Ten years after its opening, the SABSA nursing clinic is still struggling to finance itself. The first clinic of its kind to have opened its doors in Quebec, it is not eligible for the nearly $400 million program launched by the Legault government in 2022 to finance… nursing clinics.
Nurse practitioner specializing in primary care Isabelle Têtu was stunned when she realized it. “We’ve been waiting for ten years,” she said.
Located in the Saint-Roch district, in Quebec, this solidarity cooperative which offers services with a low threshold of accessibility (SABSA) has welcomed the marginalized, the homeless and other orphans of the system since 2014. A social work which has earned its team a plethora of prizes and honors (Order of Nurses, Laval University, CHUM, etc.).
But at the time of opening, the very idea of a nursing clinic faced a block of resistance. Doctors saw this as a dangerous precedent, and Health Minister Gaétan Barrette was opposed to funding them.
Ten years later, we are elsewhere. The current Quebec Minister of Health, Christian Dubé, has released $395 million in 2022 to finance 23 nursing clinics in Quebec by 2028.
However, SABSA does not have access to this fund. In its “reference framework” on the financing of clinics for 2023, the ministry is committed to producing a “specific framework” for clinics with an “interdisciplinary vocation” of a “non-profit organization type” like SABSA.
When will it be ready? The Ministry of Health is unable to say and maintains that it is “in drafting”.
The SABSA team says it was told by ministry officials that it would be done within two years. But she is on her guard. “In two years, we will return to elections,” retorts Isabelle Têtu. We heard the tape…” And what will happen if SABSA does not fit into the new framework either?
Salaries paid by the foundation
Currently, almost half of SABSA’s budget comes from its foundation (46% of around $400,000 per year).
However, the activities of the foundation are plateauing, according to its president, the former PQ MP Agnès Maltais. “The foundation’s part is enormous,” she said. The average in organizations is between 10 and 20%. »
Originally funded by the Interprofessional Health Federation as part of a pilot project, the clinic concluded a tight-knit agreement in 2016 with the Ministry of Health and the CIUSSS de la Capitale-Nationale.
The state therefore pays the salaries of three of its specialized nurse practitioners, provides its equipment and pays a certain percentage of the salaries of other employees, for the equivalent of $200,000 per year.
But it was never enough. The clinic therefore got by thanks to the activities of the foundation, which pays the salaries of a large part of the staff.
At the ministry, we emphasize that SABSA is not a network service point and that its status is more similar to that of a community organization or a non-profit organization (NPO). ” It’s necessary […] understand that a large part of an NPO’s funding generally comes from philanthropy, particularly for costs related to infrastructure,” its spokesperson indicated in writing.
The seemingly simplest solution to resolve the clinic problem would therefore consist of leaving the cooperative model and completely integrating the health network, agrees the general director of SABSA, Amélie Bédard.
But the team refuses and argues that SABSA would no longer be… SABSA. The name says it all: the SABSA clinic takes its name from the expression “low eligibility threshold”, that is to say that it welcomes everyone, including those who do not have an admission card. Health Insurance.
“It’s not just the CIUSSS, it’s bad, but we would no longer have the agility we need to serve the people we serve,” explain Amélie Bédard and Isabelle Têtu.
The union structure and seniority, for example, would prevent the clinic from hiring “the people it wants to hire,” believes M.me Bedard. It takes people with “particular profiles”, capable of interacting with people who are often “colorful”, who come here under the influence of drugs or alcohol, who “may insult you”.
The SABSA model would also not fit with the procedures, argues Marie-Christine Leclerc, a long-time nurse at the cooperative. “If the person arrives intoxicated, we can tell them to come back tomorrow. We have this flexibility. »
“We should no longer exist”
In the meantime, the ministry still offered to increase her subsidy, but not to the desired level, says the director. “We’re not asking for millions,” she says, rolling her eyes. Maybe $700,000 or $800,000 [de plus] ? »
The clinic is not on the verge of closure, but it is not supplying the demand. Indeed, Steve Giroux — the only social worker on the team — says he is overwhelmed with patients with addiction problems. “It doesn’t make sense,” he said. I am not able to respond to all references. »
Management would like to convert part-time positions into full-time positions and improve the associated conditions. “We would set up a management structure that makes common sense,” continues Amélie Bédard. We are trying to have coordinators, a full-time administrative assistant to manage the accounting…”
The clinic’s situation has nevertheless improved in certain respects over the past ten years, recognizes Isabelle Têtu. The establishment has moved to larger premises and can count on a larger team. In total, no less than 30 employees are now attached to it.
Because during this time, SABSA’s responsibilities have expanded. In partnership with the CIUSSS, since 2022 it has offered a mobile clinic service which now travels to Charlevoix and Portneuf. It was also SABSA which took charge of the supervised injection center in Quebec (L’Interzone) in 2021, still in partnership with the CIUSSS. A service from which she can refer people to the clinic and maintain contact with those who have health problems. To carry out these projects, she receives an additional $900,000.
Is the cooperative falling apart? Amélie Bédard responds that the money from the projects makes it possible to partly finance the clinic through management fees. “At the same time, the projects meet the needs of our customers. We felt very, very, very challenged. »
“Somewhere, SABSA should no longer exist,” says Marie-Christine Leclerc, explaining that the clinic was originally created to bring disaffiliated patients back into the network and direct them to second-line services.
“We should have a decreasing number of patients because the network has decided to do something for them. But here, ten years later, it’s the opposite. We have more patients and the clientele has not been taken care of. It’s only getting bigger. »