I am unable to imagine Santé Québec — this government agency resulting from the Act respecting the governance of the health and social services system — being able to improve the well-being and health of Quebecers. If not to increase the volume of surgical operations and medical consultations, I very much doubt that this reform will make public services more humane and more egalitarian. Moreover, how will the new CEO of Santé Québec go about piecing together the dimensions of a broken socio-health network and taking appropriate action on the social determinants of health?
The divorce between the medical and social components, which already worked poorly together, poses a major problem. The decision of the Council of Ministers (in 2022) to split the Ministry of Health and Social Services by appointing, on the one hand, a minister responsible for Health (Christian Dubé) and, on the other hand, a minister responsible for Social Services (Lionel Carmant) was, in my opinion, a serious mistake. This will have confirmed the secondary role of social services in health and will contribute to increasing the contribution of private health services.
Quebec’s problem is not essentially the waiting lists, but rather the growth of social inequalities, which result in increasing difficulties in accessing care and social services. Social vulnerabilities – the root cause of illness and social problems – are now neglected, in a system that relies on the treatment of illness, in a hospital environment.
Social services in the pay of hospitals
Social workers carry a heavy burden in local services within communities. Faced daily with situations of great vulnerability experienced by certain less fortunate citizens, social services must work hard to support these people through the twists and turns of our system. These marginalized people often do not have access to a family doctor or are unable to obtain an appointment.
Social workers also have great difficulty obtaining an appointment, or even simple communication, with a medical clinic. At the same time, while social workers are waiting for this helping hand to assess a worrying situation, it is the hospital which is requesting them for a user in its caseload, having been treated for an infection, but for whom the patient must be prepared. leave.
In Quebec, doctors hold significant decision-making power. In the socio-health field, these are key professionals without whom it is difficult to work. Social workers need their collaboration to assess situations and plan their interventions. When they encounter an adult presumed unfit or a suicidal individual, they need the expertise of the doctor to determine the unfitness of an adult in a vulnerable situation or to admit an adult presenting a danger to himself or herself. for others.
But there is much less solidarity in health! In our public network, too many doctors have chosen to practice exclusively in hospitals or in offices in a private clinic or GMF. In addition, since 2015, family medicine groups (GMF) have recruited hundreds of front-line social workers, often the most experienced. Having fewer resources in CLSCs, social workers find themselves working with the most deprived citizens, not registered in GMFs.
During this time, we hear echoes from certain specialist doctors in hospitals who are indignant at the meager social work carried out in the community, with the consequence of delaying hospital discharge.
When the medical field takes over the social domain
Today, social services are devalued, particularly those offered on the front line, traditionally provided in CLSCs. Since the 2015 reform, we have seen a recovery of the social field by specialist doctors. Indeed, some child psychiatrists have understood that a disadvantaged neighborhood can be transformed into a business opportunity to showcase their expertise.
These medical specialists affirm that the community really needs them, that they can intervene better on the vulnerabilities of marginalized individuals than a designated CLSC team could do. Likewise, geriatricians have understood that the community is a nerve center where interventions can be made to prevent the hospitalization of our elders… forgetting that social workers have been working there for a long time!
In fact, this medicalized and very targeted approach to “vulnerabilities,” among young people and among our elders, is costly and cannot be generalized. These initiatives of specialized clinics which are emerging here and there in Quebec, financed by the public, are all the more shocking since we see, throughout Quebec, a major obstacle, sometimes insurmountable, to obtaining the expertise of the doctor in a timely manner to help the person in a vulnerable situation or in need of protection.
To strengthen local services
The appointment of a CEO at the head of Santé Québec and an assistant from the hospital environment does not bode well for people in socially vulnerable situations. The health network transformed by the passage of this new reform will undoubtedly reduce the delays in obtaining a surgical intervention or treatment, but in my opinion this will have a pernicious effect on local communities, whose access to local services will be more difficult.
For me, it is a serious error to conceive of health strictly in terms of care, by extracting the person from their life context, which explains their vulnerabilities, including illnesses. The divorce between the health and social components risks making us lose the modern vision of health which involves, as a priority, the consideration of the social determinants of health.
Clearly, I fear the drift of our social and health system, which seems to be heading in the wrong direction. If the board of directors of Santé Québec does not pay enough attention to this, I fear the privatization of front-line services and the development of a specific care offering that will be found in hospitals.
But now, what can we do now? To make a move in the right direction, a directive will need to result in a realignment of medical practice in favor of local services, including home services. Family doctors and geriatricians must leave their offices more to meet their patients at home, as well as improve their collaboration with social workers and other professionals working in local services.
Without this realignment of medical practice, people in vulnerable situations will continue to flock to hospitals for help.