After several weeks of bad news with the new Bill 21 ending the oil and gas industry in Quebec despite nearly two-thirds of Quebecers in favor of energy independence and Bill 96 further eroding the constitutionally protected rights of anglophones, it’s a bit of a relief to comment on potentially good news. The health care reform proposed by Premier Legault is a source of optimism.
The plan addresses several major failures head-on. And he frankly does. The only caveat is that although Health Minister Dubé has said decentralization will be a major component of the plan, the government must stick to it, with decision-making responsibilities devolved to local health agencies and hospitals.
But Dubé seems serious about what the government has called a “historic” reform. It does not approach the financing of the plan gradually. It always fails. As former President of the Treasury Board, he and the Prime Minister got the Board to release some $8.5 billion to help achieve their proposed solutions.
The plan is 80 pages with about fifty measures, but there are several that are critical and the success of the reform will be judged by their success.
The plan promises to limit ER wait times to no more than 90 minutes. He proposes to do this by installing “command posts” in each hospital that will link the emergency room to all the departments of the hospitals and have an immediate flow of information and the availability of beds, doctors and nurses in each department. Which patient can be seen, by whom and when the tests can be carried out, the results obtained and the patient admitted if necessary. This “command post” model exists at the CIUSS West-End at the Jewish General Hospital. That works. The JGH has reached the goal of 90 minutes of waiting. The essence of its success is that the structure was developed from within. It was a bottom-up approach. Hopefully Quebec will follow this model and not try to impose a one-size-fits-all, top-down approach. It would be doomed to failure.
The plan also proposes a hiring target of 1,000 additional nurses. Measures will include wage increases and an end to forced overtime. These are two things nursing unions have been calling for since before the pandemic. The last two years have seen a catastrophic loss of nurses leaving the public sector. More money and no forced overtime should just be the prescription for getting plenty back. Let’s hope that the government will not impose any conditions on nurses who want to come back and benefit from the new working conditions.
The third major reform will be to expand our healthcare capabilities and reduce the backlog of elective surgeries by leveraging private sector solutions. It was both surprising and refreshing that Minister Dubé said so publicly and recognized the need to use existing capabilities. This does not mean that people will pay money. What this means, for example, is that the licenses of orthopedic surgery clinics and cataract clinics will be extended and expanded. The plan also includes giving more powers to healthcare professionals such as pharmacists like in many jurisdictions in North America. Pharmacists have already administered more than 3 million doses of flu and COVID-19 vaccines and they can do more. “We have been doing more for some time and if we are allowed to, we will do even more,” Bertrand Bolduc, president of the Order of Pharmacists of Quebec, said of the plan.
The proposed reform also proposes to improve the treatment of family doctors. Currently, more than 900,000 Quebecers do not have a general practitioner. Doctors leave en masse and are not attracted by the discipline. The plan includes ending caps on the number of patients a GP can see and paying family doctors more for each patient they see. To achieve this, the plan calls for expanding telehealth services and paying doctors for their health as they are paid for in-person visits.
A fifth major focus of the plan is to bring doctors to homebound elderly people. This could save up to 25% of hospital beds. The plan aims to provide intensive care at home to people in very vulnerable situations and even at the end of life. “Nobody wants to die on a stretcher in an emergency room,” said Dubé, adding that especially for the elderly, an integrated system of home care in partnership is made possible, citing the example of CLSCs working with affiliated nurses and physicians.
The only thing the plan does not address is reducing the number of bureaucrats who have nothing to do with the delivery of health care, but who make up most of the salaries paid into the health care system. . Bureaucracy must be reduced as France did in the late 1990s. It was a crucial reform that allowed France to have the second best medical system in the west after Israel.
In a tweet, Minister Dubé wrote: “In the spring, it’s not just the maple trees that leak… but good producers know very well that you don’t bottle the first pour. We reserve the good syrup. It is to be hoped that the syrup in this plan produces sweet results and not bitter sap. The government has all the tools it needs and it seems this time around it has the right instincts too.