MONTREAL — The administration of public health and social service establishments with deep roots in Montreal’s Jewish community will be dramatically changed under legislation tabled in the Quebec National Assembly Sept. 25.
Bill 10, presented by Health and Social Services Minister Gaétan Barrette, aims to save $220 million annually by reducing bureaucracy throughout the province. Barrette said the reorganization will not only save money, but also result in greater access to and more efficient delivery of services.
The bill appears to be “a massive re-engineering” of the health and social services system, Eric Maldoff, Quebec chair of the Centre for Israel and Jewish Affairs (CIJA), said Oct. 2, and is “likely to have significant effects on the community as a whole.”
Montreal’s Jewish General Hospital (JGH), Miriam Home and Services, Mount Sinai Hospital (MSH), Maimonides Geriatric Centre and the Jewish Eldercare Centre will be run, along with five other institutions, by the new Centre intégré de santé et de services sociaux du Centre de l’Île-de-Montréal (CISSS), while the Jewish Rehabilitation Hospital will be grouped with institutions under a CISSS in Laval.
There will be 18 such regional umbrella organizations in Quebec, including five on the Island of Montreal, that will administer hospitals, long-term care institutions, local health and social services centres, rehabilitation centres, youth protection agencies and other public facilities in a given territory.
The most notable change will be the elimination of the current regional bodies, the Agences de la santé et services sociaux, which act as intermediaries between the institutions and the ministry.
But individual institutions’ in-house administrations are also to be scrapped, with some exceptions.
Maldoff said the Jewish community is concerned about the impact of grouping several institutions together under one administration and of more direct government control over them, both in terms of the community’s sense of engagement with those institutions and in the delivery of services.
“We [with Federation CJA] are looking carefully at the impact Bill 10 would have on access to culturally and linguistically sensitive services in an environment which is welcoming and comforting to the community.
“We are also consulting on the impact this proposed reform will have on the continued support from the community, which has been vital to our institutions and has allowed them to flourish and serve all Quebecers.”
Gaétan Barrette
The number of separate institutions in the province will be reduced from 182 to 28, without closing any points of service, Barrette said.
The discrepancy between the 28 and the 18 regional umbrellas groups, Barrette explained, is due to the fact that some centres won’t come under umbrella groups. The big university hospitals – the McGill University Health Centre, the Centre hospitalier de l’Université de Montreal and Centre hospitalier Ste. Justine – along with the Montreal Heart Institute and other institutions in remote locations on the North Shore and the far north will be allowed to maintain administrative autonomy.
The CISSS will report directly to the ministry.
The JGH issued a terse statement about the bill on Sept. 29.
“The JGH welcomes the opportunity to join the new CISSS Centre de l’Île with its new partners from the West End of Montreal. These health-care institutions provide complementary services with the common goal to provide exemplary care for all patients,” said executive director Dr. Lawrence Rosenberg.
They are St. Mary’s Hospital, CSSS Cavendish, CSSS de la Montagne (not to be confused with the proposed CISSS), the Gingras-Lindsay Rehabilitation Centre and the Constance Lethbridge Rehabilitation Centre.
“This unprecedented announcement will bring profound changes to the way health-care delivery is managed in Quebec,” said Rosenberg. “I believe the proposed restructuring will help improve the continuum of care to all who set foot into any medical facility in the province.”
JGH president Allen Rubin further commented: “Generations of Montrealers have come to count on this fine institution, and can continue to do so.
“The JGH has a long and auspicious history in Montreal, and the uniqueness that makes this institution so special will remain intact.”
The JGH, which has 637 beds, is marking its 80th anniversary this year.
The JGH said it’s not giving interviews on this subject at this time.
Barrette said the composition of the CISSS boards will reflect the area’s cultural, historical or local character, and he specifically mentioned that the Jewish community should be adequately represented. He also said those institutions so designated will not lose their bilingual status.
Moreover, Bill 10 will not eliminate institutions’ foundations or research centres.
While Mount Sinai has not made any public comment so far, Maldoff, who is also the president of its foundation, touched on the issue at the institution’s annual public information meeting on Sept. 17. The reorganization, along with recent budget cuts, represent “serious challenges,” he said. “We are committed to doing whatever is necessary to preserve the essence of MSH.”
The 107-bed institution in Côte St. Luc provides intermediate respiratory care, long-term care and palliative care. The hospital was founded in the Laurentians 105 years ago by the Jewish community as a tuberculosis sanitorium.
These institutions are currently governed by centre boards and corporation boards, as well as professional staff. The lay and professional administrations of Maimonides and Eldercare were merged a decade ago under an earlier reform of the system.
“The changes proposed by this bill have the goal of assuring a true integration of services, permitting as well a simpler and more fluid course of care for patients,” Barrette said in tabling the proposed law.
“It aims equally to streamline the structures and the bureaucracy in favour of a more rigorous and sound management. Finally, it would result in a clearer line of authority, governance and accountability.”
CIJA and the federation plan to consult broadly in the community on this issue.
“We are at the beginning of a long process with the introduction of this bill, and there will be several opportunities to raise these and other concerns in the future, including possibly submitting a brief once our consultation and analysis are complete,” Maldoff said.