(Quebec) Accused of carrying out a centralization operation, Minister Christian Dubé plans to adjust his reform by creating local surveillance committees composed, among others, of elected municipal officials, in order to “go further” in the surrender of accounts to the people.
The Minister of Health also assures that he has no intention of axing the hundreds of user committees of the health and social services network, he said in an interview with The Press after two days of consultations on his imposing Bill 15.
The decentralization promised by Mr. Dubé was at the heart of the work, while the commissioner for health and well-being, Joanne Castonguay, and the former president of the commission of inquiry which passed the health network to the sieve in 2000, Michel Clair, invited the Minister to go a step further to speak of “true decentralization” 1.
PHOTO EDOUARD PLANTE-FRÉCHETTE, THE PRESS
The Minister of Health, Christian Dubé
I hate that, the debate about whether or not this is real decentralization. What I want is real local management.
Christian Dubé, Minister of Health
In this sense, he says he is very interested in the suggestion of the author of the Clair report who submitted on Wednesday the idea of constituting a “supervisory board and community alliance” in each MRC or CLSC territory for large cities. .
These committees, which would “speak” for local populations, could bring together elected officials from MRCs and representatives of “major” community organizations, such as social economy enterprises and the chamber of commerce, explained Mr. Clair. .
This would thus “bring back” a local body, a missing element of the Dubé reform, according to him. This committee would have the power to make recommendations and could report to the hospital director.
“He had a very good suggestion,” emphasizes Christian Dubé. “To go further in […] accountability,” he says.
Michel Clair told to illustrate his point that a CEO of a CIUSSS in the greater Montreal region told him that he only learned the name of the city’s director general during the pandemic.
Proximity management
“It really tickled me,” says Mr. Dubé, who said he was thinking about “finding the right stakeholders and elected municipal officials” to be the base.
” For me [ce qui est important]is: do we go far enough for the person on the ground, and sometimes it can be the mayor, [puisse ramener l’information]. The mayor can hear, for example, that his GMF [Groupe de médecine de famille] is closed on Sundays… That’s local management,” he explains.
The Dubé reform provides for the abolition of the boards of directors of the CISSSs and CIUSSSs, and their replacement by governing boards, which will report to the head of Health Quebec in the region.
PHOTO EDOUARD PLANTE-FRÉCHETTE, THE PRESS
The Minister of Health, Christian Dubé
The CISSS and CIUSSS will now be called Santé Québec, including the territorial designation, for example Santé Québec-Estrie.
These new oversight committees would, however, do so for the local director of a facility, such as a hospital or CLSC. Mr. Dubé’s bill promised to bring back accountable local managers to all network facilities.
The constitution of these committees would thus come to “credibilize” the role of the new directors and would give them “a legitimacy of action other than only hierarchical”, pleaded Mr. Clair.
Joanne Castonguay went in the same direction, wondering about their “real leeway” in the current version of the reform.
Users’ committee
The Council for the Protection of Patients and the Provincial Regrouping of Users’ Committees (RPCU) have expressed the fear that, with the creation of Health Quebec, user committees will disappear in facilities where health care is provided.2.
The legislative text provides that a users’ committee be established for each Health Quebec establishment and not one per hospital or CLSC.
“They had the perception that we wanted to limit ourselves to just one user committee per establishment […]but no, we can set up sub-committees,” said Mr. Dubé in an interview, indicating that the RPCU represents some 540 user committees in the province.
I will not deprive myself of 500 committees if they are functional and things are going well. But I want these to be sub-committees that will report to the establishment committee.
Christian Dubé, Minister of Health
Bill 15 – a brick of 300 pages and more than 1,200 articles – aims to make the health system more efficient with the creation of Santé Québec, a new state corporation where the operational component of the Ministry will be centralized, he will focus on directions.
The reform makes Health Quebec the sole employer in the network, merges union seniority and will force medical specialists to a “population responsibility” 3.
Dubé wants to avoid a fiasco like at the SAAQ
After a first version that died on the order paper due to a parliamentary traffic jam, the new Bill 3 aimed at increasing access to health data – this time led by Minister Éric Caire – was adopted at the end of March. This new law is necessary for the deployment of the famous Digital Health Record (DSN), which should allow Quebecers to have access to all information in the same place. The contract for the acquisition of the technological solution must be sealed in the fall (with a year’s delay due to the cancellation of the first call for tenders). A pilot project will first be deployed in two establishments, namely the CIUSSS du Nord-de-l’Île-de-Montréal and the CIUSSS de la Mauricie-et-du-Centre-du-Québec. “It’s what we call the agile approach, not a bing bang like at the SAAQ,” says Mr. Dubé, who says that the province-wide implementation will take “five, six years”.
Towards the end of placement agencies
Another important piece of legislation for the Minister, Bill 10 aimed at eliminating the use of placement agencies in the health network, was adopted on Tuesday.4. The Legault government wants to wean itself off the independent workforce by 2026. In Montreal, Quebec and Laval, the deadline has been set for December 2024. independent work,” summarizes Mr. Dubé. Exceptions will have to be authorized by the minister himself. For adjoining regions, such as Estrie and Montérégie, the deadline is 2025, and 2026 for remote regions such as Côte-Nord and Abitibi-Témiscamingue. The list of regions must be established by regulation within a month, as must the maximum rates that will be imposed on agencies. If an agency does not respect them, it will be subject to financial penalties. Mr. Dubé hopes to bring some 11,000 agency workers back into the public network and curb the exodus.