Letter addressed to the Minister of Health
According to what we learn from the media, your next objective would be to rebuild the health and social services network, that is to say, according to the Larousse definition, “to rebuild on new foundations”, a task for the less colossal! Given the dismal state of the governance structure inherited from the previous reform, this is an obligation that your government cannot avoid. However, according to the media rumour, this “refoundation” would be done quickly by legislative modifications without prior consultation (apart from parliamentary debates).
However, to bring things back to more modest ambitions achievable in the short and medium term, despite the problems brought to light by the management of the pandemic, it would be preferable to speak of reform or revision of the system. Because rebuilding on new foundations would require a process as cumbersome and complex as the Castonguay-Nepveu or Rochon commissions, not to mention the time required to carry it out, leaving time for at least two successive ministers to occupy your functions! But time is running out!
To achieve your objective, whether through a reform or a simple revision, there are planning rules to follow, especially in the field of health and social services.
The first rule is to proceed from the needs of the population and not from the needs of managers or politicians, despite their sincere desires to improve service delivery. It will be necessary to proceed by clientele, given the scope and categories of needs: services for young children and adolescents, families, adults with a mental health problem, chronically ill people, the elderly, very old and frail people… The task is immense, but a large part of this work has already been carried out by your department and the network over the past 20 years, and a review coupled with an update for these clienteles can be completed in less than six months.
From the identified needs, it will be necessary to define measurable health objectives and organizational objectives, otherwise the result of the process risks being nothing more than a list of means worthy of a hodgepodge which would lead to ideological battles without end. The result of this work should first be presented in the form of a white paper or working document for broad discussion in the population and among health workers at all levels of intervention and in each health region. From this approach, a draft law may emerge that will have more chances of resulting from a widely established consensus, if we can dream a little!
Regarding network structures, if your desire to see things happen more quickly is impossible to repress or is unfulfilled by this unavoidable step, you could immediately correct an aberration of the last reform by detaching the network of CLSCs from hospital megastructures to give it back its true mission, that of being at the service of local populations to provide local services, in particular home care and services, while finally guaranteeing the required resources. At the same time as this action, it would be a good idea to include in the white paper the proposal to entrust the MRCs with the management of CLSCs, rather than creating independent boards of directors, in line with the Villes et Villages en santé movement which its evidence a few years ago.