Ruby Pratka, Local Journalism Initiative reporter

editor@qctonline.com

The sweeping reform of the Quebec health-care system steered by Health Minister Christian Dubé was voted into law a few hours before sunrise on Dec. 9 after an all-night debate.

The law, expected to go into effect in six months, will create a single Crown corporation, Santé Québec, responsible for the administration of the entire health system, merging local health administrations and hospitals into the provincial body.

This centralization has been widely criticized by unions, patient advocates and politicians, including six former premiers – Liberals Daniel Johnson Jr., Jean Charest and Philippe Couillard and péquistes Pierre Marc Johnson, Lucien Bouchard and Pauline Marois – who argued in an open letter that the centralization was a “dangerous step away from the reform’s objective of making the health and social services network more efficient.” Dubé, for his part, has argued that the creation of a single agency would increase flexibility, creating a uniform system for employee seniority and allowing patients to get around long waiting lists by choosing to be treated in another region or at a private facility on the public dime.

At more than 1,200 pages long, featuring more than 1,000 articles and hundreds of amendments, the law is one of the densest in Quebec history. It was passed through closure, a procedure that allows the National Assembly to cut short debate and fast-track the passage of a bill. Some articles had yet to be fully analyzed in committee, despite well over 200 hours of debate.

Advocates for English-language health care have raised concerns about the bill. The Quebec Community Groups Network (QCGN) wrote a petition against the bill that gathered more than 6,400 sig- natures. “This bill centralizes everything in Santé Quebec and eliminates all [individual] institution boards. One board of directors will be responsible for everything. There goes community input,” said QCGN president Eva Ludvig. “It’s an ill-thought-out bill to start with, and it doesn’t address the major issues, like backup in ERs and lack of access to family doctors.”

Dubé caused alarm in the English-speaking community last week by proposing an amendment that would allow the Santé Québec board to withdraw bilingual status from health facilities that provide less than 50 per cent of their services in English after consulting with provincial and regional health-care access committees and the Office québécois de la langue française. He later modified the amendment so the access committees must recommend – not only be consulted on – the change and a regional access committee must ap- prove removal of status by a two-thirds vote.

“We are confused about why the amendment needs to be there in the first place, since [the government is] saying they don’t want to touch ac- cess to health care in English,” Ludvig said.

“If regional access committees are active and functioning and the provincial access committee is kept abreast of the community’s needs, [the new amendment] should be sufficient to prevent the removal of bilingual status, but it all depends on the final wording,” said Jennifer Johnson, executive director of the Community Health and Social Services Network (CHSSN), who spoke to the QCT the day before the bill was passed. “If they’re asking for a decision [from the access committees] it’s acceptable, but if they’re just asking for our opinion, it’s not. This bill is not supposed to affect an English-speaking person’s ability to access health and social services; that is the guarantee that we have had since the outset, although I am a little skeptical. We’re not satisfied until we’ve seen the final wording.”

Both Ludvig and Johnson said they would keep a close eye on the regulations devised by the Ministry of Health and Social Services as part of the bill’s implementation process in the coming months. The regulatory process is “where the rubber hits the road,” Ludvig said. “We are going to be watching and trying to bring to Quebecers’ attention when we see things that aren’t in their interest.”