2023-04-19 18:08:03
Minister Christian Dubé’s promises of decentralization were undermined on Wednesday, on the first day of hearings on his vast reform of the health network.
In general, witnesses welcomed the objective of Bill 15, which will entrust day-to-day operations to a new agency, Santé Québec, while retaining strategic orientations within the Ministry of Health.
But the speakers expressed doubts regarding the assertion of the Minister of Health, who sees in it an important decentralization thanks to the appointment of responsible managers at the head of each establishment (hospital, CHSLD, Youth Center, etc.).
“Although the Minister’s brief on Bill 15 states that the intention is to decentralize decision-making to establishments, the bill does not confer the operational component on establishments, but rather on Santé Québec”, noted Health and Welfare Commissioner Joanne Castonguay.
The piece of legislation also does not specify the “wiggle room that decision-makers will have” in exchange for their accountability, she added.
“We can wonder to what extent local managers will have the autonomy necessary to achieve the objectives that will be demanded of them by the central authorities. In our opinion, it will be necessary to bring clarifications to this debate”, declared Joanne Castonguay.
A solution
Author of an important report in 2001 on the organization of the health system, the former minister Michel Clair also believes that the appointment of local managers will lead to “deconcentration”, rather than decentralization.
However, he recognizes that a real return of power to regional authorities would be difficult following 20 years of mergers. “We went too far in the other direction,” he said.
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To overcome this problem, Mr. Clair proposes a solution of his own: the establishment of regional “supervisory boards and community alliances” to which managers should be accountable.
These councils, made up of a dozen members, would be made up, among others, of representatives of RCMs, social economy enterprises, community police, community mental health organizations, etc.
For example, they might alert local leaders of the health network if the money invested in home care has little impact on the ground, he illustrated.
Pedagogical work
Before the start of the work, Minister Dubé pointed out that the parliamentary committee will be used to explain to citizens how his reform will bring decision-makers closer to patients.
«[La] 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, “said Christian Dube.
“For example, how are we going to ensure that complaints go more directly to the right people so that we can act,” he said.
In particular, the Minister argues that the new user committees – which will now come under the regional authority rather than a hospital or a CHSLD – will allow Santé Québec to have a better pulse on the ground.
“Because, unfortunately, often in the user committees that existed, the information did not reach the establishment [régional]“says the minister.
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