Christian Dubé does not lack determination to bring his essential health reform to a successful conclusion, which is to his credit. If one thing is clear to all Quebecers, it is that the status quo can no longer continue.
But these days, the Minister of Health reminds us of someone who wanted to hang a picture without taking out his tape measure… and who made a lot of holes in the wall before managing to place the picture in the right place.
Fortunately, the minister is listening. He made dozens of amendments to his copious Bill 15 – a bundle of 1,180 articles – adjusting to comments from doctors, pharmacists, students and even universities.
Until this week, he has handled resistance to change calmly. He watered his wine, without watering down his reform.
But the discontent increased a notch with the joint outing of the six former prime ministers of Quebec to denounce the impact of the reform on flagship establishments such as the Montreal Heart Institute or the Sainte-Justine hospital.
Some might be tempted to tell the members of this “ex club” to mind their own business, they who failed to cure the ills of the health network when they were in power.
But with this extremely rare transpartisan intervention, the “ex” have put their finger on an important blind spot in the reform.
Indeed, the integration of large establishments within the new Santé Québec agency would harm their ability to collect donations and continue their research activities, which are essential to the development of better care for the entire population.
Mr. Dubé therefore accepted that their board of directors would keep free rein in these areas… but not for the management of care for the population, which will be coordinated by Santé Québec. However, in practice, it is not so simple to dissociate research from care. Hence the persistent grumbling.
Faced with this rather technical standoff, patients are entitled to wonder what this umpteenth reform will change for them.
As a citizen, it is disheartening to pay the highest tax bill in North America and to be forced to pay again to see a doctor or undergo private surgery because you can’t take it anymore. to languish on a waiting list.
When we are sick, we want accessibility. No reshuffle in the bureaucracy.
Nonetheless, the creation of Santé Québec is a good thing. By entrusting the daily management of the network to this new agency, we will depoliticize health. And we will allow the minister to concentrate on the main directions, rather than managing the slightest crisis directly from the National Assembly.
For the patient, the new agency will make it possible to standardize the surgical waiting list at the provincial level. Patients will know where they are on the list and can be operated on in another region where there is less waiting, promises the minister. This will be fairer than letting patients suffer based on their zip code, as is currently the case.
The implementation of a single employer is also promising. By cutting through the spaghetti of 134 collective agreements, Quebec will allow a nurse to go and work in another region without losing their seniority, which currently leads to aberrant situations.
Combined with bonuses, this greater agility will make it possible to provide reinforcement to establishments going through a crisis, as we saw at the Maisonneuve-Rosemont hospital. Except that we must not forget the lessons of the pandemic where forced displacement pushed employees to resign. Rolling is good. Too much turnover, no.
Christian Dubé also wants to rehire hundreds of local managers whose positions had been eliminated with the Barrette reform, leaving the teams without points of reference. Headless CHSLDs paid the price for this centralization during the pandemic.
Bringing managers back to the field is therefore excellent news. But Health Quebec still needs to give them room to maneuver.
When he presented his preliminary plan in 2022, the minister pleaded for a “vast decentralization” of the network where establishments would benefit from a “large degree of autonomy” with managers capable of “taking more initiatives and finding solutions. solutions adapted to their reality.
But we do not find this spirit in Bill 15, which seems more written by civil servants who are fans of micromanagement than by people on the ground who have the pulse of patients.
That Quebec wants to improve the coordination of the network with Santé Québec is laudable. But we must prevent directives coming from above to slow down local initiative, limit innovations that meet the needs of the community and push disenchanted employees to jump ship.
It is not with more centralization that we will heal the health network.
The position of La Presse
Beyond the mixing of structures, health reform will have positive effects for patients. But we must avoid the trap of centralization.