(Quebec) Accused of carrying out a centralization operation, Minister Christian Dubé plans to adjust his reform by creating local monitoring committees composed, among others, of elected municipal officials, in order to “go further” in the surrender of accounts to the people.
The Minister of Health also assures that he has no intention of axing the hundreds of user committees of the health and social services network, he said in an interview with La Presse after two days of consultations on his massive Bill 15.
The decentralization promised by Mr. Dubé was at the heart of the work as the health and welfare commissioner, Joanne Castonguay, and the former president of the commission of inquiry which passed the health network to the sieve in 2000, Michel Clair, invited the minister to go a step further to talk about “true decentralization” 1.
In this sense, he says he is very interested in the suggestion of the author of the Clair report who submitted on Wednesday the idea of constituting a “supervisory board and community alliance” in each MRC or CLSC territory for large cities. .
These committees, which would “speak” for local populations, could bring together elected officials from MRCs and representatives of “major” community organizations, such as social economy enterprises and the chamber of commerce, explained Mr. Clair. .
“He had a very good suggestion,” says Christian Dubé. “To go further in […] accountability,” he argues.
Michel Clair said to illustrate his point that a CEO of a CIUSSS in the greater Montreal region told him that he only learned the name of the city’s director general during the pandemic.
“It really tickled me,” says Mr. Dubé, who said he was thinking about “finding the right stakeholders and elected municipal officials” to be the base.
“For me [what is important] is: do we go far enough so that the person on the ground, and sometimes it can be the mayor, [can bring back the information]. The mayor may hear, for example, that his GMF [Family Medicine Group] is closed on Sundays… That’s local management, ”he illustrates.
The Dubé reform provides for the abolition of the boards of directors of the CISSSs and CIUSSSs, and their replacement by governing boards, which will report to the head of Health Quebec in the region.
The CISSS and CIUSSS will now be called Santé Québec, including the territorial designation, for example Santé Québec-Estrie.
These new oversight committees would, however, do so for the local director of a facility, such as a hospital or CLSC. Mr. Dubé’s bill promised to bring back accountable local managers to all network facilities.
The constitution of these committees would thus “credibilise” the role of the new directors and would give them “a legitimacy of action other than only hierarchical”, pleaded Mr. Clair.
Joanne Castonguay went in the same direction, wondering about their “real leeway” in the current version of the reform.
The Council for the Protection of Patients and the Provincial Regrouping of User Committees (RPCU) have expressed concern that with the creation of Santé Québec, user committees will disappear in facilities where care is provided2 .
The legislative text provides that a users’ committee be established for each Health Quebec establishment and not one per hospital or CLSC.
“They had the perception that we wanted to limit ourselves to only one user committee per establishment […], but no, we can make sub-committees,” qualified Mr. Dubé in an interview, indicating that the RPCU represents something 540 user committees in the province.
Bill 15 – a brick of 300 pages and more than 1200 articles – aims to make the health system more efficient with the creation of Santé Québec, a new state corporation where the operational component of the Ministry will be centralized, which will he will focus on directions.
The reform makes Santé Québec the sole employer in the network, merges union seniority and will force medical specialists into a “population responsibility” 3.
After a first version that died on the order paper due to a parliamentary traffic jam, the new Bill 3 aimed at increasing access to health data – this time led by Minister Éric Caire – was adopted at the end of March. This new law is necessary for the deployment of the famous Digital Health Record (DSN), which should allow Quebecers to have access to all information in the same place. The contract for the acquisition of the technological solution must be sealed in the fall (with a year’s delay due to the cancellation of the first call for tenders). A pilot project will first be deployed in two institutions, the CIUSSS du Nord-de-l’Île-de-Montréal and the CIUSSS de la Mauricie-et-du-Centre-du-Québec. “It’s called the agile approach, not a bing bang like at the SAAQ,” says Dubé, who says province-wide implementation will take “five, six years.”
Another important piece of legislation for the Minister, Bill 10 aimed at eliminating the use of employment agencies in the health network was adopted on Tuesday4. The Legault government wants to wean itself off the independent workforce by 2026. In Montreal, Quebec and Laval, the deadline has been set for December 2024. independent work,” summarizes Mr. Dubé. Exceptions will have to be authorized by the minister himself. For adjoining regions, such as Estrie and Montérégie, the deadline is 2025, and 2026 for remote regions such as Côte-Nord and Abitibi-Témiscamingue. The list of regions must be established by regulation within a month, as must the maximum rates that will be imposed on agencies. If an agency does not respect them, it will be subject to financial penalties. Mr. Dubé hopes to bring some 11,000 agency workers back into the public network and stem the exodus.
