A real revolution in the world of health, the forthcoming creation of a Health Agency outside the ministry will make the health system more efficient and more human, promises Christian Dubé. But some experts see it as a risk of drift.
In Alberta, we still remember the “biscuit incident” caused by the first CEO of the Health Agency, in 2010. Pressed by questions concerning the failures in an emergency, Stephen Duquette had fled the journalists repeatedly pretending that he had to “eat his biscuit”. The sequence, which, unfortunately for him, had been filmed, caused a scandal and led to his resignation.
In Quebec, many fear that the creation of such an agency would allow the Minister of Health to discharge his responsibilities on a person sitting on an ejection seat. “We are going to have a scapegoat, the minister will be able to pass the puck to this CEO of the agency, whom I pity with all my heart”, remarks the former Minister of Health and researcher Réjean Hébert.
However, in an interview To have to this week, the minister strongly denied it. “I remain accountable, but I structure differently,” he argued.
Should we expect the same level of transparency from Santé Québec as that offered by Hydro-Québec, which only meets with elected officials once a year in a parliamentary committee? “No”, answers Christian Dubé, who did not want to provide more details at this stage.
Would the Minister have gone to Maisonneuve-Rosemont Hospital if there had been an agency? The answer was ambiguous. “Yes,” he said, before suggesting something else. “We had an illegal strike last week,” he said. In a case like that, yes, I would have gone. I would have gone to see the CEO of Santé Québec and I would have asked him: “What are you doing with Maisonneuve-Rosemont?” »
Christian Dubé likes to repeat that we must distinguish “the important” from the “urgent”. An agency would allow the Minister of Health to focus on the first component. The former boss of Cascades wants to import effective recipes that have benefited the private sector… and the fight against the pandemic. And wants, as his right arm in the field, the equivalent of a Daniel Paré, the one who had successfully managed the vaccination campaign.
The Hydro-Québec model
The idea is not new. In 2001, the report of the Clair commission recommended that the government seek advice on “the renewal of the ministry” and “the creation of a national agency”.
Former president of the College of Physicians and author Yves Lamontagne proposed the concept of “Hydro-Santé” at the time. “I had met André Caillé [le patron d’Hydro-Québec de l’époque]. Him and I, we thought we looked alike, he recalls. We had to provide services 24 hours a day, 365 days a year. And we were dealing with crises like the ice storm and emergency room overflow. A “Hydro-Santé”, he adds, could more easily give a place to the private sector in the network. “He could afford to find other ways of doing things. »
The president of the Federation of Medical Specialists of Quebec (FMSQ), Vincent Oliva, also finds the concept promising. But Health Quebec “will have to quickly give results,” he warns. We should not content ourselves with “splitting the ministry in two” and “changing its name”.
Régis Blais, full professor in the Department of Management, Evaluation and Health Policy at the University of Montreal, struggles to understand why a new structure must be created to coordinate the operations of the regions in the field. “Do we need it to be [fait] by an agency? he asks. It can be done by people who are in the department. There is one, regional coordination service. Keep doing it. Do it better. »
He wonders if the agency will have “more powers over Maisonneuve-Rosemont than the minister himself”. “It’s not easy,” he said. And if the same civil servants move from the ministry to the agency, will they do something else or will they do the same thing? »
Professor of health economics Maude Laberge, from Université Laval, wonders about the turnover within Santé Québec. “Will there be more stability in the management team of the agency than in the management of the Ministry of Health? That’s crucial, she says, because it takes “a certain stability to get things done.”
In Alberta, she notes, “the management of the Health Agency [Alberta Health Service] changed hands many times. In 2022 alone, the CEO was replaced and Prime Minister Danielle Smith kicked out the entire board.
David Levine, former CEO of the Montreal Health and Social Services Agency, recalls that health is a “very political” and “highly publicized” field. “There is a lady in a long-term accommodation center who is scalded because the water is too hot in the tap and it makes a big headline,” he cites as an example.
In context, will a government that wants to be re-elected be able to “accept negative press” towards the agency and not get involved? David Levine asks.
Lighten the task of the Deputy Minister
Minister Dubé rightly maintains that the biggest “benefit” of Santé Québec will be the “stability” it will bring to the network. How ? He did not want to go into details this week, for fear of contempt of Parliament by revealing the content of a bill that has not yet been tabled.
We know, however, that it will be a big law, of the “mammoth” type. This week, he said that between 300 and 400 ministry employees assigned to infrastructure and information technology will be transferred from one box to another.
The CISSSs and CIUSSSs will remain, but it is unclear how they will interact with the Agency. Which makes some critics say that the network is being centralized instead of being decentralized as promised by the Coalition avenir Québec (CAQ). In the eyes of former Health Minister Réjean Hébert, Quebec certainly does not need another “structural reform”. “We’ve been involved in structural reforms for 20 years. There was the Couillard reform in 2003, the Barrette reform in 2015, and the network suffered a lot. »
The ministry would inherit a simplified management structure. Thus, the current deputy minister, Dominique Savoie, would no longer have to supervise 15 assistant deputy ministers and 35 CEOs (of the CISSSs and CIUSSSs, in particular), which is completely abnormal, argues Christian Dubé.
We will also remember that it is Mme Savoie who had proposed to the government to take this route in a report. “The solutions are known, we must take action,” she wrote.
And the patients in there? How would Santé Québec improve the quality of care? Minister Dubé replied this week that this would make it possible to avoid stories like that of the widow of Robert Bourassa, who died in great suffering in the hospital without palliative care. “Cynical” remarks strongly denounced by the opposition.
The minister also mentioned that the agency, on its own, was not going to solve everything, but that it was necessary to deploy its Health Plan as a whole. (see Health Plan summary box).
For Professor Maude Laberge, “we should not pretend that the Agency will ensure that we will no longer see patients treated as Mr. Bourassa’s widow was. The creation of an agency will not solve all the complex ills of the health system. There is no solution that is a panacea, there are solutions that each can contribute to improving the system”.