By dint of denouncing private placement agencies, we have forgotten that they were less the cause of the problem than its consequence.
The Minister of Health, Christian Dubé, had already promised to put an end to it. He finally gives himself the means. His bill provides a timetable and fines for those at fault – both the agencies themselves and the establishments. He is the first to dare this weaning.
It is both necessary and of limited use. Because this file only reminds us of the real problem: the working conditions of the public network, which encourage nurses and other professionals to resign.
Even if Mr. Dubé has the merit of attacking the agencies, that will be the easy part. His main challenge will be to convince staff who have left the public to return.
On the diagnosis concerning the agencies, there is consensus.
To put it bluntly, they have become a nuisance.
First, they tend to cost more. In 2020-2021, the bill exceeded $1 billion. Exceptions exist – for home help, the cost is lower – but in general, they act as an intermediary who slips between the State and the professionals to enrich themselves.
Then, they can demotivate the public network. If agency staff get coveted work hours, public staff get the rest.
These agencies thus look like a nuisance. Why let the private sector enrich itself while destabilizing the organization of work?
Managers don’t do it on purpose, of course. They resort to agencies to plug the holes in the schedules. To maintain daily services. This dependence is particularly acute in the regions. It is up to the Minister to reorganize the network. Mr. Dubé had already promised to eliminate the use of agencies, starting with Montreal and Quebec, where they are less needed anyway. But no sanction was foreseen.
His bill corrects this flaw. It provides for financial penalties. And in order not to create disruptions in services, it retains the possibility of adapting the speed of their elimination according to the particular needs of the regions.
Mr. Dubé weighs his words. He does not speak of “abolishing” the agencies. We understand that it is prudent not to give ammunition to the agencies that are suing Quebec because of the Emergency Measures Act and the conditions imposed in the recent call for tenders to hire staff.
Basically, the agency concept is not necessarily bad. It may be relevant to allow certain employees to travel on the territory with a variable schedule, if this suits them. But the state should be able to manage this system. Without giving in to a logic of profit and without creating inequity in the schedules.
Mr. Dubé shows interest in the creation of a public agency, without being ready to make an announcement. Anyway, for now, the urgency is elsewhere.
We must break the vicious circle of desertion.
This bill is part of the health system reform plan tabled by Mr. Dubé last spring. There will be no miracle recipe. For nurses and other professionals to work, they have to be made to want to, by promoting their profession and giving them decent working conditions. The use of compulsory overtime resembles forced labour. Who would want to go to work in the morning without knowing what time they will be back in the evening?
The solution lies in the renegotiation of collective agreements led by the President of the Treasury Board, Sonia LeBel. The pressure is on her and the unions. And the money will not be enough.
For years, we have heard of establishments – especially English-speaking ones – where the timetable is shared more equitably. Job satisfaction would be increased.
We also hear that nurses whose autonomy is valued would be happier. For example, despite the reluctance of some physicians, specialized nurse practitioners were allowed to open their own clinics. Should other professions be decompartmentalised? It is up to the experts to answer this question, but one thing is certain, any openness would help in the retention and recruitment of employees.
Another delicate issue: what to do with nurses from private agencies? Should we recognize their seniority if they come back to the public? Tensions are to be expected with the union, but this would help repatriate them.
When considering all these questions, one number should be kept in mind: 7.6. It is the ratio of nurses in direct care per 1000 inhabitants in Quebec1. The rate has increased over the past 10 years and is above the Canadian average.
There is no shortage of nurses. There is a lack of nurses who want to work, because their passion is destroyed by too often imposing inhumane working conditions on them.
With his bill, Mr. Dubé has just taken a step forward, but the most difficult part is yet to come.