Reforms are always built on laudable pretensions and a sincere desire for improvement. We have no doubts about the good faith of Prime Minister François Legault when he announces for the coming year the return to decentralization of the health network. In short, he promises to cut the Barrette reform to pieces. In the name of a return of power to regional and local authorities, the CAQ leader hopes that Quebecers will have access to services efficiently and quickly.
We would cry genius if the formula had not already been worn out. And if the establishments and the staff – also worn out – had not suffered from this waltz of reforms that the various governments have been dancing for decades. In reaction to this promise from Mr. Legault to make health his next big project, the actors of the network were divided Tuesday between relief and concern: thank you for wanting to help us, but please do not force us to start all over! How can we not sympathize with this inner conflict?
Died Tuesday, the same day the Prime Minister gave his inaugural speech, the former Minister of Health Jean Rochon chaired in the 1980s a Commission of Inquiry on Health and Social Services which made decentralization – oh surprise – the main focus of his recommendations. Before that, there was the Castonguay-Nepveu commission in 1970, which pleaded for strong national leadership but a transfer of decision-making levels to the regions, for greater efficiency. We also knew the Clair commission, in 2000, which chose for its part to make the couple centralization-decentralization a marriage not to be undone, as tradition dictates which seems to dictate that we choose one or the other.
In 2015, Minister Gaétan Barrette instead put on the big shoes of centralization to literally redesign the architecture of the network. It was the advent of the CISSS and the CIUSSS, the abolition of health agencies; the increase from 182 to 34 structures; the promise of savings of $ 220 million per year, but a total dispossession of local powers: no more boards of directors, only CEOs chosen by the minister. In short, in the name of efficiency and cost control, a ministerial ultra-power. We know the rest: this hated reform is described today as the source of all evil.
There is therefore a measure of relief in seeing a Prime Minister sympathetic to the impatience of Quebecers, who are literally waiting for everything: a family doctor, rapid access to the first line of care, emergencies really intended for emergencies, functional operating theaters. But it is understandable for healthcare workers, whatever their position in the network, to fear another storm of evanescent promises. And worse: a complete deconstruction of the whole device and yet another restart.
The Clair commission was perhaps all right in having the audacity not to want to destroy the centralization-decentralization couple. Legault, as in everything, could very well ask his department to set goals, as he announced, and continue to monitor the results closely, as he also promised. But apart from these centralizing responsibilities, that the regions and establishments find some room for maneuver does indeed seem to be one of the solutions for better efficiency. Greater transparency in decision-making processes, increased citizen participation in network bodies, adaptation to regional realities and so on, a little more agility and flexibility! Basically: return decision-making to where it counts, which is where the service is delivered.
This whole theory is idyllic, but on the ground, the network is bleeding, we know it. Tired, exhausted, fed up with being treated without humanity, the workers are deserting. The labor shortage is worsening with this bleeding, in particular around the crisis of compulsory overtime and the 4,000 nurses who are missing. The mammoth bill promised for this fall by the Minister of Health Christian Dubé will he also take into account this exasperation manifested Tuesday by François Legault at the place of “some” family physicians who did not respond to the call of patient care? It will be necessary, because this missing part of the equation becomes troublesome in the long run – in Quebec, the average waiting time to see a doctor for so-called priority patients is… 451 days.
Everyone will indeed have to get their hands dirty for this new reform to be a success, but its success depends on getting out of the human resources crisis and also on the pace that the site will take. Hopefully they opt for network renovation rather than new construction.