Health cuts

Nelson Sergerie, LJI Journalist

GASPÉ – The Gaspé Peninsula Integrated Health and Social Services Centre (CISSS) assures that it will not close the 24/7 emergency rooms at the Grande-Vallée, Murdochville and Paspebiac CLSCs, despite their low attendance at night. 

Martin Pelletier, President and Chief Executive Officer (CEO) of the Gaspé Peninsula CISSS, emphasized that no such closures are being considered as the network scrambles to find $40.7 million in savings to meet a $535 million budget. “We are not there. We are really not there,” says Mr. Pelletier. 

This CLSC emergency room question regularly comes up in the news. In 2013, before the creation of the Gaspé Peninsula CISSS, the former regional health and social services agency of the Gaspésie conducted a review that included the issue. It was mentioned in 2017 following the Barrette reform, which had once again caused discontent among the population. 

“Can we review the use of resources from these less busy emergency rooms to help other busier emergency rooms at the same time?” wonders Mr. Pelletier, considering that a doctor and a nurse are on site while the volume of activity is lower. 

“Another thing we can look at is: do we always need a nurse or could we use a nursing assistant in a network where there is not a lot of night volume? But (the nursing assistant) would be affiliated with a nurse who is already working (at another location) and able to be in contact if a case requires the judgment of a nurse. This is another example of transformation work,” he says. The union will have to be involved. 

The overall labour shortage situation is forcing the region’s health network to explore this avenue. “We’re going to have to look. It’s not just a question of budget, it’s a question of survival and maintaining services and the ability to find resources to offer these services. Even if I had the budget, the problem is finding the resources. Changing our ways of doing things is essential to the survival and sustainability of services,” says Mr. Pelletier. 

This hypothesis, raised following the Gaspé Peninsula CISSS board of directors meeting on November 28, is not being well-received by the Eastern Quebec Nurses, Auxiliary Nurses and Respiratory Therapists Union. 

“It’s a complete rejection,” says union president Pier-Luc Bujold. “The population has the right to quality service, professional service and we cannot, to a certain extent, replace a nurse with a nursing assistant,” he adds. 

He provides examples of administering medication in an emergency or managing triage, which could not be done by a nursing assistant. 

“In terms of collective agreements, it doesn’t hold water and, logically, it doesn’t hold water to send a nurse from Grande-Vallée to work in Gaspé,” says the president. 

According to him, these measures would not be attractive and could harm staff retention. “We have already expressed our concerns about this and the CEO tells us that nothing will be done in this regard without having discussions with us and that it holds water. For us, it doesn’t hold water,” says the union representative. 

Former Gaspé Member of the National Assembly, Gaétan Lelièvre, who fought for the survival of the services in 2017 believes that the CISSS is not on the right track with the idea of changing the teams to offer these services. 

Mr. Lelièvre notes that this is a security issue. “This is a decrease in the level of security of the population. Political and economic stakeholders must send a very clear message to Quebec: we do not accept these service cuts,” says the former minister responsible for the regions in the Marois government between 2012 and 2014. 

He points out that health is a basic condition for regional development. “We know that the government has an $11 billion deficit to wipe out, but we cannot accept that this is in services as essential as a CLSC that serves communities 100 kilometres from a hospital. This is unacceptable,” continues the man who is now a regional development advisor. 

For his part, Noël Richard, the mayor of Grande-Vallée, fears service disruptions in the emergency room if the CISSS was to go ahead with this idea. He notes that if a nurse has to go with a patient to the Gaspé hospital, the service would be in danger. 

“Because we have a shortage of manpower, we would be in temporary service disruption. This is unacceptable,” thunders Mr. Richard. In his eyes, such a cut is non-negotiable, especially since several concessions have been made in recent years on health issues. 

“The conversion of ambulance drivers from shift schedules to hourly schedules was not included in this program. We also made concessions on community dentistry, but I will not make any concessions on such an essential service,” added the municipal elected official. 

Nelson Sergerie, LJI Journalist

GASPÉ – The Gaspé Peninsula Integrated Health and Social Services Centre is still facing a $50 million deficit for the fiscal year ending March 31. The organization, however, is focusing on recovering the $40.7 million demanded by the Ministry of Health, mentioned the President and CEO Martin Pelletier following the board of directors meeting on November 28. 

For the moment, there are no plans to cut jobs. “We are not there, and we are not at a  hiring freeze for nurses. We are Some services under development will be reviewed to assess whether they should be maintained. 

Several measures are being analyzed to meet the requirements by March. “I will tell you right away. It will not be $40 million. It will be what we can do. Forty million dollars in five months would take drastic measures. We will not do that,” says the manager. The independent workforce alone represents about $25 million of the projected deficit. 

One example of a measure is to review the housing supply for the independent workforce. Currently, the ratio is one worker per housing unit. “We will implement a measure that will put two or three independent workers in a dwelling, for apartments with several bedrooms, which would eliminate dwellings,” says the president and chief executive officer (CEO). 

This measure could generate savings of hundreds of thousands of dollars. Mr. Pelletier is not concerned that some workers may refuse to come to the region. “Maybe. On the other hand, we are aligning ourselves with other regions. They (health workers from outside) do not come for vacations. Winter is less attractive than summer in the Gaspésie. We have a choice to make and this is an example of a hypothesis that does not affect care,” he says. 

The preliminary studies to launch the engineering work for the emergency and intensive care units at the Maria hospital cannot begin before April 1 due to a lack of funds. 

“We have no guarantee that the project will be included in the PQI (Quebec’s Infrastructure Program) in the next year. The guarantee we have is that we will do the studies next year and if the emergency project is only in a year, it will not prevent us from moving forward. It was an idea to get ahead of things by thinking that the project would be announced next April. We will start in April using independent nursing workers. The idea is to hire nurses to replace them. What we are going to do is not develop new services so we won’t have to create new positions for which we will not be able to respond,” says Martin Pelletier. 

and we will have the year to do the analysis if the emergency project arrives in 2026,” analyzes the President and CEO. 

The MRCs of Bonaventure and Avignon maintain that the project is essential for the Bay of Chaleur area. 

“There were promises made. We have been waiting for more than 15 years. We reiterate that the emergency is in the PQI,” says Bonaventure Prefect Éric Dubé. 

“It is a $100 million project. We estimate that for $250,000, we must find solutions to not delay this project. It’s a relatively small amount on the CISSS and health system budget. We have to find solutions,” mentions his colleague from Avignon, Mathieu Lapointe. 

The elected officials will meet Martin Pelletier on December 11. However, one must not have any illusions. 

“I’m going to tell them the same thing that I just explained. The relevance of the project is recognized. The problem is Quebec’s financial capacity to put this project in the PQI. It’s not at our level. It’s going to happen. When? That’s the question,” says Mr. Pelletier.