Quebec anticipates a deficit of at least 1 billion in health care.
Mid-September: in an internal memo, Deputy Minister Daniel Paré asks to reduce expenses without reducing patient services.
The reaction of managers is predictable: mission impossible. The ax blow will leave marks. We will have to make cuts in services, but without saying so.
September 27: The Press tells us that the CIUSSS du Centre-Sud-de-l’Île-de-Montréal is canceling two surgery contracts with a specialized medical center. Dozens of waiting patients will not be operated on. The service is not cut, it is postponed in time. The patient will wait longer. The new hip will be for later. Skillful.
September 27: The ploy makes headlines. Minister Christian Dubé annuls the decision and decrees that the contracts are maintained until further notice.
The politician says one thing, the machine does the opposite.
The Mammoth at the top of its form!
Mandarins were high-ranking officials during the era of imperial administration in China. In Quebec, they constitute a small bureaucratic elite which exercises the real power. They are unknown to the public, live in the shadows, comfortably installed at the top.
We find their names in immense organizational charts overseeing an army of state servants. They survive changes in government or, at worst, move their companies from one ministry to another.
Having had the confidences of several ministers, let me describe to you the characteristics and ways of speaking Mandarin. When a new minister is appointed, the mandarins will stun him with a pile of briefing binders, the ministry’s bible. Exchanges follow in a technocratic dialect furnished with acronyms and empty phrases which hide their impatience with the recruit drowned out by the avalanche of information.
Enter Christian Dubé, who wants to change the culture of the health system and make it more efficient. He set up the Santé Québec agency and appointed two women from private business to head it, Geneviève Biron and Christiane Germain.
You can imagine the reaction of the machine!
There is no question of letting yourself be stripped and losing power. The plan is simple: make the minister believe that it is a good idea. Then, place pawns within the new agency to maintain control and kill any desire for change. A little new blood drowned out by a massive transfer of generals and soldiers from the Ministry. The mammoth is not on the verge of extinction.
I no longer know how many times Christian Dubé has used the word “unacceptable” because the machine leaves patients who need a hip hanging or threatens to take legal action to forcefully leave a hospital on the Coast. -North an elderly person who refuses to go into exile in a CHSLD miles from home.
Faced with the media, he cashes in and takes the blame while the person responsible for the mess will receive a slap on the wrist.
I believe that Christian Dubé really wants to create a better system so that Quebecers get value for their money. But he sees very well that any change is torpedoed by the machine. You may have convictions and be in good faith, but when the ball leaves the minister’s office, it risks never landing. The mandarin knows how to play with calls for tender, knows all the ins and outs and knows how to save time.
At the microphone of Patrick Lagacé who asked him if employees witnessing cuts in patient services should spread the information, the minister replied: “Ideally, I would not need this news to leak out. At the moment, when people are not happy, let them do it so that we can be informed. »
Mr. Dubé therefore invites whistleblowers to come forward to journalists. This shows the level of confidence he has in the system.
Currently, 11,000 frustrated Quebecers have been waiting for more than a year for an operation. Doctors are grumbling because their operational priorities are being limited. The first line overflows. What do the mandarins do? They send directives in all directions, multiply protocols which dehumanize care and kill any form of initiative. They place the blame on those who provide treatment on the ground, which in most cases they have never done, while protecting their backs.
Will Santé Québec change things or will it become one more bureaucratic level in decision-making which is already slow and cumbersome?
Christian Dubé is the tenant of the Ministry of Health. He can stay, leave at the end of the lease or be ousted by the Prime Minister. Then someone will become the new tenant. The mandarins, who are also excellent courtiers, will multiply the bows which camouflage an iron fist on the Mammoth.
And time passes and nothing changes. They will wait for the next minister.