Handing over the reins to the health mammoth

Le Devoiris today publishing an excerpt from a book to be published in spring 2025 by Somme toute/Le Devoir. The book, written by Pascal Mailhot and Marie-Michèle Sioui, traces the history of the health network, from the birth of health insurance to that of the Santé Québec agency. The former political advisor and the journalist interviewed nearly thirty personalities from all political backgrounds. Through reforms and crises, they take a cross-eyed look at significant periods in the history of health in Quebec, including the COVID-19 pandemic, which they experienced on both sides of the political wall. In this first part: Minister Christian Dubé is preparing to present his mid-term report, and above all to hand over the reins of the network to Santé Québec.

The voice of Health Minister Christian Dubé betrays the fatigue accumulated over the past four years, largely devoted to the “rebuilding” of a health system battered by the pandemic. Surrounded by his team, in Complex G on Parliament Hill in Quebec City, he rehearses, on this November 7, his speech in preparation for the mid-term review of his “Health Plan,” a sort of road map for the network he leads. The ministry’s new prevention mission was announced a few days earlier. Santé Québec is preparing to take its first steps. At the cabinet, it’s time to take stock.

“I have a little… a little something. Sorry,” Mr. Dubé tells his entourage, his voice suddenly choked with emotion. He holds back tears. “I think it’s when I said ‘change management’! It’s an important word for me,” he says. He grabs his glass of water to pull himself together.

At his side, press attaché Audrey Noiseux has tears in her eyes. The chief of staff, Julie Lussier, too. In a few days, on December 1, Santé Québec will be connected to the health network, of which it will become the sole employer. The ministry, for its part, will be able to focus on the major orientations. With this change in governance, the minister and his team believe they are experiencing a pivotal moment in the history of the health network. The transformation, which affects 345,000 executives and employees, will become the minister's great legacy, or a failure associated with his name forever. In short, the pressure is high.

“Proud and reassuring”

Mr. Dubé, with a cold, unwraps a lozenge. “That’s not from the SQDC ?,” he asks to lighten the mood. There’s no cannabis here, but there’s plenty of excitement. “This is your moment. You shouldn’t be embarrassed to be proud of the results that are there, and at the same time realistic,” Julie Lussier tells her boss. Proud and reassuring.”

Commentators and opposition members may see the creation of Santé Québec as the addition of a “trinket,” but the firm is convinced that it is piloting a major shift that will finally steer the health network in the right direction. Two days earlier, over a bowl of popcorn, Dubé’s entourage watched the United States paint itself red with Donald Trump’s return to power. While monitoring the swing states, the team put the finishing touches on the mid-term review of the Health Plan.

It’s a bit like the first time you leave your child at daycare. You’re in the parking lot and you’re like, “I’m leaving, I’m not leaving.” ?

— Julie Lussier

While the minister is rehearsing his text for the press briefing, Audrey Noiseux warns him: A journalist will probably ask him why he is not doing this review in the presence of his colleagues Lionel Carmant (Social Services) and Sonia Bélanger (Seniors). The latter has other obligations. The former, for his part, is “fed up this week,” with all these headlines about the dysfunction of the Youth Protection Department (DPJ). “I don’t know how I’m going to say this… Not in the same way, eh ?” asks Christian Dubé.

Letting the baby go

The minister starts eating a bag of baby carrots. “Not right away,” he replies when his colleagues ask him if he wants to eat. He is stressed. For him, this mid-term review is a major turning point. In a few days, he will hand over management of the network’s operations to Santé Québec. “It's a bit like the first time you leave your child at daycare. You're in the parking lot and you're like, 'I'm leaving, I'm not leaving' ?” illustrates Julie Lussier.

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Speaking of babies, the minister wonders if he can entrust the management of his precious dashboards to Santé Québec. “I don’t want us to take care of them anymore. I just want to receive them,” he says to Étienne Grenier, a numbers maniac who developed these tools (with the assistant deputy minister, Marc-Nicolas Kobrynsky) when he arrived at the office in 2020. “Anything that is ‘internal monitoring’ can be their responsibility. But what concerns the performance of the network, we have to keep that,” replies the advisor.

