On December 3, the Minister of Health and Social Services, Christian Dubé, tabled Bill 19 with the objective, according to the ministry’s press release, “to implement a new management model, to modernize our network of health and decentralize the health network. Quebecers deserve a human and efficient health network ”. However, we will have to wait for another bill to achieve these objectives, because the current proposal essentially deals only with the management and security of personal information, including the medical record.
Even if these questions are important and deserve a legislative upgrade, we are far from the implementation of a new management model and decentralization of the health and social services network, which are nevertheless among the conditions. major to make it a “human and efficient” network.
Three changes are priority now: moving away from hospital-centrism to develop local services and prevention; re-involve users and producers of services (and not just doctors) in their management and that of establishments; democratize the health and social services network by decentralizing the first line to local communities.
The latest network reforms have gone in the opposite direction, with the results we know. Changing course requires a change in structure and a political will that has not yet manifested itself. Mentioning decentralization in a press release is certainly interesting, but it requires a necessary step, namely the dismantling of the mega-infrastructures that are the CISSS / CIUSSS and the creation of a new local public establishment, probably at the level of the RCMs and cities – MRC, the management of which will be the responsibility of a body where the various stakeholders will be present.
The experience of CLSCs can be enlightening on this subject, but we must go further by ensuring the contribution not only of users and producers of services as well as community organizations, but also that of municipal authorities and local elected officials, as well as indigenous communities if they wish.
Responsibility
Participatory governance at the first line of the network would allow accountability to the communities, in addition to ensuring more consistency between ministerial orientations and population needs.
This shared governance could help to reverse the current strong trend towards ever more curative, private and authoritarian management. We can thus estimate that taking communities, as well as producers and users of services, on local orientations and decisions would not be favorable to two-tier medicine or to super-kitchen type projects in CHSLDs that are not in the general interest and which dehumanize public services.
Decentralizing and democratizing the health system makes it possible to promote its public service purpose which contributes to the quality of life and the development of communities which requires the ability to deliberate and act collectively on their priority issues, including demographic changes, exclusion and discrimination, climate change and socioecological transition.
This transition, which calls for changes in lifestyles, can only be a matter for governments, scientists or companies. It should include and mobilize local communities where public health and social services establishments have a role to play as actors and partners in the structuring leadership.
The health system in Quebec is a common good of the utmost importance and its governance must guarantee both efficiency and quality. The last 20 years have demonstrated the limits and the perverse effects of centralization. We have everything to gain from a new configuration of the health and social services network focusing on local services, prevention, community action and organization.
The future of the health system lies in its reorientation towards local communities through democratic decentralization of frontline services. This was the founding vision of the CLSCs in the 1970s, which must be reinvented in the light of current challenges, and with the ambitions and resources of the 2020s.