Healthcare: Reforming the reforms

CIUSSS West End Director Dr. Lawrence Rosenberg's suggested reforms of our new health agencies could have an important positive impact for the English community of Montreal. Rosenberg has proposed that Montreal's English healthcare institutions - in the West End, West Island and MUHC agencies - be merged with regard to establishing a seamless flow of information and communication as well as easing the ability of doctors to have input on their patients regardless of which of the hospitals in the English stream their patients may be treated at on any particular occasion.

This would go a long way toward realizing the goal so often espoused by politicians that "medicine should follow the patient." In fact, this may be the first concrete step in getting this done. The institutions involved already have a commonality of interest and culture since they are McGill University teaching hospitals. Health Minister Barrette seems to be moving to supporting the Rosenberg plan. He has stated that "these ideas merit serious study." 

The Rosenberg initiative began several months ago when a search started for a new head of the MUHC agency to replace retiring Director Normand Rinfret. Many in the healthcare community have openly pushed for Dr. Rosenberg to be named Rinfret's successor. Currently, Rosenberg is both the professional head of the CIUSSS West End and the director,of the Jewish General Hospital. Rosenberg himself has made it clear several times that he would be prepared to consider the post if he has the government's support for the integration.

It is to be hoped that Rosenberg's ideas can actually be put into practice. We would, however offer a few notes of caution. The first is that if accepted, the government not dilute the community and cultural identities of the institutions involved. They are too important, morally and materially, to the non-francophone communities who see the foundational building blocks of their history and vitality chipped away with troublesome regularity. The second is that if this needed integration of information and professional talent leads to the creation of one super agency for all of anglophone Montreal, that the process be undertaken with great care and consultation and not presented as a fait accompli. A rush to "bigger is better" administration would be a virus that our communities would not recover from.

We would also suggest that while the business of "reforming the reforms" continues, there are still needed solutions and answers on other matters that have arisen from Bills 10 and 20.

These Bills were supposed to save the province approximately $220 million in the healthcare system. It is time for the Couillard government to issue a state of the system report to the public focusing on two items. First, what were the actual savings that have been realized. Second, given the approximately $30 billion cost of our healthcare leviathan, will the economies that have supposedly been put in place ever make a serious dent in the number of unionized bureaucratic personnel in the system who have no relation to the actual delivery  of health care yet make up about 50% of our costs. Can we not bring the percentage of bureaucrats in our system down to at least the high 30s as they are in France?

Bill 10 put enormous powers into the hands of the Minister of Health. Including the naming of directors and boards. Quebecers were told that there would be further amendments to ensure that we would never have healthcare by executive fiat. It is important for the government to tell us what if any progress has been made in that area. For the Anglophone community which the Rosenberg plan seeks to benefit, this is a core concern.

It is clear from all available evidence, that patients do better in smaller, more human-scale environments. That is true whether they be hospitals or CLSCs. The personal touch and community input is important. There have been enough instances this year alone to prove this true. The large agency structure has deficits in personal attention and needs satellite support programs. Is the government doing anything in this critical area, particularly with regard to seniors?

The bottom line is that small may not always be beautiful, but large is always an impediment to efficiency and communication.  Dr. Barrette has said that Anglophone board positions are guaranteed and that Anglophone rights are protected by the province’s language charter. “I understand people have an emotional attachment to their institutions,” he said during a press conference. We trust that he understands not to position the Rosenberg plan as that protection. It is not meant for that purpose. Answers on the legitimate outstanding concerns must be forthcoming. And soon.