Sophie Kuijper Dickson, reporter

Funded by the Local Journalism Initiative

Quebec’s Coalition Avenir Québec (CAQ) government has adopted the major healthcare reform bill it has been reviewing for the past eight months.
Bill 15, tabled by health minister Christian Dubé in March, will centralize all health and social services, merging the CISSS and CIUSSS networks into one agency which would oversee the day-to-day operations of healthcare services across the province.
The agency will also become the province’s sole public healthcare employer.
Policy guidelines for the agency, called Santé Québec, will still be directed by the province’s health ministry.
The bill became law early Saturday morning, after Minister Dubé invoked closure, a procedure that limits debate on a bill and forces a vote before it has been fully reviewed.
One of the largest healthcare bills in Quebec’s history, Bill 15 is over 300 pages in length, and more than 1,000 articles long.
After over 200 hours of study and debate of the bill since it was first tabled, there were still hundreds of articles left to be reviewed by committee members.
“It’s almost like government is saying, ‘trust us, we’ve got this right,’ but because we had to make so many changes to the rest of the bill it’s hard to trust that it is done properly and didn’t need any corrections,” said André Fortin, provincial member for Pontiac and the health critic for the Liberal Party of Quebec
This is the fifth time the CAQ government has invoked closure to fast-track a bill into law since it was elected five years ago.
In a press conference on Saturday, Minister Dubé said the bill would bring greater efficiency to the province’s healthcare system, something he has promised it would do since the beginning, and would reduce wait times for Quebecers needing to see health specialists.
However, critics are concerned the amalgamation of all health services into one centralized body will reduce the capacity of regional health bodies to address their unique challenges and will undermine the ability of specialized health units to carry out their mandates.

Concerns over further centralization
Fortin said one of his greatest concerns with this bill is that it will demobilize healthcare workers, removing their agency in tailoring their services to the unique demands of the communities they serve.
“It takes away some of the innovation that often comes from staff, some of the local adaptations that often come from regional healthcare boards, and it takes away some of the pushback that comes from local doctors and nurses,” Fortin said.
“If people can’t make those suggestions anymore, if they don’t have a sense, as employees, that they can impact the way things are done in their work environment, then it will demobilize them and that’s the last thing we need from any healthcare reform right now. There comes a point where centralization is no longer of any benefit and we think we’ve reached that point in Quebec healthcare.”

In 2015, the Quebec Liberal Party, for which Fortin is a representative, invoked closure to pass another major healthcare reform bill, Bill 10.
At the time, it was criticized for dissolving the boards of individual health institutions, including hospitals, and consolidating them into 28 regional boards, the CBC reported.
Fortin said Bill 15 crosses a line that, eight years ago, his government “did not dare cross.”
“The merger of institutions back then didn’t affect the specialized institutions. All those institutes that have a very specific mandate were kind of left on their own in 2015. This time, they’re roped in just like everybody else,” Fortin said.
“Given that their mandate is so different, there’s a big worry on our part. That’s why six premiers spoke out against Bill 15, because of the loss of our very specialized healthcare institutions.”
Fortin said his concerns about a standardized, top-down approach also extend to how unique regional needs will be addressed.
“The Outaouais as a whole has a very different situation than the rest of the healthcare network. We lose our staff to Ontario and that doesn’t happen in Sept Îles, it doesn’t happen in Trois-Rivières. So we need to have local adaptations and Bill 15 takes that away from entire regions.”

English language services
An amendment to the bill tabled two weeks ago by Minister Dubé gave the government power to unilaterally remove minority-language access to health and social services in regions where the minority language is spoken by less than 50 per cent of the community served.
After significant pushback, the minister amended the amendment, only slightly, so that Santé Québec still has power to remove minority language services, but can only do so in consultation with two health advisory committees – one national and one regional.
The regional committee will include representatives from minority language communities, and will need support from two-thirds of its members to change the language status of a hospital.

Unclear effects on healthcare workers
Under Bill 15, Santé Québec becomes the province’s single healthcare employer. The bill also allows nurses to move between different regions while maintaining their seniority.
Jérémie Grenier is the secretary for SPSO, the syndicat des professionnelles en soins de l’Outaouais, the regional branch of the FIQ union that represents nurses across the province, including 1,200 in the Outaouais region.
He said his union was completely against the bill, and that he does not believe it will solve any of the problems the province currently has with attracting and retaining nurses.
“We in the Outaouais, we’re so close to Ontario, and so we are worried [the bill] will create an exodus if people are scared of how the bill will affect their work and leave for Ontario where they can find more stable employment,” Grenier said, in French.
According to Grenier, the FIQ has asked the government for clarity on how the bill will affect nurses and has received no response.
“We don’t know exactly how it is going to apply to us, which is causing fear,” Grenier said.
Fortin echoed this frustration with lack of communication from the government on what this bill will mean for healthcare workers.
“The problem is that the government itself has refused to debate that point and hasn’t told anybody what the possible implications of that are,” Fortin said.
“The analysis doesn’t seem to have been done, and so to adopt a measure like that without measuring it, without doing a thorough analysis, it seems like a big risk.”
The passing of the bill came just days before 80,000 nurses and healthcare workers across the province were set to join the hundreds of thousands of public service workers already on the picket line, demanding better pay and working conditions.
He said while Bill 15 may not affect the conditions that arise from the bargaining underway between the province and healthcare workers, “it certainly puts a cloud over the negotiations.”