2023-08-20 05:43:11
Objective: efficiency
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
Bill 15 promises to improve access to care in the public network.
The centerpiece of his Health Plan, Bill 15 tabled in March by Minister Dubé is strong. This is the most important reform of the second term of the Legault government. The objective is clear: to review the organization of the health and social services liner to make it more efficient. Christian Dubé has promised to “shake” the columns of the temple. The legislative text – which thoroughly reviews the Act respecting health services and social services – modifies the governance of the public network. The aim is to make it an “employer of choice” and to improve access to care.
Bill 15 in brief
- 1180 articles
- 305 pages
- 35 amended laws
- 114 briefs submitted during consultations
Creation of Health Quebec
The central element of Bill 15 is the creation of Santé Québec, a brand new Crown corporation, which will coordinate the operational component of the Department, which will focus on defining major orientations and strategies. This is a recommendation from the Clair report, which dates back more than 20 years and which no government wanted to implement. Santé Québec will have its own board of directors, like Hydro-Québec, and will be led by a CEO who will report to the minister. By separating operations from orientations, Quebec wants the Department to regain its primary planning role to better meet population needs.
A single employer
Santé Québec will become the sole employer in the network to “reduce bureaucracy”, which means that union seniority by establishment will be merged to “offer greater flexibility” to staff. A worker can therefore change region without losing his seniority. This is an upheaval in the union world: the law will increase the current 136 negotiation tables to 4 national tables (one per job category). The establishments will continue to be led by a CEO, who will report to Santé Québec. This will be the end of the acronyms CISSS and CIUSSS – which will be replaced by “Santé Québec – Estrie”, for example.
Return of “local” managers
PHOTO OLIVIER JEAN, LA PRESSE ARCHIVES
Joanne Castonguay, Health and Welfare Commissioner
The new law will make it possible to rehire several hundred “local” managers so that each facility – from the CLSC to the hospital – has a director who will be accountable. Former Liberal minister Gaétan Barrette admitted that he had abolished too many middle managers in his reform, forcing the departure of nearly 1,300 managers in 2015. The Legault government has already brought managers back to CHSLDs during the pandemic. Health and Welfare Commissioner Joanne Castonguay recommended that Minister Dubé establish the real leeway of these new managers if he wants to talk regarding decentralization.
Obligations for medical specialists
PHOTO PATRICK SANFAÇON, LA PRESSE ARCHIVES
The Dr Vincent Oliva, President of the Federation of Medical Specialists of Quebec
In his reform, Christian Dubé wants to tighten the screw on medical specialists by linking their license to practice to the execution of “specific medical activities”, as for general practitioners. They will be subject to support obligations and to offer better availability, for example. The Federation of Medical Specialists of Quebec does not oppose it on the merits, but calls for a negotiated agreement rather than it being enshrined in law. A standoff is looming, since for his part, the minister affirms that “the populational responsibility of doctors” is a “key element” of the change of culture that he wants to operate.
Doctors removed from power?
PHOTO FRANÇOIS ROY, LA PRESSE ARCHIVES
Physicians and their professional orders particularly deplore the “disappearance” of medical co-management.
Last spring, Christian Dubé faced a group fire from medical specialists, general practitioners and their professional order. According to them, the changes made to governance come to “remove” them from decision-making places. At the center of their grievances: the reduction in the weight of the councils of doctors, dentists and pharmacists (CPDP) in the organization of care and the “disappearance” of medical co-management. The two federations and the College of Physicians are asking the Minister to step back and keep intact the responsibilities of the CPDPs – which would no longer have direct access to the CEO following the reform.
The end of CAs
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
Michel Clair, ex-president of the study commission on health services and social services
Bill 15 marks the end of the boards of directors of the CISSSs and CIUSSSs to make way for new governing boards. After hearing the criticisms of Michel Clair, ex-president of the commission of inquiry which scrutinized the health network in 2000, Christian Dubé proposed to amend the legislative text to add a stronger representation of elected officials municipalities at the table. The maximum will be set at four people “from the municipal sector of the territory served”, whereas the initial version provided for only one. It also adds two places for staff.
Fewer user committees
Another element of the reform: the creation of a national users’ committee. However, the proposal is not unanimous among the groups representing network users. It is planned that a users’ committee be set up for each health establishment, whereas currently, several hospitals and CLSCs have their own committee. The Council for the Protection of the Sick fears that the reform will result in the abolition of several dozen committees, which would “reduce the presence of citizens and, therefore, of democracy”. Mr. Dubé plans to make adjustments to this aspect of his reform.
What the opposition thinks
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
André Fortin, Liberal Party of Quebec health critic
The Minister of Health is proposing a bill that completely misses the number one priority in health: the staff, whom he does absolutely nothing to attract, to keep. He proposes a structural reform.
André Fortin, Liberal Party of Quebec health critic
PHOTO JOSIE DESMARAIS, LA PRESSE ARCHIVES
Vincent Marissal, Québec solidaire health critic
Agence Santé Québec will be able to give contracts to whoever they want, private, public, it’s the open door, it’s the fantasy of Jean Charest and Gaétan Barrette which is realized under a bill which claims to make efficiency in health.
Vincent Marissal, Québec solidaire health critic
PHOTO PASCAL RATTHÉ, ARCHIVES SPECIAL COLLABORATION
Joël Arseneau, Parti Québécois health critic
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