There is no more living symbol of Quebec immobility than the display of orange cones. Sometimes to indicate works, often to divert from a risk linked to the deterioration of the road. And many times, uncoordinated detours, leading to going around in circles, even ending up in a dead end.
Posted yesterday at 9:00 a.m.
The degradation of infrastructures and their often disorderly renovation/reconstruction are proof of the difficult management of resources in Quebec. Traffic jams ensue, waiting leading to impatience, missed appointments, vanished opportunities.
The obstacle course in the road network is sometimes similar to that of people seeking or waiting for care in the health network. There are frequent impediments, services closed for lack of resources, endless administrative red tape, a crying lack of capacity in relation to demand.
The result is a population caught in a traffic jam that cannot benefit from a competent and sufficient health service.
The individual competence of health professionals is appreciable and verifiable, framed by professional orders, codified by standardized training. On the other hand, the competence of the network, assessed globally, to coordinate care within and between establishments is questionable. In this regard, the Savoie report, which named shortcomings in local and regional management, despite the training of the CISSSs and CIUSSSs, which was to promote a more harmonious evolution of care, identifies a creeping, patent and essential deficiency in the Quebec health network. At all levels of the network, orange cones are planted and hinder the provision of coherent, planned care that complies with standards.
Saturation of healthcare facilities
On the other hand, the reduction in access is not only functional or the result of the absence of a culture of good management. It lacks traffic lanes and home destinations. The places of care have been saturated for a long time. The Rochon reform aimed to shift to ambulatory care to reduce the need to resort to hospitals, but without previously or concomitantly ensuring other places of care. And since then, despite the increase in the population, the number of hospital beds has remained stagnant and insufficient for care evolving towards over-specialization and requiring technical platforms.
During the pandemic, the government realized the hard way that the stretching of the health system prevented it from adapting to absorb the progression of acute care related to COVID-19. The government had to spend several additional billions to temporarily ensure the integrity of the network and therefore preserve social and economic integrity. This is a meaningful observation that must be made without the pandemic pressure: societal cohesion, including the economic component, can only be preserved by the integrity of the health network. The significant expenditures that have been granted for this since the start of the pandemic have shown us that it is possible to integrate increased health expenditures without unduly compromising the province’s budgetary balance.
The endless orange cones of health unfortunately do not allow us to assume that work will lead to better, unlike the detours announcing bridges, viaducts, metro and REM.
Major health projects are not enough to foresee a real recovery adapted to the evolution of care and to a growing and aging population. Quebec laws define a right to care, but they do not indicate the procedures for ensuring it from one government to another. Without wishing to arouse unnecessary controversy, we must ask ourselves whether the restriction of care capacity due to a lack of resources does not have effects similar to those resulting from judgments. The cancellation of Roe v. wade in the United States is decried, but several organizations have also reported health care restrictions in Quebec that have similar effects for some people.
We are not, fortunately, to review the basket of care because of value judgments. Nevertheless, mechanisms must be created so that the health network continues to carry out its task.
“Man is under the obligation to allow himself to be guided in all his actions by moral considerations”, Gandhi dictated to us. It is a great and noble goal. In health, it must push us to offer care in quality and quantity to offer life in quantity and quality. Orange cones are inevitable to carry out a project, but they must be accompanied by diligent, public planning, effective communication presenting the options and engaging a discourse on the necessary evolution of care to ensure the competence and quantity of care.
The City of Montreal recently presented a summer table of construction sites and traffic restrictions. Such a table does not exist in health. The acknowledgment of reduced services, waiting lists, cumulative delays would of itself impose a necessary apolitical debate on the investments that must guide the overhaul and sustainability of health.