“Plan santé” – what is it?

The key goal: access to care

Minister Dubé’s plan to overhaul health care – the full title, which is long but nonetheless vague, is “Plan to implement changes needed in health care” – makes its intentions clear from the outset. The goal is nothing short of “restoring the foundations on which to build a more human and effective system,” and the guiding principle is to provide better access to care, regardless of cost.

To reach this goal, the health and social services ministry (MSSS) is putting forward 50 specific measures divided up into 13 categories. Four of these categories are viewed as the system’s “foundations” (personnel, access to data, information technologies, and infrastructure and equipment), while nine others relate to elements of the system or targeted “client groups”.

The 50 measures include:

• Reducing the administrative workload of employees who provide care, and reviewing the composition of care teams in order to reduce their tasks.
• Ensuring better control over the use of private placement agencies.
• Providing services locally, and referring young people to the right professional at the right time through improved access to mental health services.
• Establishing standard assessment systems for all living environments, regardless of their status or the service users involved.

Does this sound like good news? Let’s take a closer look.

How does the MSSS plan to meet its goals, and what will be the consequences?

It’s hard to criticize something that looks so virtuous, but we do need to analyze the Ministry’s intentions, and the means it plans to use to achieve its goals, in the light of basic principles. What will be the impact of the reform on the quality of care and services we provide? Under what conditions will care and services be provided? What will be the cost incurred by the system? And – especially – will everyone benefit equally from this improved access to care and services, or will we see the opposite, i.e., the emergence of a two-tier healthcare system?

What will be the impact of the reform on the quality of care and services we provide? Under what conditions will care and services be provided? What will be the cost incurred by the system?

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To answer these questions, we need to read between the lines. While using a more socially acceptable language, Minister Dubé is actually moving in the same direction as his predecessors, endorsing the neoliberal ideology that has severely damaged the health and social services system over the past decades.

Private companies win out over the public system

For one thing, the MSSS isn’t hiding the fact that it wants to accentuate the turn to the private sector. It’s clear that the much-criticized strategy of privatizing health care and social services will be maintained, whether on the front line through continued investment in family medicine groups (GMFs) – which, as we know, have not achieved a single one of their objectives over the past 20 years – or by subsidizing specialized medical clinics. What price will we pay for this? Employees will continue to leave the public system in droves, increasing work overload for those who remain and harming both those employees and service users.

A system that still revolves around hospitals

Another problem is that the MSSS is following the Legault government’s policy from the last round of contract talks by giving precedence to professions on the basis of their popularity rather than the importance of their contribution to the system. The MSSS strategy completely ignores medical labs and the sectors of medical imaging, nuclear medicine, radiation oncology and medical electrophysiology; social services are represented only when they relate to youth protection or mental illness. All of these sectors are insufficiently known and face major issues such as labour shortages, work overload, and problems in recruiting the next generation of employees. They would certainly have been helped by more attention, which the MSSS could have provided if it really cared about ensuring their long-term presence in the system for the benefit of Quebecers. But maybe these services, too, are simply being viewed as fodder for the private sector?

Obsessional statistical disorder

Meanwhile, the rapid movement towards computerization and digitization of health and social services data is well-intended, but shows a complete lack of understanding of the role played by employees in creating these highly desirable statistics. The goal is to make managers more accountable by requiring them to provide an increased number of statistical reports, but somehow the MSSS seems to have forgotten that these statistics will necessarily be produced by employees. It seems very likely that this orientation will not reduce their workload, as the Plan santé promises it will do, but will in fact make it even more overwhelming

The Health and Welfare Commissioner may have called for a “radical transformation of the system’s governance,” but that’s not what we’re getting. Governments pass, micromanagement endures and employees are the ones who suffer from it.

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The cult of “performance” and the optics of phony decentralization

Finally, another contradiction arises from the focus on performance rather than on the quality of the care and services provided – a mindset that is deeply influenced by corporate culture. Agility, flexibility, optimization, values centred on the client experience and the managerial role, tools to ensure standardization and other performance indicators – using all of these, the MSSS continues to make the system more and more technocratic, following a tendency that peaked in the Barrette era. The Health and Welfare Commissioner may have called for a “radical transformation of the system’s governance” in her report Le devoir de faire autrement, but that’s not what we’re getting. Governments pass, micromanagement endures and employees are the ones who suffer from it.

What’s next?

In short, while the MSSS plan is full of good intentions, it also includes multiple contradictions and blind spots that will certainly lead to negative consequences for our public system, its employees, and the people it serves. With a majority of seats at the National Assembly, the government will have plenty of leeway to endorse ministerial decisions that other parties – whether or not they form the official opposition – will not be able to block. Once again, it will be up to the labour movement to take up the issue and act as a watchdog and counter-force. Our teams are ready to act, and we’ll tell you what they do. Stay tuned!