If he wishes to bring about a cultural change in the health network, Minister Christian Dubé will have to recruit half of the managers of his future Health Quebec agency from outside the ranks of the Ministry, believes former minister Michel Clair.
The observation of the former president of the Commission for the study of health services and social services is clear: the Ministry of Health and Social Services (MSSS) has fallen “a huge delay” and time is running out. to “adjust the service offer” to current and future needs.
Whether it’s the aging of the population or increasing mental health needs, there has been “no planning” to deal with “issues that were already easily identifiable in 2000”, deplores the former PQ minister, in an interview at The Pressa few days before the tabling of Minister Christian Dubé’s bill aimed at increasing the efficiency of the system.
“Now is the time to recognize that we haven’t done any planning and that we have major challenges [devant nous]. We need a ministry that does just that, planning, so that we can control our future,” says Mr. Clair.
Minister Christian Dubé’s reform must create Santé Québec, an agency headed by a CEO who will coordinate all the operational aspects of the health and social services network. The Department will concentrate on defining the major orientations and on its planning role.
This was a recommendation from the report signed by Michel Clair in 2001, which asked the Landry government to consider setting up a “national agency”. We spoke at the time of a “light organization, very operational and results-oriented, fully accountable”.
More than 20 years later, the Deputy Minister of Health, Dominique Savoie, also went in the same direction, in June 2022, after having made a diagnosis on the governance of the network after the pandemic.1
Health and Welfare Commissioner Joanne Castonguay also concluded that the Department “does not sufficiently value its role of governance in the health system, which is hampering the development of its care and service offer” at the population.
“When operations are merged with planning, operations and crises dominate. We urgently need to have a ministry that will look and plan the future rather than react,” explains Michel Clair.
The Minister of Health has already warned that his reform will “shake » the columns of the temple by making major changes in the governance of the network.
Avoid “the pitfalls”
Michel Clair did not particularly appreciate reading that the Minister of Health was seeking to recruit the “top guns” of private industry to carry out his reform, as revealed The Press Monday.2
It takes a variety of experiences […] other backgrounds, and for me, it’s not fair […] “successful big bosses” of private enterprise.
Michel Clair, former PQ minister
Former Minister Michel Clair, on the other hand, believes that at least half of the civil servants, managers and senior executives who will be hired in the future agency will have to come from “outside” the Ministry of Health and Social Services, whose CEO.
It is “a trap to avoid”, according to him, if the Legault government wants “a change of culture and getting out of ministerial paradigms”.
“There has to be new blood. It’s not a blame, it’s not a judgment on the quality of the executives who are there today, but the culture of the Department, the way in which the evolution of health management has been designed over the for the past 25 years, it’s been a bureaucratic view,” he says.
Power to local authorities
Once created, Health Quebec should have the mandate to bring the decision-making power closer to the communities, believes Michel Clair.
There must be, somewhere between the top and the bottom, a board of directors that must be accountable to the population and that has real leeway in decision-making.
Michel Clair, former PQ minister
According to him, this is a “major strategic choice” for the future. Quebec should then identify different “models of decentralization of front-line services” which would be negotiated according to the region. We can think at the level of MRCs or CLSC territories in metropolitan areas, he says.
In his reform, Minister Christian Dubé intends to rehire several hundred local managers so that each facility, hospital and CLSC, has its own boss.
The carnage in CHSLDs at the start of the pandemic has already pushed the Legault government to hire local managers in these establishments.
Christian Dubé wants to be able to count on an “accountable manager” in each establishment, a bit like a “hospital director”, they say behind the scenes. This is also a recommendation of the Savoie report.
Bringing local managers “is not bad”, believes Michel Clair, but it is a solution with a “limited impact”.
“This is not what the regional circles want. That’s not decentralization”, illustrates Mr. Clair, who evokes “deconcentration”.
In the Girard budget, Quebec reserved 60 million over two years for the creation of the Health Quebec agency. Part of these sums will be used to fill these new management positions.
By the admission of the former Minister of Health, Gaétan Barrette, the controversial Liberal reform resulted in the abolition of too many middle management positions.