Quebec adopts sweeping health-care reform bill

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The Coalition Avenir Québec (CAQ) government has adopted its sweeping health-care reform legislation, Bill 15.

The motion was adopted at 5:15 a.m. following an electronic vote at the National Assembly, with 75 votes in favour, 27 against and no abstentions.

Overnight, MNAs debated the bill, which centralizes much of the health-care system’s decision-making in a new entity, Santé Québec.  

After failing to reach an agreement with opposition parties to extend the session on Friday, the CAQ government invoked closure — a procedure that enables it to end debate and fast-track the bill’s adoption, before the end of the legislative session.

Legislature business was adjourned until Jan. 30, 2024.

This marks the fifth time the government has invoked closure since coming to power in 2018. 

Health Minister Christian Dubé said at a news conference Saturday that Bill 15 is intended to make the health-care system more efficient. 

For instance, he said, it would allow Quebecers to access a medical specialist more quickly and “no longer be refused access to a hospital because we don’t have the right postal code.” 

He added that health-care workers will be experiencing “significant changes in the coming months and it will be up to us [the government] to properly explain these changes.” 

Efficiency of bill not proven, health union leaders say

The bill contained nearly 1,200 articles, making it one of the most imposing bills in Quebec history.

It will make way for the creation of provincial agency, Santé Québec, which will oversee all activities related to the public health-care system, including providing services and facilitating access. The Health Ministry will provide the agency’s guidelines.

Santé Québec will become the sole employer, integrating the CISSS and CIUSSS networks. Union accreditations will be merged and a single seniority list will be established, allowing staff to move from one region to another.

Leaders of the Centrale des syndicats du Québec (CSQ) and the Fédération de la Santé du Québec (FSQ-CSQ) — which represent more than 5,500 nurses and respiratory therapists — are blasting the bill’s adoption. 

Luc Beauregard, secretary-treasurer of the CSQ, said in a news release that Dubé is applying “an entrepreneurial vision” to manage the health network, whereas “a social vision is needed” to ensure the quality of services for the public. 

Beauregard criticized what he called the government’s determination to develop “at all costs” the private sector in health care. 

“The effectiveness of the private sector has never been publicly demonstrated,” he said in a statement. “On the contrary, several studies establish significant shortcomings linked to private partners, such as issues of lack of transparency, communication, training and abusive costs.” 

FSQ-CSQ president Isabelle Dumaine said in a statement that the government “waited until the last minute” to considerably change labour relations and job categories, which would further disrupt the network. 

“We are very disappointed. We still had hope until the last minute that the government would see reason and extend the study of this enormous bill that is bringing major changes to the health-care system,” she said. 

“Was it that urgent for this bill to be adopted catastrophically like this, when there has been so much opposition and so many questions that are still without answers?”

Dumaine pointed out that closure was also used to pass the last reforms made to the health-care system — measures she said didn’t help. She also worries about further privatization of Quebec’s health-care network, amid tense negotiations and strikes in the province.

“Health should be a public good, not up for marketing,” she said. “We’re having so many issues right now with the collective agreement.” 

The Association des gestionnaires des établissements de santé et de services sociaux (AGESSS), which represents administrators in the health-care system on the other hand, said it was welcoming the news “with nuance.” 

Previous reforms had led to mass layoffs, and AGESSS says many will be able to return to work.

But the group is still concerned that it will be absorbed under Santé Québec. The bill was not amended to limit the health minister’s powers of direct intervention in the day-to-day management of institutions in the health and social services network, which AGESSS disapproves of. 

Government invoking closure ‘shameful,’: Official Opposition

The Legault government had offered opposition parties the option to extend the session and resume the study of the bill in a legislature committee next Monday. 

But that offer was rejected in part because it included a deadline. The government had insisted that the work be completed by Dec. 15 at the latest, despite hundreds of articles not being studied. 

Joël Arseneau, the health critic for the Parti Québécois (PQ), said the government invoking closure prevented MNAs from studying a third of the bill, which will likely lead to the law being modified many times.

Man standing in front of Quebec flags
Parti Québécois MNA Joël Arseneau said about a third of Bill 15 could not be studied because the government invoked closure. (Sylvain Roy Roussel/CBC)

“It’s going to make people more insecure,” Arseneau told reporters Saturday. “Democracy is losing, the parliamentary system is losing, citizens are losing and the personnel in the health system are losing.”

Before the government invoked closure, “no fewer than 464 amendments out of 769 articles were adopted to correct the government’s errors,” said Québec Solidaire MNA Guillaume Cliche-Rivard.

“If the CAQ had let us do our job to the end, we could have limited the damage,” he said. “The 709 pages of amendments that the CAQ presented overnight for its own bill illustrate the extent of Minister Dubé’s improvisation.”

The Official Opposition health critic André Fortin, the Liberal MNA for Pontiac, said it was “shameful” to have MNAs study the bill for eight months only to have the government adopt it by invoking closure. 

“We should have been looking for ways to attract more workers and keep them in our public health-care network,” he told reporters. 

Man speaks in National Assembly
Liberal MNA André Fortin said time would have been better spent working on ways to attract and retain health-care workers. (Jacques Boissinot/The Canadian Press)

“Just about everyone who came to committee told us this was a bill that would demobilize our health-care workers and that is something we simply cannot afford to do,” he said.

Québec Solidaire co-spokesperson Gabriel Nadeau-Dubois said the bill is the “opposite of change.”

“We have been centralizing, privatizing and bureaucratizing the health system for 25 years and this bill continues in that direction,” he said. 

“This is the completion of the Barrette reform,” Nadeau-Dubois said, referring to the controversial health network reform of the former Quebec Liberal Party health minister, Gaétan Barrette, whose Bill 10 was also adopted after the Liberal government invoked closure in 2015.

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