Health Network | When governance does not explain everything

The Savoie report on the governance of the health network presented this week adds to the recent ministerial announcement of the modification of the financing of hospitals.

Denis Soulieres
Hematologist and medical oncologist, CHUM

The latter unduly favors, in my opinion, the more or less orderly production of care for uncomplicated conditions to the detriment of the management of complex diseases. The Savoie report does not change this perception. Allow me to explain.

The Savoie report rightly reports deficiencies in supervision of staff and resources. That is. But this statement unfortunately fits into a context of vacuum of real management of health objectives. In fact, managing locally ensures a certain cohesion and a feeling of belonging for the teams. However, hospital mandates remain vague, instructing them to provide health care to the population.

This vagueness is likely to be accentuated with volume financing of hospitals. We therefore perceive a lack of ambition to ensure real coordination with a view to responding globally to the health care of the population and not simply to the imperatives of resources.

For example, this week we reported the failure of the Ministry of Health and Social Services (MSSS) to establish a registry of cancer cases in Quebec for more than 10 years, while several provinces benefit from such a registry for over 40 years. Without data, there remains an inability to define the quantity and quality of care to provide for cancer patients: to detect them early, to diagnose them, to treat them. Without these numbers and real provincial leadership, it is impossible for hospitals to predict the number of surgeons and oncologists, operating rooms, chemotherapy chairs, general and innovative drugs, radiology and radiotherapy resources. It is not a decentralization like the one proposed, quite the contrary, that will allow the necessary care to be structured. The report is silent on the major orientations that the MSSS should take or on the structure it will adopt to do so.

Of course, the Savoie report proposes the formation of an independent body responsible for management by prioritizing that the MSSS be involved in more general orientations. But this proposal does not change the fact that the main and urgent problem of the Quebec health network is a problem of volume and capacity, and not only of management of the resources currently available. This is evidenced by the increase in waiting lists and delays in accessing care. Because we must recognize two levels of health management. The management of health programs should be the primary responsibility of the Minister of Health and his ministry.

For example, it is unthinkable that the Quebec Cancer Control Department would be unable to demonstrate the availability of the network to diagnose and treat new cases of cancer, with dedicated operating rooms, own radiology availability, laboratory capacities specialists, and a hierarchy of care for rarer cancers. These resources must also necessarily ensure compliance with practice guidelines established on a medical basis and treatment delays ensuring the greatest probability of survival and benefit of the care applied. Once the objectives have been established, care can be updated through network management, literally negotiating the obligations of each hospital or place of care in order to provide a sufficient quantity of care for the province. What I mention for cancer can apply to several pathologies.

The fee-for-service funding of care sites, without supervision by provincial care programs, goes, in my opinion, against the integral management of health care in Quebec.

Budgeting should take care criteria into account well before calculating their one-time costs. The search for results of applied care, in quantity and quality, should consequently guide government actions and the definition of both types and places of care.

Thus, even if we can welcome the intention of the Savoie report to restore local leeway to adapt care, the current care crisis confirms above all the stretching of Quebec resources: in number of beds, in personnel, in diagnostic resources specialized and innovative, able to generate population data. It is the increase in this capacity, taking advantage of a competent framework, which would ensure a health system adapted and adaptable to new circumstances, such as a pandemic.

Thus, the Savoie report does not present what should motivate a review of governance. Quebec is still waiting, beforehand, for a global health policy, affecting oncology, mental health, screening, metabolic diseases, etc. The Savoie, Castonguay, Clair and other reports are the occasion for discourse on health revolution, when we should be discussing marginal adjustments in a learning and evolving network, free from daily political influence.