Honorable Minister of Health of Quebec,
Concerned about the social inequalities in health that COVID-19 has revealed, the Ligue des droits et libertés (LDL) has taken note of its Plan to implement the necessary changes in health. And the concerns that we publicly expressed last March remain unresolved.
Although some of the proposed measures seem valuable to strengthen some aspects of the Health and Social Services Network (RSSS), the plan does not take into account at all the right to health, which, it should be remembered, includes a set of measures and services that go beyond the medical and curative field. The review of the operation of the first line essentially aims to filter the cases that will receive medical services and then, if necessary, the second and third line services. With this plan, the hospital component is at the center of the government’s concerns, as it was during the pandemic.
One observation that we must make in the face of the pandemic is that our “health network” is not capable of guaranteeing access to various social services that play a determining role in the state of physical, mental and social well-being, a central objective of the right to health. . The social services sector is not approached in such a structured way as the hospital network. The proposed measures consist more of future analyzes and recommendations for older people, vulnerable people, mental health, youth protection and home care.
Patronage and the private sector
In addition, Minister, you maintain that “the best patient experience” would be the main objective of your reform. However, as far as the right to health is concerned, the patient is not a client, much less a telepatient whose relationship with the RSSS would be reduced to going to it only in a situation of illness. The right of every person to health includes, in particular, the obligation to implement a mode of government designed, as mentioned in article 2 of the Law on Health Services and Social Services, to “guarantee the participation of and groups that[les ressources humaines, matérielles et financières] train in the choice of orientations, the establishment, improvement, development and administration of services”.
Obviously there is a long way to go here if you consider the lack of public consultation prior to the development of your plan.
In addition, when it comes to undertaking a “great decentralization” of the RSSS, we understand that this would be above all administrative and operational, while the objective should be to reinforce the population responsibility of the territorial structures and establishments, which you had, however, identified as a deficiency. It is above all about increasing the autonomy and powers of managers and staff, without taking into account the participation of the population in decision-making. However, hasn’t the pandemic shown that it is convenient for us to rely on the knowledge that the members of a community have of their reality to establish the conditions of access to the most appropriate care and services?
In addition, as a solution to the difficulties of access to the RSSS, it intends to rely heavily on the private sector. Is there not a parallel here with “the shock strategy”, highlighted by Naomi Klein, which implies using a crisis situation (the pandemic) to launch permanent measures? This would be the case if the measures taken to respond to a crisis situation, such as the use of specialized medical clinics to reduce waiting lists for ambulatory surgery or the use of telemedicine, were maintained beyond the crisis.
The rapid development of a healthy private sector concerns us in the same way that we should concern ourselves with this issue in education, although in this case we are faced with a two-speed system, which opposes private school to public school.
Physician Privacy and Remuneration
As for the RSSS information systems, the LDL is deeply concerned about the lack of consideration that they seem to give to the right to respect for private life and the obligation to obtain the consent of the person concerned. In addition, we intend to participate in the Health and Social Services Commission’s consultations on Bill 19, the Health and Social Services Information Act.
Finally, it is surprising that the mode of remuneration of doctors, which represents a colossal part of the budget, is not taken into greater consideration in a plan aimed at the necessary changes in health. The only announced measure aims to review the remuneration of family doctors without taking into account that of specialist doctors. Should we understand that the debate on this issue will, if it takes place, be held behind closed doors?
However, the thorny problem of physician compensation brings us back to such fundamental issues as the need to promote interprofessional collaboration within the RSSS, the need to ensure the establishment of collective professional responsibility, the need to change the idea that the doctor is solely responsible for health problems, etc.
In light of these concerns, Minister, the League for Rights and Freedoms intends to closely monitor the progress of your plan. We wish to encourage the emergence of a collective reflection on the right to health in the public space, which aims to regain control of our network of social and health services from a collective and participatory point of view.