(Quebec) The granting of thousands of over-the-counter contracts during the pandemic led to “a risk of dependence” on certain suppliers, such as the appointment platform Clic Santé, which received $ 17.3 million in contracts , notes the Auditor General (AG).
In a performance audit published on Thursday, Guylaine Leclerc also reveals that the use of independent labor in nursing is on the rise and that hourly rates have experienced “sharp increases” at the lifting of ministerial decrees capping prices last December.
The Auditor General examined 29 contracts worth $25,000 or more awarded under the state of health emergency, which made it possible to circumvent the usual rules for calls for tenders by proceeding by mutual agreement, March 2020 to March 2022. After examination, it concludes that these contracts still had a direct or indirect link with the pandemic, but establishes “a risk of dependence” on certain suppliers.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
Guylaine Leclerc
In particular, it targets the Clic Santé platform, which was heavily used during the vaccination campaign. In December 2020, the MSSS informed all of its health establishments that the Clic Santé platform had been chosen for the operation. This choice was based on the fact that a majority of CISSS and CIUSSS already used this platform for making appointments, writes the VG.
Separate landlord agreements have been made with each health facility, which pays a user fee per appointment. In addition, the MSSS also awarded four over-the-counter contracts with the company Clic Santé to add functionality to the platform, such as making it possible to book appointments by age group. These four contracts amount to nearly $1.3 million.
In all, 80 contracts were awarded by mutual agreement during the health emergency period for the online appointment booking platform, for a total value of $17.3 million.
“Online appointment booking is a solution that will remain in the health network beyond the health emergency, in particular with the aim of optimizing processes and standardizing the customer experience” , notes the VG in its report while the Minister of Health Christian Dubé is carrying out a major reform of the health and social services network.
The MSSS also recently encouraged institutions to renew their contract with the platform for 18 months, i.e. until September 2024.
Dependency and costs
“In the context where the ministry is not itself the owner, there is a risk of dependence on the firm. In fact, if the MSSS calls for tenders, the current supplier has an advantage over other potential suppliers, in particular because it received approximately $1.3 million to adjust its platform to the needs of the ministry” , supports VG.
And if the latter signs a long-term contract with the supplier, this service will never have been the subject of a call for tenders, and no other bidder will have been able to present itself.
Excerpt from the report of Auditor General Guylaine Leclerc
In the event of dependency, there is also a risk of “observing an increase in costs” for the service, illustrates the VG in its report. Mme Leclerc also demonstrates that the costs per appointment for using the Clic Santé platform “have increased sharply in a few years”. It highlights an increase of 89.1% compared to the average cost of 2020.
The AG recommends that the MSSS carry out an analysis of the costs and benefits of expanding the use of the Clic Santé platform “and take the necessary measures if necessary”.
It also notes that the purchase of accommodation places in the context of the health crisis also induces a risk of dependency since contracts for temporary places have in some cases been transformed into permanent places.
Independent workforce
In addition to having access to data from the Ministère de la Santé et des Services sociaux (MSSS) and all data from health establishments, the VG teams audited more specifically the CISSS de la Montérégie-Centre, the CIUSSS de l’Estrie – University Hospital Center of Sherbrooke and that of the West Island of Montreal.
Unsurprisingly, the use of private employment agencies has exploded during the pandemic. For the three CISSSs and CIUSSSs audited, expenditure on independent labor for nursing care and assistance care amounted to $14.4 million in 2016-2017, to $25.5 million in 2019- 2020 and 50.5 million in 2021-2022.
The VG’s work also confirms that companies have taken advantage of the end of ministerial decrees capping hourly rates, in December 2022. For example, in Estrie, for nursing staff, 17% of agencies have tendered at rates higher than double those established by the decree, we write in the report.
Bill 10, which aims to limit the use of agencies, was adopted in April. The government must, by regulation, reintroduce hourly rates similar to those provided for in the decrees.