(Quebec) The decentralization promised in the Dubé reform was at the heart of debates on the first day of consultations on the imposing Bill 15. Christian Dubé must establish the real room for maneuver of future local managers, whom he will make accountable, believes the Health and Welfare Commissioner and former Minister Michel Clair.
Although he wants to make the managers of the health network accountable, Minister Christian Dubé must clarify the “counterpart of accountability” and establish their real room for maneuver, argued Joanne Castonguay on Wednesday. The Commissioner for Health and Welfare opened the ball for parliamentary consultations on the Minister of Health’s Bill 15.
Although very favorable to the creation of Santé Québec – a brand new Crown corporation that will coordinate all the operational aspects of the Ministry – Ms. Castonguay expressed certain reservations about the future autonomy of health establishments.
“The decentralization of responsibility and accountability to local decision-makers comes up a lot in the government discourse surrounding the bill,” noted the commissioner. However, despite Minister Dubé’s intention “to decentralize decision-making to the establishments, the bill does not confer the ‘operational’ component” to the establishments, but rather to Santé Québec”, she underlines.
Furthermore, the legislative text does not specify the “accountability counterpart”, that is to say the room for maneuver that local decision-makers will have. In its reform, the Legault government wants to bring back hundreds of local managers – one for each facility, hospital and CLSC.
The former president of the Commission for the study of health services and social services and former PQ minister, Michel Clair, raised similar questions.
“This measure [to add a manager per installation] is welcome, but it is not decentralization, it is more deconcentration, still it is necessary to decide what will be the real decision-making power of this new director”, has underlined the author of the Clair report.
On the other hand, he proposes, to operate a real decentralization, to create “supervisory boards […] which would be constituted at the level of the 95 territories and communities of the former CLSCs”.
The Dubé reform abolishes the boards of directors of establishments and replaces them with establishment councils, which will bring together patients and community stakeholders. The organizations proposed by Michel Clair would be below these governing boards and would allow very local accountability, he explained.
The Association of Senior Health and Social Services Executives also asks that the roles and responsibilities of each body be “clearly defined”. The Association of Managers of Health and Social Services Establishments is asking in particular that the bill be amended to limit the Minister’s “powers of direct intervention” in the daily management of establishments.
The Auditor General of Quebec said she sees a “risk of limiting parliamentary control and oversight” of private health care institutions when the legislative text stipulates that health care and social services will be provided by public and private institutions. Me Guylaine Leclerc reported on the obstacles encountered in the past to access private data.
She cited the ambulance companies. With the creation of Santé Québec, intermediate resources, medical clinics or private residences for seniors will enter into operating agreements, she recalled.
“It is important to ensure that the Auditor General will have the opportunity to adequately audit the use of public funds by these institutions. Only then can I fully play my role of fostering parliamentary oversight through financial audits and performance audits,” Ms. Leclerc explained.
Several criticisms have been voiced since the tabling of the bill at the end of March about the proposed decentralization and the accountability of the minister. The opposition accuses Minister Christian Dubé of wanting to rid himself of responsibility for what is happening in the network by creating Santé Québec, whose CEO will be accountable.
“I think we’re going to talk a lot about decentralization,” said the minister upon his arrival in consultations. “Decentralization, we will have the chance to explain it to Quebecers, it also means being able to go close to the field, to be able to get closer to them to find out what they want”, he assured. Mr. Dubé assured that his bill is perfectible and that he is open to amending it.
“We are embarking on a titanic task”, launched the minister at the opening of the consultations. Bill 15 is a brick of some 300 pages that contains over 1200 articles. All opposition parties offered their cooperation to the minister on Wednesday. Christian Dubé remains optimistic that the legislative text could be adopted by the end of the parliamentary session in June.
About forty groups will be heard in the parliamentary committee, which is held until May 19 with a two-week break for the study of credits.
