Health and Social Service Centres (CSSS): at the heart of the new service organization In December 2003, the Government of Quebec adopted draft bill 25, which launched a major reorganization of Quebec’s health and social service network. In April 2004, the Agence proposed to the Government of Quebec an organization model based on twelve health and social service centres (CSSSs) on the island of Montreal, which involved bringing together 54 theretofore independent institutions. The proposal was approved n June 2004, and the CSSSs were launched. A new way of seeing and doing things in the area of health and social services was set up.
By combining the forces of the CLSCs, residential and long-term care centres (CHSLDs) and community hospitals on a given territory, CSSSs have a unique mission within that territory. This mission has three major aspects, each with its attendant management challenges:
In order to rise to these challenges, CSSSs must equip themselves quickly with an organizational and clinical project. In December 2005, the adoption of draft bill 83, which will amend an Act Respecting Health Services and Social Services and will support the new service organization, will confirm the respective responsibilities of the CSSSs, the Agence and the MSSS.
A central role: developing and sustaining the local health and social service network In order to be in a position to fulfill its mission thoroughly, CSSSs will have to set up and expedite a local service network, and work in an increasingly integrated fashion to improve the health and well-being of the population, and to ensure case management for users, particularly for persons with special and/or complex needs. Case management will be ensured and services will be improved by setting up referral and follow-up mechanisms for users, and introducing clinical protocols for the services they receive. With this in mind, CSSSs are responsible for creating, with the partners on their territory, conditions that foster the accessibility, continuity and networking of general medical care, notably prevention, evaluation, diagnostic and treatment, and rehabilitation and support services. CSSSs will be able to achieve this goal by developing ties with partners on their territory (physicians, pharmacists, etc.). For examples, CSSSs must enter into associations with the family medicine groups and network-clinics. This partnership will make it possible to provide medical services with or without an appointment from 8:00 am to 10:00 am, 7 days a week. It will also guarantee the case management of vulnerable clienteles and liaison with the CSSSs’ relevant programs. CSSSs will also be in charge of guaranteeing, through agreements, that their population has access to specialized and ultra-specialized services on the Agence’s territory. . In addition to medical services, ties are needed with other sectors of activity that have an impact on health and social services, such as school boards, municipalities, housing environments, community pharmacies, social economy enterprises, non-institutional resources and community organizations. By cooperating with these sectors of activity, CSSSs will be able to develop a coherent vision and coordinate actions aimed at improving the health and well-being of the population.
An organizational and clinical project The CSSSs must equip themselves with an organizational and clinical project that will rally its personnel and network of partners. This project must aim to improve the health and well-being of the territory’s population, and ensure better, more continuous, higher quality and more integrated services provided to this population by local-network partners. To achieve this, taking into account ministerial and regional guidelines, the project of each CSSS must set out:
The Agence must support and facilitate the unfolding of CSSS clinical projects, and ensure coordination with regional and supra-regional partners. More precisely, the organizational and clinical project specifies how the CSSSs intend to deliver the nine service-programs and two support-programs for which they receive funding. In order to support this process, budget allocation methods will gradually move away from a trends approach toward a populational approach based on indicators that reflect needs and the amounts available.
CSSSs and the populational approach The CSSSs were created to meet the challenges of the populational approach, which involves more proactive health care management, and helps to maintain and improve citizens’ health. They have been given the responsibility to define the clinical and organizational project. In order to create a true local network focused on populational responsibility, CSSSs must rally network and community actors to progress through a series of steps that can be defined in the following manner:
And, with regard to service organization:
A major responsibility: public health Prevention and health promotion are one of the CSSSs’ major responsibilities. As the entity in charge of the public health program on its territory, a CSSS must provide public health services and deploy the required public health interventions for the entire population on the territory, and for some of the more vulnerable population groups. In particular, CSSSs have the mandate of proposing and implementing the local public health action plan in line with the regional public health action plan “Action for Prevention”.
CSSSs provide a range of general and specialized services aimed at the territory’s population as a whole: prevention, evaluation, diagnosis, treatment, rehabilitation, support, and residential care services. When CSSSs include a hospital, that hospital provides general and specialized hospital services. In addition to providing front-line services to people on its territory, a CSSS provides them with access to a wide range of health and social services by entering into agreements or engaging in other forms of collaboration with other service providers. It also guarantees user case management and helps users navigate the health system. The important role of case managers should therefore be highlighted, particularly for vulnerable persons. In its guidelines to implement the local service networks, the Ministry defined the basic basket ofservices that a CSSS should provide, as follows:
Among the front-line services provided by the local body, emphasis is placed on prevention, evaluation, diagnosis, treatment, rehabilitation, support, and public institutional residential care services. With regard to public health: public health services and interventions for the population and for vulnerable clienteles; actions aimed at health promotion, prevention and health protection in line with regional and local public health plans.
It should be noted: when there is no hospital grouped within a CSSS, a formal service agreement must be entered into with a hospital centre in order to ensure that the local population has access to general and specialized hospital services.
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