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home / 世界杯决赛2022

quebec's health-care reform bill finds mnas in a co-operative mood so far

a motion adopted across party lines says mnas recognize the urgency to act on bill 15, and the desire of all quebecers to "render our health and social services network more human and efficient."

by philip authier

apr 24 2023
read time 4 minute read
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quebec — it will be a long haul, but the government and opposition parties say they are willing to put in the time.

in a rare move last week at the national assembly, mnas of all stripes adopted a motion put forward by health minister christian dubé pledging to co-operate in passing bill 15, the government’s massive overhaul of quebec’s excessively bureaucratic and often criticized health-care system .

the motion says mnas recognize the urgency to act and the willingness of all quebecers to “render our health and social services network more human and efficient.”
it says they agree the status quo is not an option and it is everyone’s responsibility to contribute to the needed changes that will give quebecers the health services they deserve.
finally, mnas agree to co-operate to “diligently move the bill forward.”
it remains to be seen if the tactic works, given the highly partisan nature of the legislature. reforms have been tried before and flopped.
but in having the motion adopted the same day hearings on the bill opened, dubé was playing his best poker card. in his mind, failure is not an option.
“i think (the motion) is a nice indication of what quebecers expect of us parliamentarians. we must be able to agree among ourselves to find the right compromises to improve our health system,” dubé said in his opening remarks to the health and social services committee examining bill 15.
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he also conceded a 300-page bill with 1,200 clauses is “perfectible” — an olive branch to the critics who will seek amendments.
“we are embarking on a huge task,” he said. “if things need to be corrected, adjusted, we will do it.”

tabled march 29, bill 15 — labelled “an act to make the health and social services system more effective ” — is the centrepiece of legislation up for debate in the national assembly’s spring sitting. it was a key promise of the coalition avenir québec’s election campaign last year.

at the launch of the bill, dubé invited all players — from patients to doctors and nurses — to consider the facts.
“is it normal to be so difficult to have access to a doctor? no. is it normal to have to wait for hours in an emergency (ward) or to have access to a doctor? no.”
so, how does dubé propose to get where he wants to go?
here are some of the key features of the bill.

— the bill would create a new state-owned enterprise, santé québec , to take on the job of providing health and social services. with a president and a board of directors operating in much the same way as hydro-québec, santé québec would become the sole employer of the system. the opposition parties have already criticized this idea, saying quebec is setting up an “accountability shield” to distance itself from day-to-day fiascos in the system. but dubé has said ministers will still be held responsible for what works and what does not.

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the 30 regional cisss and ciusss agencies created under the last overhaul by the liberal government would be integrated into santé québec and get new names such as santé montréal or santé estrie.

— the bill addresses the question of management accountability in the health system, a defect revealed during the covid-19 pandemic when the government discovered many institutions — such as the chsld herron — had no local managers responsible for making things work. under bill 15, each of quebec’s 1,540 health institutions, from clscs to hospitals, will have their own boss.

quebec says local management would reduce bureaucracy and make those on the ground accountable. decentralizing is one of the stated goals of the bill.
— bill 15 addresses another issue that popped up during the pandemic: the lack of mobility of the health workforce, owing to strict union rules. the bill proposes to merge seniority lists, which would allow workers to move to different institutions or regions without being penalized. dubé argues it is not normal that a montreal nurse with 20 years of experience can’t choose to work in a region without losing their seniority.
the number of union accreditation units would drop from 136 to four. the net result would be a bank of mobile labour that could come to the aid of a region struggling with long waiting lists or a particular crisis.

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critics of the clause say it could also result in workers fleeing traffic-clogged cities with a high cost of living, like montreal, in favour of working in regional health establishments.
— besides setting the stage for a confrontation with labour unions, the bill also focuses on quebec’s 11,000 medical specialists. as is the case for general practitioners, bill 15 would oblige specialists to do more to reduce waiting lists and spend more time working less attractive hours in emergency wards.
— the bill would create a complaint examination system to be managed by a provincial “service quality and complaints commissioner,” who would listen to citizens and order corrections to the system. it would also create the obligation of measuring user satisfaction levels.
dubé says once the bill is adopted, he plans to phase in the new system in stages, completing the process by 2025.

the first in a series of public hearings on the bill opened last wednesday, and the mood was constructive. comments came from such personalities as joanne castonguay, quebec’s health and social services commissioner , who questioned how decentralized the system will actually be, given the sweeping powers handed to santé québec.

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the conseil pour la protection des malades and the regroupement provincial des comités des usagers presented briefs expressing concern that the creation of santé québec could reduce citizen input into the way health establishments are operated.
the hearings resume may 9. about 40 groups are expected to comment on the bill, which dubé hopes to see adopted before the june 9 recess of the legislature.
pauthier@postmedia.com
twitter.com/philipauthier
philip authier, montreal gazette
philip authier, montreal gazette

hello from the quebec capital where i have been covering work at the national assembly since around 1989 when i joined the montreal gazette. i have seen many interesting events working here including the 1995 referendum, the rise of the coalition avenir québec and heated debates on touchy issues like bill 21 on state secularism and bill 96 on language. quebec being a winter city, i enjoy cross-country skiing and the carnaval. in the summer i am often found fishing and biking.

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