(Quebec) Christian Dubé tackles the underutilization of private clinics in the face of a new setback in surgical targets. Two years after submitting his Health Plan, the minister admits that he is not yet “where he would like”, even if he is generally satisfied with the results.
In March 2022, the Minister of Health unveiled with great fanfare his roadmap to restore the health and social services network, weakened like never before after the pandemic. Mr. Dubé gave himself three years “to implement the necessary changes”.
“I had a time horizon of 2025, because from my experience, turning over a boat of that size, you don’t do that by shouting scissors,” explains the main interested party, who agreed, at our request, to do his balance sheet.
“I am very happy to have set this horizon, because we have not reached where I would like, but at the same time, there are a lot of improvements and the trend is good,” pleads the minister. The Press reported on the progress of 10 of the 50 measures of the Health Plan. Many yellow and red indicators are still flashing on the minister’s dashboard.
This is the case in surgery. Quebec will miss its first target of reducing the number of operations waiting for more than a year to 7,600 as of March 31. “I’m honest, I don’t think we’re going to [l’atteindre] in the next two weeks,” concedes Mr. Dubé.
Operations pending for more than a year
- Interim target as of March 31, 2024: 7,600
- Balance sheet as of February 14, 2024: 12,221
- Target as of December 31, 2024: 2,500
Source: Ministry of Health and Social Services
This observation is bitter for the minister, since this list has decreased considerably since the submission of the Health Plan, going from some 21,000 to 12,000. However, the strikes in the health network last December combined with the daily cancellations of operations weighed down the balance sheet.
Last month, the Federation of Specialist Physicians of Quebec deplored the fact that the targets of the catch-up plan had become “unrealistic” and requested their revision1.
Private interventions
The Minister of Health is now asking CEOs to “redouble their efforts” by “optimizing” the use of private surgery clinics that have a contract with the Quebec state. Quebec says it is ready to offer “a financial bonus” to hospitals which increase their volume.
According to Mr. Dubé, establishments do not all have “the same desire” to use these clinics – called in the jargon “specialized medical centers” or CMS – to relieve congestion in their operating theaters. Some clinics would therefore be underutilized despite the contracts in force.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESS
The Minister of Health, Christian Dubé, in his office in parliament
In a letter sent to CEOs on Friday, the Deputy Minister of Health, Daniel Paré, gave them the green light to “adjust” the contracts within the limits of the law in order to “identify new operational priorities” and increase the number of operations.
“The calls for tenders were made by establishment,” recalls Minister Dubé. There are some who don’t have a CMS, but that doesn’t matter. [Même si tu es] in the Laurentians, maybe we can send you [au CMS de] Rockland”, illustrates Christian Dubé.
The movement of patients from one region to another to obtain a service must be facilitated with the creation of Santé Québec, which will become the sole employer of the network.
“Blitzes” at $1000 per hour
Furthermore, the prize pool of 400 million to pay overtime to nursing staff who want to participate in surgical intervention “blitzes” is finally available, one year after its announcement.
The information was confirmed to CEOs in another missive from Mr. Paré, sent last week. Each establishment is granted “a provisional non-recurring budget” to carry out offensives aimed at “out of deadline” operations.
“The overall amount calculated for each hour of blitz is $1,000 per hour,” writes the deputy minister, which includes funding for human resources and “expenses related to the additional time required to implement this practice “.
The Press reported in the fall that Quebec was slow to make this pot – announced at the same time as the catch-up plan last May – available to establishments2.
The minister’s office specified that a first tranche of 50 million had been made available. However, “it didn’t percolate,” admitted Christian Dubé in an interview.
These sums come from the Institute for the Relevance of Medical Acts, which ensures that savings generated from the remuneration of specialist doctors are reinvested in the network.
“Basic changes”
Over the last two years, Christian Dubé believes he has managed to lay the foundations for “fundamental changes” in the health network, even if it took “much longer” than he thought.
He cites his law to abolish the use of placement agencies and that to increase access to the first line.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESS
My colleagues know how strategic this is. But the Quebecer has not yet seen the effect of that. What’s difficult is that I see it, but the patient doesn’t feel it everywhere.
Christian Dubé, Minister of Health
The same goes for the creation of Santé Québec and the renewal of collective agreements (an agreement in principle was reached on Tuesday between the Fédération interprofessionnelle de la santé du Québec and the government).
Mr. Dubé finally welcomes the progress in prevention and access to the first line with the creation of the Front Line Access Desk and the improvement in fluidity in emergencies. He explains that he pushed back government targets for emergency room waiting times to somehow motivate CEOs.
“ [On] was so far away that I asked myself: is it attainable? », confides the minister.
According to him, it is “small successes” that will enable in-depth changes to succeed.
1. Read “Unrealistic targets, according to the FMSQ”
2. Read “400 million are lying dormant in state coffers”
Home care: a shift that is long overdue, according to Joanne Castonguay
The “massive” shift towards home care promised by the Legault government, a commitment of the Health Plan, is still awaited, according to the Commissioner for Health and Well-being, who has just completed a vast examination of the issue at hand. the request of Quebec. ” If [le virage] is started, it is not transparent. I have not seen any reaction from the Ministry to our report,” says Joanne Castonguay. “There was a tweet from the minister and that was it. » The commissioner welcomes the increase in the budget and the measures announced by the Minister for Health and responsible for Seniors, Sonia Bélanger, who cut red tape and confirmed accelerated training to recruit 1,000 home support workers. But these “initiatives are a continuation of what we have always done” and do not attack the “fundamental elements” proposed in his report. Sonia Bélanger’s office responds that the government “had many challenges to overcome to achieve the shift and the results cannot be instantaneous.” He assures that “several recommendations” from the commissioner “are already being deployed”.