(Quebec) Price caps, limited use and risk of criminal offences. Minister Christian Dubé grants himself a series of powers to “regulate and prohibit” the use of private employment agencies, which he wants to get out of the health network by 2026. The opposition and the nurses’ union accuse him of to have “given birth to a mouse”.
“It’s an important day,” launched Minister Christian Dubé on Wednesday, saying that his new bill is a “key element” to the success of his Health Plan, tabled nearly a year ago. The Minister of Health’s intention is clear: he wants to “free” the health network from dependence on independent labor from private employment agencies.
Bill 10, which consists of six articles, prohibits an “organization of the health and social services sector” from using independent labor “except to the extent provided for by government regulation”. This is because the legislative text gives the Minister of Health the power to “supervise and prohibit” the use of agencies through regulations, which are still in preparation.
The Legault government has chosen to proceed by regulation to give itself more flexibility, explained Minister Dubé at a press conference.
With Bill 10, the Minister of Health will notably be able to set a maximum hourly rate per job title, as he had done by ministerial order during the pandemic. This means that the agencies will have to respect a maximum hourly rate to provide labour. We want to avoid the abuses reported where a company could charge $150 per hour for a nurse.
Moreover, most of the elements of the ministerial orders that specifically targeted the agencies will be included in the regulations, according to Mr. Dubé. We can think in particular of the obligatory buffer period of 90 days imposed on a health care worker who leaves an establishment before returning there for an agency or the obligation to offer unfavorable shifts first to workers in the private sector.
This last obligation is already the subject of a directive, but is not always applied. This is why the bill also provides for the imposition of “administrative measures and criminal offences” in the event of non-compliance with the future law and regulations. This applies to agencies, but also to health establishments, such as a CIUSSS, which do not comply with the rules in force.
These financial penalties will range “from $1,000 to $25,000, in the case of a natural person, and from $3,000 to $75,000, in other cases. In the event of a repeat offense, these amounts are doubled.
Negotiation with unions
While his colleague at the Treasury is negotiating with the union side, Christian Dubé recalled on Wednesday that legislating to eliminate the use of agencies comes from a proposal from the Fédération interprofessionnelle de la santé du Québec (FIQ).
Mr. Dubé also let it be known that he is “very, very open” to accommodations being made, such as in terms of seniority, for “agency workers who want to return to the public network”. “That’s why we have to negotiate the agreement at the same time,” argued Mr. Dubé, who admits that the outcome of the negotiations will be decisive in retaining and attracting workers to the network.
PHOTO EDOUARD PLANTE-FRÉCHETTE, THE PRESS
Julie Bouchard, president of the FIQ.
The FIQ replied that we must do both at the same time.
“The ongoing national negotiations and a bill with teeth let us believe that it was possible and that we might be able to turn things around. What an appointment the minister missed,” indicated the president of the FIQ, Julie Bouchard.
In an interview, Mr.me Bouchard would not indicate whether or not the union is in favor of offering accommodations to agency workers who would like to return to the network. She explained the principle of fairness must prevail and that it will be up to the members to decide.
According to the FIQ, Minister Dubé “has given birth to a mouse” and Bill 10 will not prevent the agencies from “making rain or shine at the expense of healthcare professionals loyal to the public network”.
The independent workforce in figures
- 11,278 workers in the network (full-time equivalent), including 2,894 nurses
- 14.8 million hours worked in 2021-2022 (208% increase since 2016)
- $960 million in spending for the Quebec government in 2021-2022 (380% increase since 2016)
Source: Ministry of Health and Social Services
A “phased” plan and penalties
The Minister will be able with his bill to “delimit the sectors” for which the use of labor will remain permitted. Mr. Dubé is counting on a gradual withdrawal plan to take into account regions such as the Côte-Nord and Abitibi-Témiscamingue where dependence on agencies is stronger. The Minister also retains the power to “extend the period” during which the agencies can be used.
Christian Dubé has given himself until 2026 to completely free himself from the independent workforce. We aim to wean ourselves off in urban areas, which includes Montreal and Quebec, as early as 2024. Targets by region will be established in a regulation.
It’s a culture change with private agencies, it’s over, it’s over. I give dates, no one can tell us […] that he didn’t know.
Christian Dubé, Minister of Health
The president of the largest association of placement agencies, Patrice Lapointe, pleads for better supervision, but believes that the government is not going in the right direction by wanting to abolish their services. “It’s as if we were attacking the firefighters by saying that there will be no more fires […] our services are complementary,” said Mr. Lapointe in an interview.
PHOTO MARCO CAMPANOZZI, LA PRESSE ARCHIVES
Patrice Lapointe
A survey conducted by its group of more than 2,000 of their employees revealed that for eight out of 10 health care workers, it is “unlikely” to return to the public sector by retirement. According to Mr. Lapointe, Christian Dubé does not take this into account and this risks aggravating the shortage of personnel.
Public establishments, private CHSLDs under agreement, private residences for seniors (RPA), private CHSLDs, intermediate resources, palliative care homes and religious institutions that provide care will be covered by Bill 10.
WHAT THEY SAID:
The question that arises is to put yourself in the shoes of a nurse who left the network in recent years to go to an agency. Will what the Minister is proposing bring you back into the network? The short term answer is no, not until there are improvements in working conditions.
André Fortin, Health Critic for the Quebec Liberal Party
I am also very worried about the discretionary powers given to Christian Dubé. It is a blank check to the minister, who can decide without consulting anyone what the exceptions will be, in which sectors, which territories and for how long. More centralization is not the solution.
Vincent Marissal, health spokesperson for Québec solidaire
We subscribe to the objective, but we wonder how we are going to achieve it because the bill is extremely thin. We are talking about six sections which basically say that everything will be determined by regulation. The government, if it passes this law, gives the minister absolutely total discretion over the means that will be put in place.
Joël Arsenault, health spokesperson for the Parti Québécois