The real reform in our health system would perhaps be to put an end to the reforms.
This is what many said to themselves, after the controversial reorganization of structures operated by Minister Gaétan Barrette from 2014 to 2018.
The employees of the enormous health system repeat it: when the structures are disrupted, it takes several months, and in some cases years, before some find their bearings, have a clear idea of their roles and responsibilities, hierarchical lines.
Good intentions
And there has been no shortage of reforms since that of Marc-Yvan Côté in 1990, 33 years ago. These great redefinitions are always imbued with good intentions (like hell, which is paved with them).
For Côté, in 1990, it was a question of “replacing the citizen at the center of the network”. The “citizen” and not the patient, let us underline this. The creation of the Regional Boards aimed to make the governance of the Network more democratic, in connection with the “environment”. The Régies became the “real masterminds of the development and organization of health and social services in their territory”. The goal was decentralization.
We wanted to change the structures defined 20 years earlier to deal with growing phenomena: “The aging of the population stands out as one of the trends that will have the greatest impact on the demand for services”, could we already read in the text presenting the reform. But also, “the radical transformation of the family”, “AIDS, violence, homelessness and family conflicts”, the acceleration of “technological development”.
Agence
Less than 10 years later, after the “zero deficit” cuts, the Bouchard government launched the Clair commission. There too, we swam in good intentions. To better serve the population, it was necessary to depoliticize. It is true that health had been strongly affected and that forced the minister and his department to indulge in micromanagement. To respond to the National Assembly in specific cases.
The notion of “agency” corresponded perfectly to the imperatives of the times. In particular a promise of neutrality, like the double-bottomed words of the time: “management”, “governance”. As if human affairs could be purely mechanical.
Agencies were indeed created, in the Charest era, by Minister Philippe Couillard. Not just one, but several, on a regional basis. In May 2007, the ADQ health critic, a certain Éric Caire, wondered if the 100 million that the Agencies cost annually were “well invested” and would really improve “the quality of care”.
Couillard answered yes. He had created them! But it was he who, a few years later, as prime minister, would accept that Gaétan Barrette abolish them. And replaces them with a few CIUSSS and CISSS.
Today, the CAQ government is returning to the logic of the Clair report and the creation of a single large agency. The intentions seem excellent: constraints for specialists, single hospital card, single employer, maintenance of seniority for nurses, etc. (We’ll see the details tomorrow.)
The operation is risky, the “patient” is not new to it. We just hope he comes out alive.