The minister pulls out his ever-present iPad and scans the text he is about to read to the media. The debate has been raging in the National Assembly since he announced his intention to table a bill to require new doctors trained in Quebec to practice in the public network at the beginning of their careers. He spent the week answering questions from journalists and opposition parties about the role of the private sector in health care. The federations of medical specialists, medical residents and the Fédération médicale étudiante du Québec gritted their teeth, saying they feared a measure that would create “intergenerational inequity.”

“I am very pleased. The public debate has begun,” Mr. Dubé nevertheless asserts. “The premier told me: ‘Christian, I didn’t think we would generate so much interest.’” There were doctors who called him and said, ‘Go there,’” he says. At her constituency office, director Claudine Binette has “never received so many congratulatory emails,” adds Julie Lussier. The momentum the team wanted is here.

Groundhog Day

As is customary when preparing for a press conference, Audrey Noiseux then proceeds to simulate questions that journalists might ask. A dry run, as they say in the jargon. “The dry run,” says the minister in an amused tone, as if to respect the Act respecting the official and common language of Quebec.

— It feels like Groundhog Day, says the press attaché, adopting the incisive tone of a reporter. You’ve been in power for six years and you come with the same old promise that every Quebecer will be taken care of. Why would we believe you today? ?

— We adjusted, the minister replied. The Collège des médecins told us: “We need to take the approach of being taken care of by a doctor or another health professional.” I spoke to the Prime Minister about it because I knew it was one of our election promises. I loved that he agreed to make this change. That’s why we set up the Front Line Access Desk.

— I love it! the press attaché enthusiastically says. We have to end with that.

— But we have to show empathy for the reality of Quebecers, qualifies his deputy chief of staff, Marjaurie Côté-Boileau. We don’t want to seem out of touch with what we said today. We are talking to the population, to Quebecers.

— We must not forget that it is broadcast on Facebook Live, reminds Audrey Noiseux

The “dry run” is interrupted by a joyful exclamation from Marjaurie Côté-Boileau. Bill 67, which allows nurses, psychologists and speech therapists to diagnose certain disorders—in addition to expanding the powers of pharmacists—has just been adopted. The team applauds.

The minister then goes to the small room where the journalists are waiting for him. Behind his lectern, he slips a hand into his jacket pocket. “That’s a good sign,” murmurs Marjaurie Côté-Boileau. “When he has his hand in a pocket, it means everything is fine…”

A non-negotiable objective

In his speech, Mr. Dubé promised Quebecers that they would all be registered in a “healthcare setting”—a GMF or CLSC—by the summer of 2026. Through a mechanism that he did not want to specify, he stated that the 1.4 million Quebecers still without a family doctor would thus be taken care of. “We need doctors and the FMOQ union, as part of the ongoing negotiations, to be there,” he said. Mr. Dubé has mastered this technique, which could be described as “anti-Barrette”: he delivers his toughest messages, most often with a smile.

His strategy was approved by the Prime Minister. By revealing his timetable for 2026, he is opening up his game in the ongoing negotiations with general practitioners. The minister wants doctors to give up and give up performing (and billing for) certain procedures in order to entrust them to other professionals. The objective, at the heart of the negotiations, is for him… “non-negotiable”. “It might be a bit bumpy at the beginning,” he predicts.

The summer 2026 target also has the advantage of coinciding with the election schedule. The Coalition avenir Québec, which hopes that the Quebec population will thank it for the improvements it has made in health and education, is taking a risky bet. Minister Dubé owns a sugar shack in Sutton. There, his family names the maple syrup batches according to current events. The 2020 harvest was called “The First Dose” and the 2024 harvest, “Top Gun.” It remains to be seen whether the “Santé Québec” vintage will taste victory.

Read Friday: Incursion au coeur de Santé Québec