(Quebec) Creation of a new Crown corporation, merger of collective agreements, addition of local managers and obligations for medical specialists. Christian Dubé’s reform casts a wide net and overhauls the governance of the health network from top to bottom. Overview.

Christian Dubé tabled his famous bill on Wednesday aimed at making the health and social services system more efficient. The legislative text of some 300 pages contains more than 1000 articles and affects 35 current laws. “It can be scary in terms of volume, but everything that was necessary to be able to make the changes […] is in there”, rejoiced the minister, a year after the filing of his Health Plan. Premier François Legault spoke of a “great day for the health network” and an “important and historic” bill.

Bill 15 creates Santé Québec, a new Crown corporation that will coordinate all operational aspects of the Ministry of Health and Social Services (MSSS). The Department will focus on the major orientations and on its planning role. Santé Québec will have its president, vice-presidents and board of directors, like Hydro-Québec, and will be subject to the Act respecting the governance of state-owned enterprises. The president and chief executive officer of Santé Québec, as well as the president of the future board of directors, will be appointed by the government. The big boss will have to have operational expertise and will come from inside or outside the network, confirmed Mr. Dubé.

Some will rejoice, the Dubé reform marks the end of the acronym CISSS and CIUSSS to make way for territorial designation, such as Santé Québec-Estrie, for example. The boards of directors of health establishments will also be replaced by governing boards that will bring together patients, representatives of the community, research and education, business and the municipal world. According to Quebec, this organization will become “the voice of the field” with the objective of bringing the network closer to their community.

A new showdown is looming between the Legault government and the Federation of Medical Specialists of Quebec (FMSQ). In his reform, Christian Dubé will force medical specialists to do more, such as tackling waiting lists, offering working hours on unfavorable shifts, participating in on-call duty or filling uncovered services. “What we are telling specialists today is that the right to practice will be subject to these particular medical activities,” explained Mr. Dubé, as is the case for family doctors. “We are not here to look for culprits”, assured the minister who did not want to specify the specialties where he expects a helm.

Santé Québec will become the sole employer of personnel in the health and social services network, while the 30 CISSSs and CIUSSSs will be centralized in the new agency. Excluded are the 4 northern facilities serving an Indigenous population. This centralization will have the effect of merging the local collective agreements. Instead of the current 136 bargaining tables with unions, the law will reduce them to just four national tables, one for each of the four job categories. Quebec hopes to “reduce bureaucracy” and “facilitate the relationship between workers and their employer”.

The unification of collective agreements will also lead to a merger of union seniority. That is to say, by having a single employer, we will now speak of “network seniority”. A healthcare worker will therefore be able to move from one establishment to another without losing their benefits. Employee mobility will also allow the creation of a bank of voluntary employees, such as a public employment agency or a flying team, who can be deployed where needed. Quebec cited the recent crisis in the emergency room at the Maisonneuve-Rosemont hospital where it was complicated to send volunteers from other establishments to lend a hand despite their desire to travel.

Quebec wants to rehire several hundred managers so that each health establishment, CLSC as well as hospital, has an accountable director. Former Liberal minister Gaétan Barrette himself admitted that he had abolished too many middle managers in his reform in 2015. The network has some 1,600 installations. The number of positions created has not yet been determined. The Legault government had already added managers in CHSLDs after the first wave of the pandemic.

The opposition believes that Christian Dubé is trying to shirk his responsibilities. “We may turn [the agency] around on all sides, it really seems like a shield for Christian Dubé. An anti-accountability shield so that when a situation arises in a hospital,” thundered Liberal MP André Fortin. Vincent Marissal of Québec solidaire also asserted that the minister is “removing responsibility” and that he will make Santé Québec responsible for the orientations that will fail to produce results. For PQ MP Joël Arseneau, the proposed reform is “an unprecedented hypercentralization” which creates “a screen in front of [the minister] where all the daily operations of the health system will escape him”, he said.