Open letter

A catastrophic health reform

A catastrophic health reform

The MSSS will soon have a new health minister taking office. A review of the harmful effects of the reform launched in September 2015 by outgoing minister Gaétan Barrette is in order – particularly its impact on frontline social services.

Why focus on social services? Because this reform has definitively altered the tenuous balance that existed between the health dimensions and the social dimensions of our public health system. In less than one term of office, this politician and former doctor succeeded in disrupting the structures and imposing his narrow vision of health, by stripping local bodies of their decision-making authority. Yet Québecers’ health doesn’t just depend on access to a doctor or care delivered by nurses. Health is a much more complex equation.

Clearly, social services — especially frontline services such as psychosocial and rehabilitation services – were especially hard hit by this centralizing health reform, and suffered catastrophic losses. Loss of power, certainly, but also loss of expertise and close contact with the communities. To take just one example of integrating youth centres within gigantic health and social services centres (CISSS) when, in a region like Estrie, the office designed to receive reports of incidents is located in Sherbrooke, while the territory that has to be covered now extends from Brigham in the Montérégie to Mégantic and Asbestos in Estrie. And we’re supposed to tell the population that access to crucial social services has been improved!

Fewer local services

The 2015 reform left rural and semi-rural communities poorer off, particularly by cutting the anchor line that tied public social services to the community. In finalizing the development of corridors of care with diagnosis-based programs/services, social services were reorganized around our major hospitals and placed under their authority. These hospitals became the “foundational unity” of this reform.

Yet the reorganization of services that ensued from Barrette’s reform runs counter to the population-based responsibility conferred on local service networks by the Act respecting health services and social services, which until then had required that local bodies play a co-ordinating role.

In removing local co-ordination and relegating all decisions to the regional level, this reform had a hand in destroying local solidarity.

As a result, individuals facing a situational crisis (a break-up, bereavement, job loss) now have more difficulty finding a satisfactory response in their locality within a reasonable period of time. Because despite the best intentions of social workers who are faced with waiting lists and strict eligibility criteria for certain services, those who are in vulnerable situations may forfeit their “right of use” by being systematically directed toward private insurance programs or to a community organization where they have to pay for a membership card.

Fewer social services

This reform has also undermined the motivation and professional autonomy of our social workers. Denigrating their expertise that’s anchored in communities, the Barrette reform gives more power and money to doctors and to big hospitals, and keeps professionals in social services far from the centres of decision-making. This devaluation of the social dimension that’s intrinsic to health is reflected in the health and social service centres’ current process of hiring new social service professionals. Flexibility is the primary criterion for hiring candidates who hope to land a first assignment in our big healthcare machine, which has become the quasi-exclusive public employer for these young professionals.

Considered simply as “human resources” that are called on to serve the big healthcare machine, these young professionals are forced to accept whatever they’re offered, and may be dispatched at any time of the day or night over vast territories.

Generating distress and illness

The Barrette reform, by centralizing services and above all by eliminating the local decision-making level, will have a devastating effect on social services, which are being ascribed a secondary (and indeed accessory) role. Because the relevance of social services hinges on the ties they retain with local communities, and this structural reform ignores that fact, entrusting doctors and accounts managers with the governance of our integrated health and social services centres. If you need convincing, take a quick look at the composition of the Boards of Directors!

In this context, it should come as no surprise that we are witnessing a steady rise in suicide crisis situations and distress calls on the part of citizens who no longer know where to go to ask for help. In reducing the delivery of frontline services (prevention) – offered in communities – to invest in the treatment of illnesses, our healthcare system today only attends to treating the sick. To put it another way, if service users aren’t ill at the time they ask for help, circumstances will soon force them to become so.

Hence the importance, in light of our provincial elections, of examining the political parties’ vision of health (beyond the strictly medical aspects), for those concerned not only about the health of Quebecers but also about the health and development of our communities..

This text was published in Le Devoir, July 5, 2018.

David Bergeron, Social worker, Institut universitaire de gériatrie de Sherbrooke  | October 1, 2018

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