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  • David Boudeweel-Lefebvre

New Québec health agency: Structural reform or bureaucratic shuffling?

Updated: Feb 27

The creation of a new health agency — a move the Coalition avenir Québec has framed as an essential step for the successful implementation of its health-care reform plans — will be top of mind when the provincial legislature returns from recess, with a bill promised this spring.

With the creation of Santé Québec, the CAQ government is promising more flexible management of health-care operations and decision-making closer to the field. These are buzzwords we’ve heard many times from Québec politicians, but still never actually seen applied to our sprawling health network. Will Health Minister Christian Dubé, well-known for his management experience in the business world, succeed where so many of his predecessors have failed?

What to expect from the new health-care reform bill

With the introduction of new legislation, Minister Dubé intends to direct the Ministry of Health to focus solely on its high-level mission guiding the direction of the province’s health-care system: setting broad objectives, developing policy, establishing budgets, and measuring performance. Under the new bill, day-to-day management of the network's operations will be delegated to Santé Québec, a new structure that will be led by a chief executive officer and a board of directors whose composition has yet to be determined. The mandate of this new agency will be to oversee the operations of the 34 existing health and social services institutions spread across the province’s 18 health regions, ensuring that the objectives set by the Ministry of Health are met.

Potential file for Québec’s new health-care agency

In mid-February, Minister Dubé promised to phase out the use of private employment agencies within the province’s health-care system, despite the fact that Québec currently sees no end to its labour shortages. Santé Québec will likely be given the task of operationalizing this major government objective.

We’ve already seen quite a lot of resistance to Dubé‘s announcement, with many nurses from private agencies saying they will never return to the public sector. If Dubé is hoping the creation of Santé Québec will pave the way for the provincial government to be considered their employer of choice, this will certainly be a significant challenge. Despite the poor image that some private agencies have had in Québec in recent years, the COVID-19 pandemic has allowed us to measure the extent to which these players can successfully deliver services as needed to the public system, especially in more remote regions. New players have also demonstrated the capacity to deploy innovative solutions that are better able to meet the objectives of Québec's health system. Santé Québec will therefore have to strike a difficult balance between the political guidelines and the reality on the ground.

Will the creation of Santé Québec actually solve anything?

Will the addition of an administrative structure be enough to save Québec’s health system? Only time will tell. The opposition was quick to call the initiative a "bureaucratic solution" and accused the health minister of trying to absolve himself of responsibility for the network's shortcomings.

The main challenge for the governing party will be to maintain the trust that Quebecers have afforded to Minister Dubé up to this point. Once his bill to create a new agency passes through the legislature, the changes he is promising will take years to come into effect, let alone yield any positive results. In the meantime, the many dysfunctional aspects of the province’s health-care system that were overshadowed by the more urgent challenges of the pandemic will return to centre stage. On top of all this, Minister Dubé’s vision will now also be tested by the powerful influence of Québec’s health-worker unions, with a new round of collective bargaining about to begin.

While it is true that most Quebecers continue to hold Minister Dubé in high esteem and are to some extent resigned to the aberrations of their health system, they are still hoping for improvements to the status quo. With their trust in his hands, and an openness to innovation and new ways of doing things in health care, Dubé has a fighting chance to succeed where many others before him have failed.

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