2023-04-19 18:07:54
(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 Health and Welfare Commissioner opened the ball for parliamentary consultations on the Minister of Health’s Bill 15.
Although very much in favor of the creation of Santé Québec – a brand new Crown corporation that will coordinate all of the Department’s operational aspects –, Ms.me Castonguay issued certain reservations regarding the future autonomy of health establishments.
“The decentralization of responsibility and accountability to local decision-makers comes up a lot in government discourse surrounding the bill,” noted the Commissioner. However, despite Minister Dubé’s intention “to decentralize decision-making to establishments, the bill does not confer the ‘operational’ component” on establishments, but rather on Health Quebec,” she points out.
Moreover, the legislative text does not specify the “counterpart of accountability”, ie the leeway available to local decision-makers. In its reform, the Legault government wants to bring back hundreds of local managers – one for each facility, hospital and CLSC.
It is questionable to what extent local managers will have the necessary autonomy to achieve the objectives that will be required of them from the central authorities.
Joanne Castonguay, Health and Welfare Commissioner
PHOTO THE PRESS
Me Michel Clair, former president of the Commission for the Study of Health and Social Services, during the public hearings on Bill 15
The former president of the study commission on health services and social services and former PQ minister, Michel Clair, raised similar questions.
” This measure [d’ajouter un gestionnaire par installation] is welcome, but it’s not decentralization, it’s more deconcentration, yet we have to decide what will be the real decision-making power of this new director”, underlined the author of the Clair report.
He proposes on the other hand, to operate a real decentralization, to create “supervisory councils […] which would be constituted on the scale of the 95 territories and communities of the former CLSCs”.
The Dubé reform comes to abolish the boards of directors of the establishments to replace them by councils of establishments, which will bring together patients and actors of the medium. 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 authority be “clearly defined”. The Association of Managers of Health and Social Services Institutions is asking in particular that the bill be amended to limit the Minister’s “powers of direct intervention” in the day-to-day management of institutions.
PHOTO THE PRESS
Guylaine Leclerc, Auditor General of Quebec, discusses with Christian Dubé, Minister of Health.
Private monitoring
The Auditor General of Quebec said she sees a “risk of limiting parliamentary control and oversight” of private health care establishments when the legislative text stipulates that health care and social services will be provided by public and private establishments. 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 be able to adequately verify the use of public funds by these establishments. Only then can I fully play my role of fostering parliamentary oversight through financial audits and performance audits,” explained Ms.me Leclerc.
“Titanic” work, says Dubé
Several criticisms have been voiced since the tabling of the bill at the end of March regarding the proposed decentralization and the minister’s accountability. 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.
PHOTO JACQUES BOISSINOT, CANADIAN PRESS ARCHIVES
Minister of Health Christian Dubé
“I think we’re going to talk a lot regarding decentralization,” said the minister on his arrival for 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 can be improved 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 which contains more than 1200 articles. All opposition parties offered their cooperation to the minister on Wednesday. Christian Dubé remains optimistic that the legislative text might be adopted by the end of the parliamentary session in June.
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.
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