Don’t delete right away

Since the nation demands constructive proposals, here is a fresh one.

Take people who ask for some new commission on health, then lock them in a room and force them to read all the reports already filed, until farsightedness ensues.

When they leave, if this happens, ask them what else they want to know.

For those whose life expectancy prevents them from undergoing such an exercise, I suggest an abbreviated version. It is found on page 19 of the report of the Health and Welfare Commissioner (CSBE), Joanne Castonguay.

She writes it in bold lowercase, but since I’m not bound to be so polite, I hit the “SHIFT” key and transcribe.

“THESE ARE ISSUES THAT HAVE BEEN CONTINUING FOR A LONG TIME AND FOR WHICH SOLUTIONS ARE KNOWN. THESE WERE NOT IMPLEMENTED, WHICH CONTRIBUTED TO THE UNACCEPTABLE RESULTS OBTAINED DURING THE FIRST WAVE OF THE PANDEMIC”, observes the commissioner.

Before COVID-19, there were dozens of expert reports, and their recommendations were similar. Last November, the Ombudsperson tabled her report on the management of the pandemic. The CSBE added its own on Wednesday.

It is almost 300 pages. It has been skimmed over and summarized in the media. Then, two days later, we were on to something else. Other hot opinions took up as much space as this report by researchers, which took 16 months to complete.

And, of course, the opposition was again calling for a public commission of inquiry into the pandemic.

However, we know the gist of the story. The CHSLDs were Quebec City’s blind spot. They were prepared too late. Then, on March 12, the director of the association of private CHSLDs sounded the alarm, in vain. Patients were nevertheless transferred to these establishments. And, for many, sent to their death.

A debate remains on the fine detail of the chronology, but on the substance, the conclusion remains the same: the government is ultimately responsible.

In deciding herself on the relevance of a commission of inquiry, Ms.^me Castonguay invited herself into a partisan debate. I see the awkwardness of a person who fears that his work will be forgotten.

I understand the opposition wanting to prolong this debate, but a commission of inquiry is not a trial. Its purpose is to discern systemic flaws and recommend solutions. However, these diagnoses are already in the reports of the Ombudsperson and the Health Commissioner.

In writing this, I am not trying to spare the government, quite the contrary. If a commission of inquiry were triggered, it would serve as a pretext for postponing urgent actions. François Legault would simply repeat that we must “wait for the filing of the report”. The machine of the Ministry of Health would also work in slow motion to undergo this exercise.

The CAQ government is on the grill. What will he do? It is on this that it should be evaluated in the next campaign.

The Minister of Health and Social Services, Christian Dubé, presented at the end of the fall two rather technical bills on the data of patients, family doctors and appointments. Another is to follow this winter. For the moment, this remains far from the vast “refoundation” promised.

What exactly does the CSBE report say?

I attempt a summary. Basically, that:

• Public health has been underfunded.
• The national director of public health should be able to communicate directly and independently with the public.
• Public and contracted CHSLDs have been underfunded and outsource places to the private sector.
• The increase in physician compensation meant that each year there was proportionally less money left over for the rest of the network.
• Data is incomplete and unavailable.
• Resource allocation is not based on patient needs.
• Employees are moved between units, which affects the quality of care and their motivation (read: burnout).
• Hospital capacity is low.
• Corporatist “rigidity” prevents collaboration between doctors, nurses and other professionals.
• The system is centered on the needs of doctors and hospitals.
• The system suffers from its hypercentralization.
• Management is not based on results.

But isn’t this similar to the “performance contracts” proposed by François Legault as PQ Minister of Health in 2002, when he tied funding to the achievement of certain indicators?

Not really, replies Commissioner Castonguay. I spoke to him on Friday. It all depends on the definition of “result”. The current system is funded based on acts, such as the number of surgeries. She recommends measuring a different type of result: the effect on the health of patients to see if their lot is improving.

It is more difficult to assess, she admits. Hence the importance of refining the data.

M^me Castonguay also recommends that the state move away from operations to focus on its management role.

I caricature. If a patient dies abandoned on a stretcher the next day in the National Assembly, the Minister will be held personally responsible. He will then look for a quick solution to avoid criticism. It is a reactive and centralizing approach, a perpetual crisis management. The request for a public inquiry commission reproduces in a way this quest for culprits.

Better to let people close to the ground answer for their actions, according to M^me Castonguay, as well as several previous reports.

To define the main orientations, the commissioner proposes to get out of the usual logic of confrontation between unions and bosses, the game of give and take and arbitrary compromises where the patient is confined to the role of spectator.

This is a vast program. But at least it does not require modifying the structures.

Where to start ? Perhaps by re-reading the report as well as those that preceded it. Then we will hound Mr. Legault to find out what he will do, in a very concrete way.

The opposition could anticipate it by specifying which recommendations it would adopt. It would be better than letting the caquists hide behind another commission of inquiry.