brought to light, the Ligue des droits et libertés (LDL) has taken note of your Plan to implement the necessary changes in health. And the concerns we expressed publicly last March remain unresolved.
While some of the proposed measures seem worthwhile to strengthen some aspects of the health and social services network (RSSS), the plan does not at all take into account the right to health, which, it should be remembered, includes a set of measures and services that go beyond the medical and curative sphere. The revision of the operation of the first line aims essentially to filter the cases which will receive medical services and then, if necessary, second and third line services. With this plan, the hospital component is at the heart of government concerns, as was the case during the pandemic.
An observation that we must make of the pandemic is that our “health network” is not able to guarantee access to various social services which play a decisive role in the state of physical, mental and social well-being, central objective of the right to health. The social services sector is not approached in such a structured way as that of the hospital network. The proposed measures consist more of future analysis and recommendations for seniors, vulnerable people, mental health, youth protection and home care.
Patronage and the private sector
Moreover, Minister, you maintain that “the best patient experience” would be the primary objective of your reform. However, with regard to the right to health, the patient is not a client, and even less a telepatient whose link with the RSSS would come down to calling on it only in a situation of illness. Every person’s right to health includes, in particular, the obligation to implement a mode of governance designed, as mentioned in section 2 of the Act respecting health services and social services, to “ensure the participation of and groups they[les ressources humaines, matérielles et financières] train in the choice of orientations, the establishment, improvement, development and administration of services”.
There is obviously a long way to go here if you consider the lack of public consultation prior to the development of your plan.
In addition, when it comes to undertaking a “vast decentralization” of the RSSS, we understand that this would be above all administrative and operational, whereas the aim should be to strengthen the population-based responsibility of regional structures and establishments, which you had nevertheless identified as being a shortcoming. It is above all a question of increasing the autonomy and powers of managers and staff, without regard to the participation of the population in decision-making. However, hasn’t the pandemic revealed that it would be to our advantage to rely on the knowledge that the members of a community have of their reality in order to establish the terms of access to care and services that are most appropriate?
Furthermore, as a solution to the difficulties in accessing the RSSS, you intend to rely heavily on the private sector. Isn’t there a parallel here with “the shock strategy”, highlighted by Naomi Klein, which involves using a crisis situation (the pandemic) to put in place measures permanent? This would be the case if the measures adopted to respond to a crisis situation, such as the use of specialized medical clinics to reduce the waiting lists for day surgery or the use of telemedicine, were sustained beyond the crisis.
The rapid development of a healthy private sector worries us in the same way that we must worry about this issue in education, although in this case we are squarely faced with a two-speed system. , which opposes the private school to the public school.
Privacy and Remuneration of Physicians
With regard to the information systems of the RSSS, the LDL is deeply concerned about the lack of consideration that you seem to give to the right to respect for private life and to the obligation to obtain the consent of the person concerned. Moreover, we intend to participate in the consultations of the Health and Social Services Commission on Bill 19, Act respecting health and social services information.
Finally, it is surprising that the mode of remuneration of physicians, which represents a colossal part of the budget, is not taken into greater consideration in a plan aimed at the necessary changes in health. The only measure announced aims to revise the remuneration of family doctors without taking into account that of medical specialists. Should we understand that the debate on this subject will, if it takes place, behind closed doors?
However, the thorny problem of physician remuneration brings us back to questions as fundamental as the need to promote interprofessional collaboration within the RSSS, the need to ensure the establishment of collective professional responsibility, the need to change the idea that doctors are solely responsible for health issues, etc.
It is in the light of these concerns, Minister, that the League for Rights and Freedoms intends to follow closely the progress of your plan. We wish to encourage the emergence of a collective reflection on the right to health in the public space, which would aim to regain control of our health and social services network from a collective and participatory point of view.