allison hanes: new structures unlikely to heal quebec's health-care system
it's still hard to understand what new agency santé québec will be able to that the ministry could not.
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what might quebecers say is most needed to heal their cherished but ailing public health system, if anyone ever bothered to ask them?
many would suggest more family doctors so they can get an appointment with a trusted care provider if they find a lump in their breast and avoid the emergency room if their child has an ear infection that could require antibiotics.
some would surely say more operating time for surgeons so they can get hip replacements without having to hobble around in agony for months or years on end.
perhaps others would call for more support workers to help look after aging spouses or elderly parents in their own homes and keep them out of long-term care facilities for as long as possible.
just about no one is likely to demand a new agency to run day-to-day operations of the public health system. but, alas, that’s what quebecers are getting.
in less than two weeks, santé québec will take charge of delivering health care in quebec. the health ministry will heretofore be relegated to setting policy and strategy. and health minister christian dubé can heave a sigh of relief that he will no longer be in the hot seat over such urgent matters as er overcapacity or surgical wait lists.
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what will this change? everything and nothing.
everything will be shaken up in terms of who is responsible. santé québec will become the sole employer. hospitals and regional bodies with unpronounceable acronyms will be put under its command.
this is supposedly to make the health system more nimble, eliminate silos, avoid duplication, improve efficiency and share best practices — among the business school clichés geneviève biron, the ceo of santé québec, trotted out during a media blitz over the past week.
“there are a lot of captains on the ice,” biron remarked during her tour.
but any semblance of institutional autonomy will be stripped out of health care once central planning is calling all the shots.
perhaps no one will miss the roughly dozen ciussses and cissses, amorphous behemoths with meaningless names created during quebec’s last major health reform less than a decade ago. but people might soon miss the independent governance of venerable institutions like the mcgill university health centre or the centre hospitalier universitaire ste-justine. they got to preserve their identities and autonomy during the contentious mergers under bill 10, but not this time. wither excellence. wither innovation.
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biron’s series of interviews was short on details about what this new streamlined organigram will achieve, what benchmarks will be used for success or on what timeline quebecers can expect to see improvements. santé québec will unveil its strategic plan … next spring.
the only concrete figure that came out of biron’s tour was the $1 billion worth of budget compressions santé québec is already seeking, as it gets set to assume control dec. 1. more like $1.5 billion, according to what well-placed sources told the gazette’s aaron derfel, although santé québec disputes the figure. but don’t worry, the new agency promises none of these cuts will curtail services for patients.
this is wishful thinking at best and double speak at worst. let’s not pretend cancelling job postings for vacant positions at various cissses and ciussses (or whatever we should call local health authorities going forward), laying off orderlies at the centre hospitalier de l’université de montréal and reducing overtime hours for employees who bridge the gaps between shifts won’t have a ripple effect. these are front-line services delivered by front-line workers.
instead of recognizing 1,300 hard-working professionals who toil at two different jobs or take extra shifts in the health sector as the glue that holds the public system together, santé québec is treating them like double-dippers and forcing them to choose one position.
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if money was so tight, why is quebec paying corporate-grade salaries to santé québec “top guns” and board members? biron, for instance, is making about $650,000 a year for the first two years of her mandate and about $500,000 annually after that. she’s not alone. and what about all the civil servants from the gutted health ministry who are being transferred over to santé québec, promoted to management and given a 10 per cent raise?.
this hardly seems like good stewardship of scarce resources. it certainly doesn’t exactly scream making patient care the priority, another of biron’s platitudes.
but odds are nothing will change for the better with the creation of santé québec because once again the effort to overhaul health care is focused on structures rather than services.
taking aim at management and governance failed to fix the system after the réforme barrette under the quebec liberals. many would argue it made problems worse. winnowing down management and governance even further is unlikely to be any more effective with the arrival of santé québec.
an aging population, a shortage of doctors, nurses and other health professionals, onerous bureaucracy and the explosion of a parallel private system are the interrelated reasons the health system is a shambles. except now that policy and service delivery have been separated like church and state, neither the health ministry nor santé québec will have all the prescriptions at their disposal to ensure a lasting remedy.
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santé québec will have to gain the public’s confidence, biron said. but it’s hard to understand what a new agency can do that the health ministry could not have — except, perhaps, insulate an increasingly unpopular government from accountability for its failures.
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