In 2018, in a spectacular gesture, the elected municipal officials of the MRC de la Vallée de la Gatineau had rented buses to present themselves, with several dozen citizens, to the board of directors of the CISSS de l’Outaouais (CISSSO).
They wanted to denounce, on the one hand, the absence of executives with real decision-making power in the establishments of the CISSSO of the MRC (they were all located in Gatineau) and, on the other hand, the difficulties of communication between the local communities. and the CISSSO, a mega health establishment with 12,000 employees, a budget of 970 million and a territory of 33,456 km2, a territory larger than all of Belgium. Beautiful symbol: they had to drive two hours to get to the council.
Minister Christian Dubé wants to tackle these two issues throughout Quebec: each local facility would have a manager on site (I can’t believe the Liberals of old thought it was a good idea to abolish these positions there!) and there would be representatives of local communities, including elected municipal officials, on the school boards.
After 20 years of setbacks, could the regions hope to regain some control from the hands of the Jacobins of the Ministry of Health1? There is hope.
Let’s get one thing clear first: if you believe cities shouldn’t get involved in healthcare, you have some catching up to do.
The Quebec Network of Healthy Towns and Villages, founded nearly 40 years ago, has 225 member municipalities representing more than 85% of the Quebec population (the umbrella organization is now called Espace MUNI). Locally, this network often takes the form of a consultation table of community partners, a table coordinated by the city, whose objective is to ensure that everyone makes decisions that promote health (active transportation, environment, leisure , community activities, etc.).
That’s not all. At least 660 municipalities and 27 MRCs have family policies. Almost all cities in Quebec, more than 1,000, participate in the Age-Friendly Cities program. All very large cities, and several others, have a homelessness policy and a growing number of cities are active in food security.
In terms of prevention and health promotion, cities are absolutely essential today and they are natural allies of the CISSSs.
The idea of making room for elected municipal officials in the governance of the network is excellent. Interestingly for the Minister, in the municipalities/RCMs, there is generally already an elected official responsible for health records.
Major challenge: there are 67 municipalities in the Outaouais, 77 in the Laurentians, 177 in Montérégie… Who will be able to sit on future governing boards? How will members be selected? Who will the selected members report to? Faced with these difficulties, the Minister does not close the door to push the idea further2, as proposed by former Minister Michel Clair. It could establish an “advisory committee” for each facility in the network (CHSLDs, CLSCs, hospitals, etc.) or even better, in my opinion, for the territories for which people have a real sense of belonging (probably the territories of the CLSCs ).
The mandate and powers of these advisory committees are yet to be defined. At first glance, the leaders of the establishments would be accountable there, in complete transparency. For example, they would make portraits of the health situation on the territory or even the follow-up of certain indicators of the performance of the establishment (accessibility, satisfaction). Leaders could even use it to ask the local community for help in dealing with the challenges they are facing. Hyper-centralization has always been detrimental to this teamwork, with people sometimes not even knowing each other.
The contribution of an elected municipal official to these discussions could be considerable. He is connected to his community, he has the legitimacy to speak for it, and his city has a capacity for action.
Of course, there are still many unanswered questions. What will be the real leeway for the establishment to adapt to what the community will say, will the Ministry continue to take all the space, etc.? ? Be that as it may, the reflection begins on a good premise: the network must be brought closer to the people it serves.
In 2018, shortly after the intervention of the elected officials of the MRC de la Vallée-de-la-Gatineau, the CEO was dismissed and, after a pilot project, the CISSO assigned managers to specific territories. Thanks to its ability to express its will, the community had moved the mega establishment. It is to be hoped that, through constant dialogue with the community, such gestures of brilliance will no longer be necessary.
1 During the French Revolution, the Jacobins favored the centralization of power in Paris, in the hands of technocrats. They opposed regionalism.