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 to that the ministry could not.

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.

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.

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.

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.

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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