Since the presentation of the bill on Santé Québec, we have heard about union rules on seniority, bureaucracy and medical specialists. But what about the patients? Will the agency give them better access to services?
“There is not one person who has been able to tell us very clearly how the patient will be better served by this reform,” thundered Thursday the Liberal MP for Pontiac, André Fortin.
Politicians are not the only ones wondering about this.
This is one of the questions posed by Mylaine Breton, professor at the Faculty of Medicine and Health Sciences at the University of Sherbrooke. No, “the effects of this reform have not been demonstrated, but the patient will have the impression that something is being done”. But the results will be long in coming. “At least two or three years,” notes the researcher, who did her doctorate on another reform, the creation of CSSSs in 2004.
Until then, health professionals will invest time and energy in adapting to the new system rather than “thinking about patient trajectories”.
Health Minister Christian Dubé would not say this week when the gains from Santé Québec will be felt. But the ambitions are high. On a paper doily offered to the media on Wednesday, it was promised in particular to “reduce the waiting lists for surgery” as well as in the emergency room. In big blue letters, we also promised to “facilitate and simplify the patient journey”.
More hours for some doctors
To a journalist who questioned him on this, Minister Dubé replied that the average waiting times of 17 hours in the emergency room were unacceptable and that he was counting on the medical federations to help him do more. “I asked the federations […] why we are not able to have appointments within a reasonable time with the number of doctors [qu’on a] ».
However, despite the thousand pages it contains, Bill 15 says little about waiting times in emergency rooms or elsewhere. On the other hand, articles 402 and 403 stipulate that medical specialists have a responsibility towards the population of the region where they practice.
Therefore, to practice in a given establishment, a medical specialist may have to work a few hours a week in another facility where the needs are glaring (“specific medical activities” in the jargon).
How many hours ? Or ? What specialties are covered? All this will have to be negotiated, warned the minister. The Federation of Medical Specialists of Quebec (FMSQ), she cried out, accusing him of having slipped into his bill on the agency issues of negotiations that had no business there.
But this issue could have a concrete impact on the services offered to patients, according to Louis-Martin Rousseau, professor at Polytechnique Montréal and holder of the Canada Research Chair in Healthcare Analytics and Logistics. “It could help,” he says, pointing out that in some specialties, doctors don’t offer enough hours to meet demand. “The thing is, it’s going to take too long to negotiate that.”
More rested nurses
Unlike general practitioners, with whom the government successfully negotiated for the first-line access window (GAP), medical specialists bring together 35 associations with very different backgrounds (radiology, internal medicine, dermatology, psychiatry, etc.) . ” I have the feeling that [chacune] will be a special case. […] I don’t know how they’re going to negotiate that. »
But the best part of the reform for Mr. Rousseau is undoubtedly the revision of the rules surrounding seniority (for nurses in particular). “The main problem at the moment is that the staff who are young have the worst working conditions. […] If we distribute the difficult work among everyone, we will solve a large part of the personnel problem, he says. From the patient’s point of view, the more staff there are, the more rested the staff, the better the service will be. »
Again, this change is not addressed directly by Bill 15. It stems from the fact that the latter makes the agency the sole employer in the network instead of the CISSSs and CIUSSSs. The boss of the network will thus only have to negotiate with 4 unions instead of 136, and will be able to revise the rules of seniority.
On the other hand, Mr. Rousseau is not convinced of the relevance of the agency as such. “What I don’t understand is what we really gain by taking this out of the ministry. […] I can see the organizational and political benefits, but for patients, I don’t. »
Towards the end of fax machines?
The Dre Élyse Berger Pelletier, emergency physician and consultant in hospital fluidity and artificial intelligence, says she is “convinced” that Bill 15 will have “an impact on the patient in the longer term”. According to her, Santé Québec will sound the death knell for fax machines in the health network and will make the system more efficient.
“The agency will be able to acquire technologies, and it will not take 12 years, three calls for tenders, as is currently the case with the Ministry of Health,” she says. As a Crown corporation, Santé Québec will not be subject to the same rules as the ministry and will have more flexibility, she believes.
According to her, Bill 15, combined with that on access to data, will make it possible to “break down the famous silos” in the public network: family doctors will be able to consult their patients’ hospital records, and medical specialists, those written by general practitioners in practice.
“The fact that there are silos, that no one speaks to each other, I think that’s much more the problem in access to specialized medicine,” says the medical specialist.
On the other hand, the Dre Berger Pelletier doubts that the imposition of specific medical activities on medical specialists — for example, working hours on call in a hospital center — will have a real effect on access to care. According to her, the vast majority of medical specialists are already working very hard.
And the beds?
Minister Christian Dubé wants medical specialists to help relieve emergency room congestion by being more available in hospitals. However, stretcher occupancy rates are not theirs alone, points out Régis Blais, full professor in the Department of Management, Evaluation and Health Policy at the University of Montreal.
“Bill 15 doesn’t talk much about other causes of emergency room overcrowding,” he notes. He recalls that patients who no longer require hospital care are occupying beds, because there is a lack of places in CHSLDs, rehabilitation centers and home care. Patients are stuck in the emergency room, for lack of places on the floors.
Yet it is on these issues that citizens will judge the Dubé reform. “If we don’t see a significant decrease in people waiting for an operation, an appointment with a health professional, a bed in a CHSLD or home care, it will have been a failure,” thinks Ms.e Paul Brunet, CEO of the Council for the protection of the sick.
Régis Blais does not expect an improvement in services for at least two years. “Certainly the minister expects to see some impact in his mandate, because [sinon], he’s going to look crazy. »