You don’t need to be a minister to reform the health system. Since her election in the 2022 by-election, MP Shirley Dorismond has made it her mission to bring patients back to CLSCs. An underutilized resource that she knows better than anyone.
While the emergency rooms are overflowing, there are nurses in CLSCs who are twiddling their thumbs, says the MP. “Yes,” she says, because they only see patients in appointments. “They’re waiting for 811!” » she says in a mixture of laughter and exasperation.
These nurses, she said, should go walk-in and see all those patients who fail in the emergency room with minor health problems. The famous P4-P5 (priority 4 and 5), even P3.
And the labor shortage? This is not a problem? “Not in CLSC! » she responds immediately, during a long interview with The duty.
Shirley Dorismond says she transmitted these findings to ministers Christian Dubé and Lionel Carmant upon her arrival in politics two years ago. “I arrived in the partial and I presented everything to them. » Hearing it, both men were surprised.
” Eh ? Do we have resources there?
– Yes ! »
Mme Dorismond knows about walk-in nursing appointments because that’s what she did in her former life at the CLSC des Faubourgs in Montreal, in one of the most disadvantaged sectors of the metropolis.
The place welcomed a lot of marginalized people, people experiencing homelessness, and the nurses, like her, had a lot of autonomy. “We had a lot of national collective orders which allowed us to practice very broadly as nurses. Stitches, we did that constantly. Someone had an asthma attack, I turned on the oxygen in my room. From noon to 8 p.m., I did walk-in nonstop. »
Ways of doing things compromised by the Barrette reform and the pandemic, she deplores. The reform meant that many professionals as well as doctors left to practice in family medicine groups (GMF), but “those who remained could only make appointments”.
The nurses could always do walk-ins… But without a doctor on site, it was more often necessary to send patients to the emergency room or direct them to another clinic, she says with a sigh.
Then there was the pandemic. “When we had problems in CHSLDs, we took these nurses to help out. When they came back, it looked like the directive was lost. » The walk-in service offered by nurses no longer existed.
The big CLSC tour
We must therefore “return to the way it was before, because it worked well,” argues the woman who has made it her mission to restore CLSCs to their former vocation. A project that the government supports. “With the arrival of the GMFs, the CLSCs were left aside,” declared Minister Christian Dubé in mid-April. We must, he said, give them back their “letter of nobility”.
The Minister responsible for Seniors, Sonia Bélanger, also wants to bring CLSCs back to the forefront. In interview with The Press recently, she indicated that she wanted to make it “the gateway” to the network for seniors.
But it is not the same project, specifies Mme Dorismond. It is not so much a question of offering them walk-in services as a reference place “to get help”. “An administrative agent will help them get care, access Clic Santé, get an appointment. »
Minister Bélanger’s pilot project, which must be tested in ten CLSCs, follows the recommendations of the Well-being Commissioner, Joanne Castonguay.
As for the Minister responsible for Social Services, Lionel Carmant, Mme Dorismond is currently accompanying him on a tour of CLSCs in Quebec. The minister’s objective is to strengthen the offer of psychosocial and mental health services in CLSCs. Without an appointment.
A model for cities
Again, this is something that was already being done in certain CLSCs, underlines the MP. “Psychosocial reception and current services [en santé physique], that’s one,” she says. “Because the signs and symptoms of mental disorders are psychological and physical, and vice versa. »
Mme Dorismond had already visited the 300 CLSCs in Quebec last year. This is her second tour and she says she is planning announcements “soon” in CLSCs that already offer the full range of services. Like the CLSC des Faubourgs in Montreal, but also that of Hochelaga. She also cites as an example the Cloutier Multi-Service Health and Social Services Center in Trois-Rivières. An interdisciplinarity model that includes a CLSC and a specialized nurse practitioner (IPS) clinic.
Since the IPS take care of patients, the context has never been so conducive to the great return of CLSCs, believes the MP for Marie-Victorin. But again, aren’t we at risk of lacking the IPS to do everything? She thinks not, because the ministry has issued a directive to ensure that 60% of NPs trained in mental health work in CLSCs.
However, the CLSC tour was not an overall success. There is resistance, she concedes. It sticks “sometimes”, especially because of the “organization of work”. “Fluidity in services is not the same everywhere. »
In one of the CLSCs she visited, the person at the walk-in reception told a patient to call 811, she says. “I don’t want that anymore. There is no return to the counter. The patient does not go backwards, he moves forward! »
Eventually, Mme Dorismond would like to see this model implemented in “all cities”. In the region, it is “different” because the CLSCs already enjoy an expanded role there. One thing is certain, the mouthful seems big. Is it a good idea ? Is this feasible?
Possible… subject to certain conditions
Yes, thinks former Minister of Health Réjean Hébert, who taught for a long time in the Department of Health Administration at the School of Public Health at the University of Montreal. “The role of CLSCs was precisely that: to be the gateway to the health system. Act on the front line, whether for psychosocial or medical problems. »
The CLSCs have never been able to “fulfill their role” well for two reasons, according to him.
Complex relationships with doctors, who, when they worked in a CLSC, were salaried – and no longer paid on a fee-for-service basis, which explains why they were rarely present there, he mentions. In addition, “CLSCs have always been underfunded in their mission compared to hospitals”.
According to him, two conditions must be met for these places to resume a central role: better financing and greater autonomy with independent boards of directors, as was the case before the Couillard reform of 2003. However, with the creation of the Santé Québec agency, Réjean Hébert doubts that it is possible.
Asked about the links between the agency and the CLSCs, MP Dorismond said that the government is “preparing” the entry of Santé Québec. She also believes that decision-making should not be centralized too much. “For me, it’s important that it starts from the ground and goes up. » After all, it was from her own “on the ground” experience that she herself defined her role in government.