“Decentralization”, the word was pronounced with application by the Prime Minister during his inaugural speech in order to announce in particular health reforms. Marie-Andrée Chouinard recalled in the pages of To have to of October 21 that, from one commission of inquiry to another, “the wind of reform” went back and forth between centralization and decentralization. She concluded by hoping that the government “opts for the renovation of the network rather than for new construction”. However, whatever the degree of room for maneuver given to establishments, we believe that we should be much more interested in the room for maneuver left to employees in the context of their practice.
The causes
Indeed, when the editorial writer rightly mentions that the employees are “weary, exhausted, fed up with being treated without humanity, the workers desert”, we must understand the causes. However, we have been conducting research on commissions of inquiry and reforms to the health and social services system for many years. These have shown that since the Rochon commission, even if the issues of centralization / decentralization have been discussed, the cross-cutting theme in all the reports resulting from government consultations, including Clair, has been the tightening of administrative controls with the aim of to make the system more efficient.
Reaching targets and standardizing practices has been an adage since the end of the 1980s. Obviously, the culmination crystallized in the Barrette reform, since it was she who was best able to “control the troops” with increased centralization, but the agencies – set up during the Couillard reform in 2003 and abolished in 2015 – had however already largely started work. It is indeed these institutions that were responsible for ensuring performance management by collecting statistics published by management teams and employees. Minister Barrette therefore stepped up an already existing control by restoring more powers to the Department of Health and Social Services.
Mme Chouinard is certainly right, the workers in the network do not need structural reform, as we mentioned in our brief and in our testimony to the Laurent commission. They need to be freed from the managerial yoke centered on statistics and targets to be reached. The culture of performance, as measured, in the name of reducing waiting lists and access to care and services, has definitely not worked and has not improved anything. In this sense, Prime Minister Legault was right to point out that performance must be determined by the people on the ground. It is also necessary to know who are the people in the field to whom he referred in his commentary. Let us remember that social workers, like other professionals, are the ones who know the needs of the population best, they are the people who come into contact with them every day.
Work conditions
From the divide to the vaccination, from homelessness to the mental health of young people, workers are connected with the population. The interveners have the expertise in the field and have the judgment to determine the number of necessary follow-ups.
For more than 20 years, working conditions in the health and social services network have deteriorated, in particular because control has been tightened over the actions of its workers in order to collect performance statistics that have not been no sense in their daily life. What do the figures say about the number of people supported and met with regard to the time needed for their recovery? Are they anything other than control measures? To work, work, like reforms for that matter, must make sense. Decentralization, why not, but it will be a pipe dream if we do not make intelligible the work carried out daily by the professionals in the field.