The reform of the health and social services network was a highlight of the parliamentary session which ends this week. More than a year after the tabling of the bill creating the Santé Québec agency, we remain very worried, not only because of the place that the government gives to the private sector and the extreme centralization, but also in the face of democratic setbacks. in the health and social services network.
The entire process leading to the adoption of this bill says a lot about the state of our democracy. Instead of listening to the collective intelligence of Quebecers and relying on it, the government instead designed this reform in isolation and without real consultations. Unsurprisingly, this goes against several solutions that are widely agreed upon by stakeholders in the field and the research community.
The population did not want yet another structural reform, but concrete solutions for better access to a family doctor, better care and an expanded basket of services (e.g. home care, mental health, etc.).
The adoption of the bill under gag order constitutes another illustration of democratic abuses. We observe this same phenomenon elsewhere, whether it is the major opening granted to the private sector in telemedicine by simple regulation or even in the questioning of the universality and free care by the Commissioner for Health and Well-being , based on an online survey and the opinions of a few targeted people.
As for Santé Québec, we fear that this gigantic structure will further distance citizens from their network. This agency must not become a big black box, inaccessible and opaque. Its board of directors cannot function like that of any private company. Public services fulfill very specific missions and assume responsibilities, which have nothing to do with a company and its shareholders.
Measures must be considered to strengthen the democratic participation of the population and groups who care about the health and social services network. This could start by granting places on the board of directors and governing boards for representation of civil society and workers and, also, by establishing local spaces for citizen participation with real powers.
For 30 years, the health system has been transformed through short-sighted reforms, which were implemented from the top down. These have imposed ever more control on work teams, who end up no longer recognizing themselves in this large impersonal whole. Rather than entrusting the future of the health and social services system to private sector managers, we must do otherwise by promoting a collective recovery of ownership.
It is urgent to restore and strengthen several levers: access to information, public debate, shared decision-making. To ensure respect for fundamental rights, governance structures must take into account the various realities and expertise and must put in place mechanisms allowing civil society to be informed, monitor and influence the major directions and work that transform our public health and social services system.
Democracy must stop being perceived as a pitfall or a necessary evil and be recognized for what it is: a great force.
* Also co-signed this letter: Fanny Demontigny, president of the Provincial Social Affairs Council of the Canadian Union of Public Employees (CPAS-SCFP-FTQ); Isabelle Dumaine, president of the Quebec Health Federation (FSQ-CSQ); Réjean Leclerc, president of the Federation of Health and Social Services (FSSS-CSN); Jessica Goldschleger, president of the Federation of Professionals (FP-CSN); Sylvie Nelson, president of the Union of Service Employees (SQEES-298); Guillaume Bouvrette, president of the Union of Professionals of the Government of Quebec (SPGQ).