At the start of the year, Christian Dubé goes hunting, but not pheasants. The Minister of Health and Social Services goes hunting for big game.
• Read also: What 2024 has in store for us: will the network regain health with the Dubé reform?
Objective: to unearth his future or his future “top gun in the private sector” to lead the new Santé Québec agency. Its mission, to use the minister’s words again, would be to “shake the columns of the temple” of the public network.
Well beyond the slogans, Quebecers will expect tangible and visible results. Point. This is why the person named big boss of this agency is not a detail.
With 300,000 workers in the public health and social services network, the Santé Québec agency will become the largest employer in Canada. Nothing less. Think bigas the other said…
He or she will have to manage the network while the minister of the current and subsequent government will limit himself to defining the main orientations.
Optimists see it as the old promise of a network that is finally depoliticized. Realists rather fear a lack of responsibility on the part of governments. Only time will tell.
For a network which, over the last 25 years, has become dysfunctional and dehumanized to the point of letting patients die in emergency corridors, this umpteenth reform nevertheless worries more than the others.
After the creation of the mega-CIUSSS by Gaétan Barrette, it is difficult to see how additional centralization at the top of the network would lead, as the minister swears, to decentralization which is nevertheless essential.
By relying on a “top gun” from the private sector, the minister also concludes in fact that the hordes of very well-paid managers in his ministry have failed.
The real question
Most, however, unless I am mistaken, would remain in post at the ministry while some would be transferred to the agency. In short, as a major cultural change, it remains to be seen. The real question to ask, however, is obvious.
For 25 years, can the serious dysfunctions that have accumulated within the public health network be explained solely by the incompetence of a public service that has been bureaucratized to the point of absurdity?
Or is there not also a blatant lack of political will, across all parties, to preserve the quality of the public network instead of voluntarily turning a blind eye to the skyrocketing rise in private care and services paid directly from the pocket of Quebecers who can afford it?
However, reality is what it is. As long as the political will is not clearly expressed to push back on private pay which, as we know, wastes public human resources, even the most “top” of the “top guns” will not be able to make the public network more accessible and more human.
This is why, as reported by Radio-Canada, the salary of $543,000 promised to the “top gun” of the future agency, in addition to incentives and a certainly generous expense account, is not which poses a problem.
Denial of the Quiet Revolution
What poses a problem is the meteoric growth of a lucrative private market in health and social services whose toxic effect is to create two classes of users and patients in Quebec according to their income.
This is the absolute opposite of the legacy we gave ourselves in the years following the Quiet Revolution. Another problem is the ultra-centralized structure of the new agency.
The CEOs of the CIUSSS, because they are responsible for immense territories and too many establishments, are already hyper-disconnected from the field of staff and users.
What will happen when a single CEO and his small team of “top guns” have to manage the entire network, its 300,000 employees and 1,500 establishments? How can we not see the very real danger of the ivory tower syndrome, however golden it may be?
It goes without saying that Quebecers have no other choice between now and the 2026 elections than to hope to see Minister Dubé make the right bet.
Otherwise, our credit card will more and more often replace the health insurance card to obtain minimally good and quick treatment.