Bill 15 on the new Health Quebec agency promises to be the main course of this parliamentary season. But with its thousand and some articles and all the issues it raises, it does not look very digestible. A short guide in ten pieces to find your way around.
Who will be held accountable for negligence in a hospital?
Since the CEO of the agency will be responsible for managing the activities of the entire network, logic would dictate that this falls in his or her yard. And if the media calls out to the Minister of Health despite everything, we can expect him to refer them to this person. This is why the Liberal opposition in the National Assembly says that the Minister of Health, Christian Dubé, has “made an anti-imputability shield”. Criticisms to which the principal concerned did not respond directly . But his past remarks suggest that crisis management is not his favorite part of the ministerial function. ” It’s the fun to put out fires and deal with emergencies, but I’m not here for that, ”he said during the crisis at Maisonneuve-Rosemont hospital in January.
Is it true that we are going to increase the number of executives in the network?
Yes. Because the Legault government wants to appoint bosses in each of the 1,540 facilities in the network (from the CLSC to the hospital). During the pandemic, the absence of managers in residences for seniors, like Herron, convinced the government that it needed respondents everywhere in the network. This is quite a pendulum swing, since the government had eliminated more than 1,000 executive positions during the Barrette reform in 2015. At the time, the majority of them had then retired early. It remains to be seen where these new executives will come from and how many will come from the ministry, of which 40% of the staff will be called upon to be moved as part of the reform.
Why does the government boast of decentralization?
The government says it is “decentralizing” because, as we said above, it will appoint bosses to head all the facilities currently under the authority of the CISSSs and CIUSSSs (CHSLDs, hospitals, CLSCs, etc.). But it is unclear how much power these managers will have. The government “installs performers everywhere on the territory, people who will obey the orders of the CEO of Health Quebec”, denounced this week Quebec solidaire. Furthermore, Christian Dubé argues that he is decentralizing by transferring responsibilities from the ministry to the future agency. The “small team” of agency managers, he promises, will have a lot of autonomy. Finally, his critics believe that he is centralizing by forcing the local unions to group together (from 136 to 4) so that they negotiate with a single employer (the agency rather than the CISSS and CIUSSS).
Is the bill too big to pass before the summer?
Probably. The bill has more than 1,000 articles and, in theory, each of them can be the subject of a long debate in a parliamentary committee. By way of comparison, Bill 59 on health and safety at work required almost 200 hours of debate for three times fewer articles. In addition, the opposition members have already indicated that they want to take the time to study the bill carefully. Questioned on this, Minister Dubé said that it would be “quite a success” to adopt it before the summer and that there was a lot of repetition and cross-checking to be done in the articles of the bill. But a lot can happen: a postponement of work until the fall, the splitting of the bill into several parts and even the use of closure, which is always an option for a majority government.
How soon will the effects of the new law be felt?
Not for a few years. In addition to the work in Parliament on the bill, the government will have to agree with medical specialists on the terms of the new model, a process of indefinite duration. In addition, setting up the agency must go through several stages: setting up a “transformation committee”, appointing a board of directors and a CEO. it will also take six months before all the installations are integrated into the agency. Finally, the consolidation of local unions will require a raiding period (during which workers may decide to change unions).
Is it a Trojan horse for private health?
This is what some experts fear. “We are in the process of building the skeleton” of a possible “parallel network” without imposing limits on it such as the “notion of pilot project”, lamented Thursday in The duty the Dr Joseph Dahin. François Béland, co-author of the book The private in thehealth. speeches and facts, fears, for its part, that Bill 15 gives the Minister of Health the power to authorize doctors to practice both in the public and in the private sector, which is currently prohibited. A month ago, the government launched two calls for interest to create two private mini-hospitals in Quebec and Montreal with the aim of reducing pressure on emergencies and lowering waiting lists.
Is it true that medical specialists refuse to work at night?
Some maybe, but not all. In the days before the bill was introduced, government sources had told the media that the reform was intended to force medical specialists to work less interesting shifts in the emergency room. The Federation of Medical Specialists of Quebec (FMSQ) reacted by arguing that it was false to say that its members were leaving hospitals as of 4 p.m. “They are mobilized to provide 24-hour on-call duty to take care of their patients. To imply the contrary shows a great ignorance of our work and our daily life, ”said its president, Vincent Oliva. The latter, however, acknowledged this week that “some doctors, in certain specialties, could do more”.
Will nurses unions lose money?
Yes. But it is unclear to what extent this bears on their claims. The bill will reduce the number of union certifications from 136 to 4. Each of them has personnel responsible for member support and negotiations who are released by the employer. Resources that will disappear if the reform goes ahead. We must also take into account the fact that the change from 136 to 4 accreditations will cause certain local unions to disappear. In the new system, there would only be one union per category of employees (for nurses, for office staff, for professionals and for the category including attendants). Currently, it depends on the region. For example, nurses in Saguenay are represented by the FIQ, but on the North Shore, it is the Centrale des unions du Québec that plays this role.
How much will the Dubé reform cost the government?
Not particularly expensive, according to the government. The only planned expenditure is the 60 million earmarked in the last budget for setting up the agency over two years. Minister Dubé also assured that the remuneration of medical specialists would not cost more, even if some will have to give more time. “No, because at the moment, we are not spending all the envelope that was given to them,” he replied to the Duty when introducing the bill. In this year’s budget, health costs $52.8 billion, or 43% of all government spending.
Is this really the biggest bill tabled in the National Assembly?
No, but almost. At the request of Duty, the Library of Parliament research team found at least three other even longer bills. However, they are particularly technical and do not relate to health. This is the case of the reform of the Civil Code of 1990 (3144 articles) tabled by Gil Rémillard, of another part of the same reform of the Civil Code of 1985 (1423) and of Bill 12 on the revision of the Code of Criminal Procedure, also from 1990 (1258). By way of comparison in the field of health, the Health Insurance Management Act of 1969 had only 43 articles.