In Quebec, health captures an annual budget of $60 billion. This amount is set to explode over the next few years due to the aging of the population. Not to mention that the health reform of 2015 strongly shook the previous anchor points.
From then on, a significant part of the 280,000 employees of the Quebec health network found themselves demobilized. In addition, an influx of heavier clienteles juxtaposed with a disconnection of leadership from the grassroots has produced a reduction in staff passion. Eventually, the publicity surrounding the exhaustion of hospital staff created an inversion of compassion in the population. Now here is the patient who, from his hospital bed, worries about the fate of the nurse.
This context, where the complexity of the care and the exhaustion of the personnel juxtapose, encourages a headlong rush. This is where structural reform changes the zeitgeist. Of this, Quebec has not lacked in health. When health insurance was created in 1971, Quebec had 225 hospitals. They are integrated into a network where reception centers and local community health centers (CLSC) are joined. “CRSSS” regional health centers are born, whose role is advisory. In the early 1980s, the health system had about 1,200 establishments. A phase of integration then began: boards replaced the regional councils in 1991, which subsequently became agencies that the Barrette reform abolished in 2015. The health network was then reduced to 34 establishments, which Minister Christian Dubé proposes to abolish it to make it a single entity: the Health Quebec agency.
Obviously, to counter the difficulties of complexity, successive governments have draped themselves in a veil of centralization. Even the unions were required to do so. The Act respecting bargaining units in the social affairs sector, which the trade union movement had not requested, obliges employees to group together in one or other of the four union units covering the following areas: nursing, auxiliary services, administrative staff and other non-nursing technicians or health professionals. Since the health system has 34 entities, notably the CIUSSS or the CISSS, this gives, for negotiation purposes, 136 union organizations (4 X 34), which are integrated into a few independent centrals or unions. In all respects, the Dubé reform will reduce them to four since there will be only one legal entity for all of Quebec. Site union unity will thus be destroyed with a reducing effect on local social dialogue, and therefore on union democracy.
This titanic administrative maneuver will merge seniority. Thus, an employee from the Îles-de-la-Madeleine will be able to apply for an accessible position in Drummondville. And conversely, an employee who sees his position abolished in Montreal may be required to move (“bumper”) an employee to Gaspé. Negotiating the movement of staff in such a centralized structure will not be easy. Because our labor relations model, based on the principles of the American Wagner Act of 1935, promotes industrial site social dialogue. Even large companies create decentralized company structures where exchanges between unions and employers, for the purpose of collective bargaining, take place at the level of an establishment.
However, the proposed reform intends to do so at the national level. Nevertheless, Quebec has already made useful adaptations. In this regard, he has proven experience. It will be necessary to continue along the path of à la carte negotiation which postulates three levels of exchange: national, regional and local. This negotiation system is already provided for in the Act respecting the process of negotiation of the collective agreements in the public and parapublic sectors.
Bill 15 or the Act to make the health and social services system more efficient should be inspired by the ideas of those who are in daily contact with the clientele, especially physicians as prime contractors , professionals and all other employees. However, to date, no health reform has really taken care to do so. It is as if every Minister of Health had said to himself, for the past twenty years, that everything would be better if everything fell under him. The health system already meets criteria of excellence. The staff must nevertheless demonstrate more rigor and passion, which postulates inspiring leadership upstream. From the top of his national technostructure, Minister Dubé will always be able to delegate to the base. Otherwise, it will achieve nothing other than another structural reform.