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Dubé reform was rushed through

Following last Saturday’s announcement that the government would invoke closure to adopt Bill 15, the Haut-Saint-Laurent and Beauharnois-Salaberry CDCs are jointly denouncing this reform, which is centralizing and does not provide an adequate solution to the population’s need for greater access to care. The significance of such a reform demands a respect for the highest democratic standards. Otherwise, the Quebec government could expose itself to growing popular discontent within a society that is watching the health care system it proudly built some sixty years ago being eroded.

The CDC du Haut-Saint-Laurent and CDC de Beauharnois-Salaberry are raising five red flags, based on six briefs that justify the importance of taking the time required to achieve a minimum of social acceptability.

Governance/Santé Quebec

We fear that the disappearance of institutional boards of directors will mean that the profile of board members will no longer be representative of users, and it will eliminate what little power local communities have to communicate their needs and the difficulties encountered by their populations. The introduction of governing boards, whose role will be largely consultative, will transfer real decision-making power back into the hands of Santé Québec. Entrusting all decisions related to our healthcare services in the hands of the ministry of Health will exclude the most concerned players from the decision-making process, while eliminating what little power local communities had to voice their needs and the difficulties encountered by their populations.

Governance and citizen participation

The briefs insist on guaranteeing greater citizen involvement, which means maintaining users’ committees and residents’ committees in all facilities, not just by institution. The Alliance des patients pour la santé (Patients’ Alliance for Health) is hopeful about the recognition of citizen watchdog committees from the community, who could maintain a constructive dialogue. The fact that citizens are remaining vigilant is proof that community members are eager to be consulted to improve healthcare such that it is adapted to the realities of each region.

Front-line care

We believe that Bill 15 focuses too much on what happens in hospitals and not enough on community care. We are concerned that access to care throughout the region will be achieved without planning, and management will be geared toward proximity care. In the absence of a clearly identified front-line service directorate, the organization and delivery of services could become disorganized, thereby seriously undermining the coordination of the gateway to the network.

Public health

For community organizations, Bill 15 runs the risk of removing consideration for the different determinants of public health (income, education, employment), which we believe are the cornerstone of health prevention. In our view, these principles are essential to support a vision that goes beyond the strictly medical.

Private-sector involvement in healthcare

Several articles in Bill 15 could be considered insidious. Article 2, for example, stipulates that health services are provided by establishments that can be either public or private. However, this is not defined in any way. The same is true of article 23, which gives the agency the power to identify the private providers it needs. It’s clear to our representatives that Bill 15 leaves the door wide open to the private sector in terms of healthcare. It would be detrimental if the government were to go ahead with its plans for private establishments, creating a two-tiered medical system that could worsen access to care for the most vulnerable population, with serious repercussions for community organizations.

The future of our healthcare system is the concern of nearly nine million Quebecers. The hasty adoption of such reform requires that we consider concerns that are raised, and that we maintain a collective dialogue. In our opinion, the creation of an agency (Santé Québec) will cast the net too wide, while failing to consider the realities experienced within each region concerned.
Edith Gariépy, director of the Beauharnois-Salaberry CDC de Beauharnois-Salaberry and Rémi Pelletier, director of the CDC du Haut-Saint-Laurent

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