Overhaul of Quebec health care voted into law in predawn hours

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Santé Quebec will run day-to-day operations of the health-care system when it is up and running in six months.

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QUEBEC — Mired in controversy right to the end, the government’s overhaul of the health-care system was voted into law in the wee hours of Saturday morning.

With the Coalition Avenir Québec government cutting short debate by using the rules of closure, MNAs voted the bill into law at 5:15 a.m. after pulling an overnighter for the debate.

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The final vote was 75 for, 27 against. All CAQ MNAs present at that hour voted in favour, all opposition MNAs voted against. Present for the vote, Premier François Legault rose and gave his embattled health minister, Christian Dubé, a bearhug.

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The vote brings down the curtain on months of debate and wrangling over the bill that at its core creates a new arm’s length agency, Santé Quebec, which will run day-to-day operations of the health-care system. It becomes the sole health employer of Quebec when the agency is up and running in six months.

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The ministry of health will now concentrate on broad planning of the system.

Rising in the house just before the final vote, Dubé insisted the reforms, even adopted amid controversy, are for the greater good and will pay off in the long run with a better health system.

“Today marks an excessively important moment for health and social services in Quebec,” Dubé told the house. “We had the political courage to carry out our vision to the very end.”

But the final process was, to say the least, messy with opposition parties blasting the government for steamrolling them and adopting a law that changes many fundamentals.

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In the crunch of closure, a parliamentary process that suspends the normal way laws are adopted, about 400 clauses, some of them issues of coordinating Bill 15 with other laws, went through without the opposition being able to comment or amend them. The result, they said, is the bill probably has flaws that won’t come to light until it is implemented.

They said their work committee before the bill was adopted revealed a string of errors and omissions, including one that appeared in a surprise last-minute amendment that appears to endanger minority rights to services in a language other than French.

Dubé corrected it, but the McGill University Health Centre and the Quebec Community Groups network say minority rights could still be in peril because Santé Québec has too much power.

Dubé, however, said his team did a second analysis of the bill, including the clauses the opposition couldn’t analyze, and believes it is sound.

“Rest assured, I had my team do a second revision of what we had left to do,” Dubé told reporters at a 6:30 a.m. news conference. “I can tell you the bill we tabled is excellent. We really turned over every stone. I am very comfortable with this.”

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Working on the law since March and anxious to move on to other things, Dubé insisted he will be proved right.

“It’s a beautiful day because it is Day 1 of the start of the transition that will transform our vast health network,” Dubé said. “It’s up to me, it’s up to my team to prove this big change today … will make a big difference in the lives of Quebecers.”

He insisted again minority rights to access to health and social services have been protected.

“Yes, I am committed to that,” Dubé said.

Opposition MNAs did not share the minister’s mood, predicting, as has happened in the past to other CAQ bills that were rushed, the government will wind up making corrections.

“I fully expect, soon, a 2.0 version of the law because the minister will realize very soon there are many things to correct,” Québec solidaire health critic Guillaume Cliche-Rivard told reporters.

The whole adoption process also left opposition MNAs feeling burned after weeks of them cooperating with Dubé at the committee stage. Dubé also expressed regrets with the way things ended.

During the closure procedure, the pleasant mood went by the wayside after Dubé did not give consent to Liberal health critic André Fortin’s request to prioritize certain clauses for discussion given the limited time.

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The opposition responded by refusing to give consent to allow Dubé’s ministry lawyer, Marc Paquin, permission to answer questions directly. Admitting throughout the process there were clauses he did not totally grasp, including the minority language one, Dubé said he was not ashamed about asking for help and he did.

But with the closure clock ticking down, MNAs were only able to analyze and adopt about 15 more clauses of the bill, which contains 1,200.

Emerging from their long night, opposition MNAs fired back at the CAQ government.

Interim Liberal leader Marc Tanguay insisted the reform deals only with structures and will do little to solve health access problems or overflowing emergency wards.

Fortin added the bill does little to solve the real problem in the health system: how to attract more workers and keep them.

“It’s mostly shameful we spent the last eight months studying something that will not have a positive impact on the future of health care,” Fortin said.

QS co-spokesperson Gabriel Nadeau-Dubois described Bill 15 as the opposite of change because it amounts to a massive centralization of power in the hands of Santé Québec.

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“It has been 25 years they have been centralizing, privatizing and adding bureaucracy to the system and this law continues down the same path,” Nadeau-Dubois said. “What we don’t need to be recruiting in out system is more bureaucrats to work at Santé Québec. It’s nurses, orderlies, respiratory therapists and care-givers.”

But Dubé said he was looking forward to setting up Santé Québec.

He said the new law offers many advantages, including more flexibility in the system. In the future, faced with long waiting lists for things like surgery, patients will be offered the option of being treated in another region or free by a private clinic and regardless of their postal code.

Patients in the future will also be able to rapidly learn where they are on the waiting lists for care and medical specialists will be forced to accept certain functions in different regions. The details have yet to be negotiated with the medical associations.

The bill creates a state-owned agency, Santé Québec, with a president and board of directors operating in much the same way as Hydro-Québec. Dubé has said he will hire “top guns” from the private sector to run Santé Québec.

The 30 regional CISSS and CIUSSS agencies, created under the last Liberal health overhaul, will be integrated into Santé Québec and get new names such as Santé Montréal or Santé Estrie.

Santé Québec becomes the sole health employer. Addressing mobility issues that made managing the pandemic more difficult, the bill merges union seniority lists, which will allow workers to move to different institutions or regions without being penalized. The number of union accreditations drops from 136 to six.

Addressing another defect in the system exposed by the pandemic where the government discovered many institutions such as the CHSLD Herron had no local managers responsible for making things work, the law means each of Quebec’s 1,540 health institutions, from CLSCs to hospitals, will have their own boss.

The law creates a complaint examination system to be managed by a “service quality and complaints commissioner,” who would listen to citizens and order corrections to the system.

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