I was a general practitioner for 38 years, first in a remote area, then in a psychiatric establishment. From 1980 to 2018, I witnessed and experienced multiple health system reforms. The two most notable were certainly the so-called ambulatory shift by Jean Rochon, in 1995, and that of Gaétan Barrette, in 2015, characterized by the creation of mammoth establishments with forbidding acronyms, the CISSS and the CIUSSS.
The Coalition Avenir Québec (CAQ) has been in power since October 2018, almost six years. Christian Dubé replaced Danielle McCann as Minister of Health and Social Services in June 2020. An accountant like François Legault, having worked in the world of high finance, his immediate mandate was to manage the crisis caused by the pandemic, particularly that of deaths in long-term care settings. Behind it was already looming its main mandate: to restore working order, or even protect from imminent death, a health system which was failing everywhere.
Mr. Dubé, a rational man, put forward management by indicators, a sort of continuous monitoring of the mammoth in the resuscitation room. Unfortunately, perhaps discouraged by the scale of the task or pushed by electoral pressures, he delivered, with the help of the forceps of gag in the National Assembly, a reform which has every chance of amplifying the mess that was the Barrette reform.
After the mammoth, we will be treated to the brontosaurus. Santé Québec will manage more than 300,000 Quebecers and will become the de facto largest employer from coast to coast. This monstrous organization, a sort of screen between the government on the one hand and the population and caregivers on the other, will be led by deus ex machinaTHE top guns from the private sector. The board of directors will be led by a hotel entrepreneur who is the minister’s personal friend. Among the 15 administrators, no general practitioner, no person who has worked in social services or community organizations, three pillars of the front line.
Christian Dubé reproduces the major flaws of the Barrette reform, gigantism and the top-down approach (top-down).
The perverse effects of gigantism have been evident for years. Caregivers are leaving the public network to find work environments where they feel respected and where they have more of a feeling of control over their lives. More than a profession, caring is a difficult vocation. To endure variable schedules, work overloads and compassion fatigue, nurses, therapists, social workers, support staff and doctors need to be part of a structure on a human scale. They find comfort there, they build relationships there, they are also more effective there. However, the essence of the current government approach is to improve mobility, to be able to distribute human resources, like so many pawns, in environments in crisis.
THE top-down… It is an understatement to say that the CAQ government is a profiteer. Its leader and leading figures — Pierre Fitzgibbon, Christian Dubé, Eric Girard — come from business or finance backgrounds. Ministers occupying less visible, but also crucial, positions are not noted for their sensitivity to vulnerable people. The current reflex with regard to the management of the health system is distressingly simple: we are going to put in place a new structure, a good top gun and he’s going to sort this out for us.
It is a repetition of Gaétan Barrette’s error, the mirage of miraculous management. Perhaps it is inspired by the same senior officials who, notwithstanding the victories and defeats of politicians, continue to make Quebec, in health and education, the champion of wall-to-wall reforms.
The health system will get better when someone has the wisdom to stop shaking it up from top to bottom every 10 years and listen to the simple solutions that come from its base: caregivers, but also the population.
Because while managers are changing structures, offices and paradigms, we, ordinary citizens, are witnessing a slow-motion accident: the dismantling of the public health care system, the greatest advance in our society since World War II. We wait years to see a family doctor, have a hip replaced, evaluate a child in difficulty; we wait around ten hours (at least) in the emergency room; we are no longer even surprised to learn that more and more people around us, at least those who have the means, are resigning themselves to private consultation. Our sad reality is this: people suffer and die from lack of adequate care.
Nevertheless, Santé Québec will see the light of day. The brontosaurus will fulfill what is perhaps its primary role: serving as an electoral screen for a political group which is likely to become, like the National Union, a parenthesis in the history of Quebec. Minister Geneviève Guilbault uses the same front agency strategy with regard to sustainable mobility.
The paradox of this health megareform is that it is put in place by a government and a minister who have every chance of no longer being in place to assume the consequences. François Legault is 66 years old, Christian Dubé, 67. Pierre Fitzgibbon, 69 years old, talks about his retirement from politics. Eric Girard, younger, would be eyeing the federal conservatives. Will these comfortable people, who have given a lot, seek re-election in 2026?
Meanwhile, the story speeds up. Climate and migration crisis, aging of the population, misinformation established as a system, we live in a world that demands solidarity and innovation.
In the last two elections, Quebecers did not vote for sorcerers’ apprentices to privatize their public services.