Quebec passes major healthcare reform after invoking parliamentary closure
The government of Quebec officially adopted Bill 15 after invoking closure to end parliamentary debate about it, December 9. The bill is one of the largest healthcare reforms in the province’s history and will centralize all healthcare administration under a single entity called Santé-Québec.
Health Minister Christian Dubé described the bill as a step towards a “more accessible and efficient healthcare network”. “After more than eight months of work on Bill 15 in the National Assembly, we're proud of its adoption … It's essential to underline all the efforts made to reach this stage, as well as all the work accomplished by the Ministère de la Santé et des Services sociaux, and the collaboration of all network partners and opposition groups,” said minister Dubé.
According to official opposition health critic and Pontiac MNA André Fortin, only 700 of the bill’s 1200 articles were studied before the government invoked closure to fast track it. He said at least 100 significant articles concerning paramedic services remained to be studied. “It’s unfortunate we didn’t get to study it and improve it,” said Fortin. “We're in a situation where we aren’t studying clauses that may have significant repercussions on our healthcare system.
Everyone was collaborating, nobody was taking too much time, nobody was filibustering the bill. The minister himself remarked that all of the committee members were being productive,” said Fortin.
Under the new law, all administrative decision making will be centralized in Santé-Québec, which will also become the sole employer for healthcare workers across the province. The CISSSO, the current health unit for the Outaouais region, will be replaced by a regional branch of Santé-Québec that will oversee healthcare operations in the Outaouais, but will no longer have any decision-making power. While the law officially came into effect December 13, Santé-Québec will take approximately 6 months to put in place, during which time CISSSO will continue to operate. According to CISSO interim president Yves St-Onge, a transitional committee led by Deputy Health and Social Services Minister Daniel Paré will oversee the transition from the CISSS network to Santé-Québec.
Minister Dubé promised transparency during the transitional period and reassured healthcare workers; “The changes to come, particularly the creation of Santé-Québec, are major. We will make this transition gradually and transparently, while respecting the staff of the health network.”
Fortin said he's concerned removing local decision-making powers may demobilize healthcare workers across the province. “The bill leaves very little space for local adaptation and innovation. If all decisions come down from Quebec City, there’s really no room for workers to get involved and better their workplaces … there are no longer any venues for local doctors and nurses to contest decisions,” he said. He added that centralizing all decision-making in Santé-Québec may also lead to further “urbanization” of healthcare with even less services offered in rural areas and institutions like the Pontiac Hospital.
In the weeks before the bill’s adoption, debate focused on the right to access healthcare in English after minister Dubé introduced an amendment granting Santé-Québec powers to revoke bilingual status' from hospitals without any recourse to contestation in areas where the English-speaking population is deemed under 50%. The amendment was later retracted following criticism from opposition parties and subsequently reintroduced with a clause stating Santé-Québec can revoke bilingual status only if the decision is approved by English-speaking access committees.