Quebec’s proposed health system reforms are oft-promised, rarely delivered

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Given that many of the reforms to be announced Tuesday promising to heal Quebec’s ailing health-care system — including quicker access to front-line health workers, improved working conditions for nurses and reduced wait times in ERs — have been pledged multiple times over the last few decades, observers could be forgiven a certain level of cynicism.

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Among the government’s pledges, which will be presented by Health Minister Christian Dubé in Montreal on Tuesday but were leaked to media last week, are an end to mandatory overtime for nurses, the hiring of 3,000 administrative assistants to help with medical paperwork, more home- care services for seniors and moving the system’s archaic, paper-based medical records system to online platforms. The overhaul is expected to be in place by 2025.

Paul Brunet remembers similar proclamations being made when he was a young lawyer, some 30 years ago.

“These promises are very nice, but the challenge will be how is it going to be done,” said Brunet, now the spokesperson and CEO of the patient advocacy group Conseil pour la protection des malades, founded by his late brother in 1974. “ I was there in 1991 when the government proposed Bill 120. That’s 30 years ago, and we’re still talking about primary care and long-term care and at-home treatment.”

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Brunet spoke to Dubé last week and said he found hope in the fact that the health minister appears to be taking a more collaborative approach than his predecessors, although that sentiment was not shared by the province’s largest nurses union.

“He has in his favor that he doesn’t pretend to know everything, like so many before, and he is talking with many people, without being condescending. … (Former Liberal health minister Gaétan) Barrette imposed his authority on him for four years, and at the very end said he wanted collaboration from people, but by then it was too late.

The Coalition Avenir Québec government’s plan, titled “More human, more efficient — A plan to put in place necessary changes in health” focuses largely on retaining and acquiring workers in a system that proved to be so lacking during the pandemic that the Canadian military had to be called in to provide essential health-care services—twice.

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The government is pledging to put an end to forcing nurses to work overtime to fill staffing needs. (The CAQ made the same promise before the provincial elections in 2018, yet enforced overtime ended up rising during its tenure). It plans to go from a lack of health workers to a surplus, in part by hiring 1,000 nurses from abroad. (The government says the system is lacking 4,300 full-time nurses; nursing unions say the number is more than double that).

It is promising to decentralize management, allowing individual institutions to create their own schedules with the input of workers. The hope is that improved working conditions will convince nurses to stop leaving the public system and entice others to join.

With 945,000 Quebecers on a waiting list for a family doctor, the province said it will increase access to front-line health workers, including nurse practitioners, pharmacists and social workers so that all Quebecers will have access to care, although not necessarily with a family doctor. The hope is this will also help ease overcrowding in emergency rooms. A telephone helpline, monitored by a nurse, will steer patients toward the proper health-care professional within 36 hours, the CAQ said.

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Remuneration for family doctors will be more heavily based on how many patients they have, as opposed to how many medical services they provide, to entice them to take on more clients. The plan calls for command centers to be set up in hospitals to help control numbers in emergency rooms and avoid perennial overcrowding issues, by linking patients with the proper care.

The government is also promising a massive shift toward home care to aid Quebec’s rapidly aging population, and to transfer medical records from paper to digital format so health-care professionals and patients can have access to them quickly.

Julie Bouchard, president of the Fédération interprofessionnelle de la santé du Québec (FIQ), said the union has serious misgivings about the coming announcement because government officials failed to consult members of the province’s largest nurses union beforehand.

“We find it very sad because, once again, the government is proposing how it will attack the problems of the health-care system by putting in place measures that were not suggested by health professionals who, every day, live the negative effects of decisions that were taken before,” Bouchard said.

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