Health and Welfare Commissioner slams public health ambiguity

The government should give the National Director of Public Health the power to independently inform the public and communicate his views and recommendations in a transparent manner, as it recommends to the Commissioner for Health and Welfare in his final report on the state of services for seniors during the initial period. epidemic wave.

the document It was presented to the media on Wednesday. In particular, he points to the government’s “paternalistic attitude” regarding the elderly and the failure of Quebec’s monitoring system to anticipate the crisis in CHSLDs — which was nonetheless emerging from March 22, according to the survey.

“The alarm was clearly not sounded in time, given the impact of the pandemic on CHSLDs. […] What people are saying is that we have been slow to respond and that the monitoring system was not adequate,” Commissioner Joan Castonguey stated while presenting her report.

She noted that the mortality rate during the first wave exceeded normal in CHSLDs by 34% – numbers that would have been expected had it not been for the epidemic – versus an increased mortality rate of 15% in the general population. Moreover, during this same wave, 47% of infected workers in the health network worked in CHSLDs.

No need for a general inquiry?

The final report of M.^I Castongoy is focused on the government’s response to the first wave of COVID-19. It does not assess measures taken to control subsequent waves. In the opinion of the commissioner, the investigations carried out by her teams, those of the ombudsman and the coroner are sufficient to shed light on the crisis that has shaken Quebec. “We have everything we need to engage in the transformation and look to the future. It is really time to move on to improving our health system to deal with future crises.”

This did not prevent the three opposition parties from repeating their demands for a public and independent investigation into the epidemic. The three formations indicated that many questions about the administration of the government remained unanswered.

The Minister of Health, Christian Duby, confirmed that he had taken a series of measures along the lines of the Commissioner’s recommendations, in particular the development of a plan for prevention and “control” of infection in addition to the addition of staff and workers. Reducing employee turnover in CHSLDs. He did not specify whether the government intended to allow the national director of public health to communicate his views and recommendations directly to the population, as suggested by the commissioner.

Public health lacks independence

During her investigation, the commissioner noted a “perceived lack of independence of the National Director of Public Health”. She notes that the roles and responsibilities of public health actors are “unrecognized and imprecise, which may raise mistrust”.

“Elsewhere in Canada, public health directors can communicate their opinions directly to residents, and this affects public confidence in the recommendations made to them,” the lady said.^I Castongway.

She explained that such autonomy in Quebec could have allowed residents “to differentiate between recommendations based on science and decisions made by the government.” This kind of transparency — which does not necessarily mean that the national director of public health should relinquish the deputy minister position — also leads to political decision-making with regard to scientific advice, according to the commissioner.

M^I Castonguay therefore suggests the government should “give express authority to the National Director of Public Health to independently inform the public”. In general, you denounce the existence of “the system” [de santé] opaque focusing on protecting personal information” and calling for a transition to “an integrated, open and transparent system that exploits the full potential of data to make informed decisions, without compromising privacy.”

More space for the elderly

The commissioner’s investigation also notes that Quebec leaders have demonstrated “inadequate leadership to lend a ‘thin lens’ to government decision-making”. The official described the government’s attitude toward the elderly as “paternalistic.”

“For example, in the main decision-making committee that was set up to manage the crisis, they are at the beginning [les dirigeants] No one was invited to represent the elders, the commissioner explained in an English reply. They didn’t call any nurses either. So they did not take into account their own needs. »

The report proposes introducing an “equal funding method” for accommodation services and deploying, through the CISSSs and CIUSSS, an assessment system “in all accommodation facilities and resources in their territory.”

Quebec “not configured”

At the end of her work, the Commissioner for Health and Welfare concluded that Quebec “was not prepared to deal with a pandemic.” It notes that its monitoring system was not adequate.

As of March 22, signals such as the high rate of positivity of tests taken by the elderly were supposed to be taken into account, the commissioner notes. “Having a good monitoring system in place would have alerted the authorities early on to the challenges posed by the pandemic in living environments,” the lady said.^I Castongway.

The report also calls for the strengthening of the strategic role of public health and the initiation of a thinking process that places health issues “at the center of public health strategic priorities.” [ministère de la Santé et des Services sociaux] ».

Let’s see in the video