Over the decades, Quebec has devoted significant sums to the production of reports on the health system, the main conclusion of which was that successive governments should have applied the recommendations of previous reports.
The one that the Health and Welfare Commissioner (CSBE), Joanne Castonguay, presented on Wednesday is no exception. Certainly, a better prepared network would not have prevented the virus from entering Quebec, but the damage would certainly have been less.
There have been innumerable warning signs and corrective actions to be taken in the past, particularly with regard to housing for the elderly and home care, without this having had the slightest effect. It would take a public inquiry just to explain such procrastination!
Useless, it is very easy to understand, you will say. The problem is that governments do not see beyond the next election. As it takes years before improvements of this nature are really noticeable, why sow today what others will reap the day after tomorrow, when a distribution of gifts on the eve of the election is much more profitable? Simply saying the word “reform” has become risky.
Of course, the opposition between the interests of the population and those of political parties is not only true in the field of health. The same could be said of the environment or transport, but the pandemic has posed the problem in a dramatically spectacular way.
In its report, the CSBE makes the comparison between Quebec, where the government has direct authority over the health network, and provinces such as Ontario or Nova Scotia, where the management and provision of health services are entrusted to semi-autonomous entities, the role of the ministry being limited to setting standards and exercising oversight.
“One wonders if in these provinces where the entities are more distant from politics, the response to COVID-19 has been based more on science and evidence and less on political considerations,” writes Ms. Castonguay. Unfortunately, it does not answer the question, which “deserves further analysis”.
Indeed, the answer is not simple. Pandemic management cannot be based on science alone. It must also take into account the social acceptability of the measures imposed, the economy, etc. Inevitably, the politician ends up having the last word. It is not the names of the experts that will be on the ballot.
After coroner Géhane Kamel, who said she was annoyed by “the two hats” worn by the Dr Horacio Arruda – and by his interim successor – that of national director of public health and that of deputy minister, the CSBE wonders about this accumulation.
“The report that the expert addresses to politics is a question in itself and deserves further analysis in order to reconcile the requirements of efficiency and valorization of expertise with the constraints of political decision-making”, she explains. .
In Ontario, the Chief medical officer of health, unlike our national director of public health, has the power to address the population directly, independently of the government, which can only contribute to its credibility. Who knows, Dr. Arruda might still be there, if many had not perceived him as a puppet.
Beyond the role of Public Health, the CSBE is not the first to question the advisability of depoliticizing the entire network. Between his two stints in politics, Philippe Couillard had proposed entrusting the day-to-day management to an independent state corporation, the role of the minister being limited to defining the main orientations. As we know, he did exactly the opposite once he became prime minister, leaving Gaétan Barrette to exercise unprecedented control.
In his opening address to the National Assembly on October 19, Premier Legault seemed to take a similar approach, when he said, “The responsibility of the Department of Health should be to set performance targets and track results.
Its objective, however, is not to remove the responsibility from the hands of the government in favor of an autonomous entity, but to decentralize its management to the regions. It’s not the same thing at all. The big boss will always be in Quebec. With or without a pandemic, getting health policy out will be no small feat.