Robert Libman: Quebec’s health-care reform already showing cracks

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Consultations and public hearings to solicit input on Quebec’s sweeping health-care reform only got underway on Wednesday, but that didn’t stop the National Assembly this week from unanimously adopting Bill 10, which limits the use of private health-care agencies and aims to ban them by December 2024.

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Quebec calls on these external placement agencies to provide personnel to fill in staffing gaps at health-care institutions and seniors’ residences, for example. However, the problem is that these agencies — by offering higher salaries and greater flexibility — siphon out of the public system thousands of nurses and professionals who may be fed up with their working conditions or forced overtime. Health Minister Christian Dubé said about 30,000 health-care workers leave the public network every year.

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When the agencies place these professionals into institutions, it creates inequity and resentment as they work alongside public employees who earn less and often work worse shifts. This contracting out of independent workers also costs the public network much more — almost $1 billion in 2022, a 380-per-cent increase over the past six years, according to the Health Department. Furthermore, these agencies get a big cut on each employee by charging more per employee than what they pay them. It’s an unfair situation that needs to be reined in.

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However, while legislation is necessary, Bill 10 seems like another example of the Coalition Avenir Québec government using punitive measures to solve a problem instead of taking a more comprehensive approach that positively incentivizes professionals to remain in the public health system.

By forcing these agencies to close, the government hopes to draw all these contract employees back into the public system. That is unlikely to materialize if the salaries and working conditions that led many to leave in the first place remain. Many will likely leave Quebec or the profession entirely. Others will seek to work in private clinics or doctors’ offices, creating even more of a vacuum and leaving scrambling institutions with no alternatives.

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Quebec nurses are already the lowest paid in Canada. To make matters worse, last December the CAQ government implemented a measure of penalizing new nurses with university degrees by unceremoniously shifting them into the lowest entry-pay echelon.

Dubé said Bill 10 “gives us time to make a link with negotiations on collective agreements, which are happening in parallel.” The external agencies in some way give some negotiating power to the nurses’ union, which can point to them as proof that thousands are leaving the public system over inadequate wages and working conditions. Is targeting the agencies during negotiations partly a calculated plot by the health minister to cut the legs from beneath the nurses’ union?

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Nurses join the profession because they want nurses to return to better health. When their working conditions compromise their own health and well-being, they cannot help others. No health reform can succeed without effective nursing resources and health-care professionals. They must be drawn to the profession willingly and work in an environment that is bearable.

In tandem, the government must increasingly facilitate access and training by bolstering educational institutions that feed these professions. It cannot be repeated often enough how ludicrous was the decision by the CAQ government to cancel the Dawson College expansion for a new pavilion for students in health-care programs, including nurses and technicians.

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The National Assembly is considering hiking MNA base salaries by 30 per cent. It is much more urgent for the government to finalize negotiations to improve the salaries and working conditions of nurses. This must go hand in hand with Bill 10; otherwise, the bill’s objective will fail miserably by breeding resentment and deepening the labor crisis in the health system even further.

Robert Libman is an architect and building planning consultant who has served as Equality Party leader and MNA, as mayor of Côte-St-Luc and as a member of the Montreal executive committee. He was a Conservative candidate in the 2015 federal election. twitter.com/robertlibman