Internal Quebec Health Ministry report highlights need to improve CLSC network

Quebec’s CLSC network must be restructured and refocused on its primary mission of being a gateway to social and health services focused on the needs and realities of the area they serve.

A document prepared for the Ministry of Health and Social Services (MSSS) ahead of the release of its major guidelines, particularly regarding home support, primary care and services, and public health, provides a stark assessment of what CLSCs have become.

“CLSCs are facing a major turning point. Although their raison d’être is based on widely recognized principles (proximity, accessibility, continuity, territorial anchoring), their ability to fully embody them is very limited,” reads the document prepared by the Deputy Minister for Physical and Pharmaceutical Health (SMSPP).

Multiple Problems

As one delves deeper into the 40-page book, the above words seem inadequate to express the findings of the research conducted in the field through visits and interviews, data collection that demonstrated its unreliability, and the consultation of multiple documents.

The report notes disembodied local governance of the CLSCs themselves, a “variable geometry” of service provision depending on the region, “fragmented and sometimes inequitable” access, and “discontinuous and poorly coordinated care and service trajectories.”

Tearing Governance

In the case of governance, the report highlights an approach that causes “significant compartmentalization of clinical and organizational action. Operating in silos complicates the deployment of a coherent territorial approach.”

It is also noted that CLSCs are torn between the Act respecting the governance of the health and social services system (LGSSSS), which proposes an integrated vision of primary care aligned with the territory and the community, and the siloed approach that tends to classify interventions by clinical or social categories to the detriment of a more comprehensive understanding of users’ needs.

Uneven and fragmented service offering

Regarding the “variable geometry” service offering, the document speaks of an evolution over the years “without an overall vision or a common framework for standardization. Several CLSCs have thus seen their clinical role reduced, particularly with the relocation of professional services to other delivery points.”

The authors speak of a “fragmented offering, difficult to understand for the public, and insufficiently aligned with local needs. Coverage appears to vary considerably from one region to another, without necessarily reflecting the real needs of the communities receiving these services.”

Inequitable Access

Regarding “fragmented and sometimes inequitable” access, the authors denounce the absence of a “single territorial gateway that is clear to the population and to local community services” and the fact that access to certain services is often linked to being registered with a family doctor, “which limits the universality of the offer and creates a two-tiered system dynamic.” Added to this is “historically determined and rigid” funding. The report deplores the fact that “CLSCs, which should embody an accessible, human, and integrated gateway, struggle to fully play this role.”

As for the care pathway, it is marked by “disruptions, redundancies, and a lack of harmonization of interventions.” Stakeholders operate in silos and do not communicate with each other, “which forces users to reformulate their requests at each point of contact.” Furthermore, there is a lack of coordination with other levels of care (hospital, rehabilitation, specialized medicine), family medicine groups (FMGs) and other medical clinics, as well as with community partners. “Critical transitions, such as returning home after hospitalization or the transition to adulthood, are particularly vulnerable to these discontinuities,” it notes.

Poor IT

The authors also note a problem that will come as no surprise: the “persistent” inability of computer systems to communicate with each other, which “greatly limits the ability to monitor users throughout their care pathways.” This is referred to as a “technological deficit” that undermines the quality of continuity of care and services.

Quebec has some 500 CLSCs spread across 166 local areas, and the report strongly asserts that they must be redefined as true local service points within their territories.

Unsurprisingly, the recommendations target the problems listed above, namely strengthening territorial governance and breaking down silos; to define a common minimum offering; to simplify access to services; and to ensure continuity and information sharing.

“According to Article 4 of the LGSSSS states that CLSCs are responsible for ensuring access to a coherent set of local front-line community services, including routine health and social services, whether preventive or curative, rehabilitation, reintegration, and public health. This responsibility is defined within a territorial framework: the CLSC provides services to a population living in a given territory, regardless of prior registration, in collaboration with a variety of partners (GMFs, community organizations, pharmacies, etc.).”

Restoring Original Intentions

However, the statement continues, their role has become primarily operational. “They host teams from various programs, but do not necessarily have the power to coordinate them systematically. This configuration contributes to a certain fragmentation, and their position as a local anchor or visible gateway varies considerably from one territory to another.”

And yet, “CLSCs remain a powerful symbolic reference in the collective imagination of Quebecers and retain a structuring potential to meet local needs, particularly for users without a clear affiliation.”

The authors conclude that “it is imperative that the role of CLSCs be clearly redefined, with a population-based and territorial focus.” The portrait they paint “forms the basis for building future ministerial directions: defining not only what a CLSC is today, but above all what it should become tomorrow.”

–This report by La Presse Canadienne was translated by CityNews