Centralization is a poor prescription

Administrative chaos seems likely to result from Bill 10, Brian Gore says.

Bill 10 has been widely criticized for the threat it poses to the English community’s health and social- service establishments. But for those of us working in the health- care sector, the major damage that this bill will cause will result from the transformation of well- run community and regional establishments by seasoned administrators into much larger organizations run by appointees named by the health minister.

In my view, this amounts to placing the health- care network in Quebec under trusteeship, and without evident cause.

Passage of this bill will see the elimination of all regional health boards across the province, all non- university hospital boards and CSSS administrative boards, and senior management positions, including directors- general, directors of professional services, nursing, finance and human resources, centralizing them into larger new CISSS structures, or CIUSS structures where a university is found within the territory.

Health Minister Gaétan Barrette is heading into uncharted waters with his claim such changes would improve health- care accessibility and provide substantial cost savings. The stated aim is to save $ 220 million, or 0.59 per cent of the $ 37.3- billion budget allocated for the health and social- services sector for fiscal year 2014- 15. Though no one can deny that Quebec finances are long overdue for an overhaul, it is far from guaranteed that the cost savings the government says will result from this bill will ever be achieved.

Barrette says that many senior administrators and managers could be reassigned to these new centralized structures. So no cost savings there. Those not rehired will be given severance packages of full salaries for two years.

Having served in several clinical, research and senior administrative capacities for over 30 years, I am deeply concerned that Bill 10 is entirely misguided for Montreal. It will lead to the dismantling of many excel- lent local establishments that have over many years developed both the expertise and fiscal responsibility in their mandates entirely due to the dedication of their senior administrators, board and foundation members, clinical and support directors, all of whom will disappear under the terms of Barrette’s bill.

Local governance, expertise, and hospital and community programs that developed based on an understanding of local needs will be coalesced into regional structures that will most certainly struggle to retain the level of competency acquired locally. For the Montreal region, where there is a wide and diverse mosaic of health and social- service needs, the consequences of this leadership elimination will be substantial.

Once senior management is dismissed and their respective institutions’ boards dissolved, several issues will inevitably arise.

Foundations will see their donations dry up. The gift of giving is closely tied to an attachment by the donor to the work, recognition and spirit of the local institutional culture. Removing local governance will have huge negative funding implications that will affect quality of care.

The concerns of the smaller member institutions of these CISSS or CIUSS will become secondary to the larger members and acute- care centres.

The individual medical councils that now address the medical services within their own institution will be absorbed into a much larger council of hundreds of professionals that will not necessarily have the same priorities. This will pose a particular problem for the CHSLDs, where small cohorts of physicians ensure both the coverage and functioning of the medical services.

There are far too many problematic, untried and major changes that this piece of legislation, if enacted in its present form, would bring to Quebec’s health- care sector. Do we need the chaos that will be created by eliminating the senior administrative and board members who serve as important guardians of our local institutions?