Massive Concentration of Decision-Making Power and Union-Busting

– Pierre Chénier –

Nurses in Drummondville protest untenable conditions of work, February 26, 2023.

On March 29, the Quebec government tabled Bill 15, An Act to make the health and social services system more effective. While the society and all health care professionals and workers are demanding that the public health care system be properly funded and the right of the people to health care be provided with a guarantee, the government is handing over the system holus bolus to narrow private interests. It establishes a new chain of command which concentrates decision-making and administrative power in the hands of the ministry along with a hand picked Board of Directors made up of CEOs from private industry to head a new agency called Santé Québec. The multiple bodies and positions Santé Québec is authorized to establish and administer reduce union bargaining units from 136 to four, none of which will be permitted to represent the demands of the people who work in the health care system.

Health Minister Christian Dubé said that he is planning to fill the Board of Directors with "top guns" from the private sector. It obviously sets the stage for the private interests to dictate wages and working conditions and close, merge and further privatize services in the name of efficiency and good management. The public purse will pay higher rates for the private delivery of services and the problem of accountability will only get worse. It is a radical rupture with the public system which at one time was guided by the principle of the greatest good for the greatest number, and All for One and One for All.

Today this has become All for One with the One being the narrow private interests that have no concern for the human factor/social consciousness. Thinking that efficiency has to be achieved by suppressing the human factor and treating workers as disposable will greatly exacerbate the crisis of the provision of services. Modern advances in medicine, which are tremendous, will not make a social contribution so long as a profoundly anti-social policy is pursued of paying the rich and justifying it with self-serving arguments that CEOs of private industry, many of whom have proven to be extremely corrupt, such as those involved in building one of the Montreal mega-hospitals, know what is required and the professionals and workers do not.

The forced reduction of union bargaining units from 136 to four is an ominous sign. It means that locally signed collective agreements, based on the concrete conditions of each region, will be abolished and conclusions will be drawn from statistics which cannot be aggregated to draw warranted conclusions. According to the government, it is acting legally (because it makes the law). It is basing itself on a law in Quebec, adopted under closure 20 years ago, that prescribes the merger of union bargaining units in all health institutions, which then numbered about 200. Then Liberal Health Minister Gaétan Barrette's 2015 reform reduced the number of health care centres to 34 and forced a new merger of union bargaining units at that time -- which did not improve the situation in the health care system. But this is ignored and the conclusion is drawn that it did not go far enough.

The 300-page bill contains 1,180 articles and amends 37 laws. Its character was addressed in the days leading up to its introduction in the National Assembly, by Health Minister Dubé and Premier François Legault. Minister Dubé stated that he would "recruit top guns from the private sector" to lead his reform of the health and social services network that would "shake the pillars of the temple." The media also reported that the Minister addressed some 50 business people who responded to an invitation extended through the Board of Trade of Metropolitan Montreal. They included executives from companies such as IBM Canada, Google Canada, Energir, Accenture, Pharmaprix and KPMG, and the Minister asked them to recommend candidates from their networks to serve on the board of directors of Santé Québec, the agency that will be created by Bill 15.

On March 28, Premier Legault told the media that it is essential to deal with the structure of the health network and that "the success of the approach depends a great deal on the flexibility that we will be able to find in the organization of work." He clearly blamed the unions for the problems of the health care system saying that "local reorganizations can be blocked by local unions. We would like this to no longer be possible, to be able to adapt locally to each situation and make a good reorganization." The reality is that it is thanks to the local unions that the workers are an organized force and have been able to maintain any cohesion of the system whatsoever at a time it has been hanging on by a thread because of the anti-social offensive, lack of funding and the treatment of workers as disposable things. But his hopes of having "reorganizations" unblocked by destroying local unions will not dissuade Quebeckers from becoming an organized force who put the full weight of their numbers and organizations behind their just claims on society.

Nurses in small communities in Nunavik, Quebec, stage sit-in to demand action to deal with staff shortages which prevent them from properly caring for patients, January 20, 2023.

The neo-liberal governments which claim to champion human rights and decry societies which are highly organized to achieve a definite aim as autocracies are in fact bringing in all the autocratic structures to achieve a maximum return on investments in the form of privately appropriated profits. It has nothing to do with achieving returns which enhance the well-being of the members of society and the society itself.

The corruption of the private interests which are plundering the public purse and scamming the system will be revealed sooner rather than later and what the Legault government is up to will be confirmed.

Creation of Santé Québec

Bill 15 establishes the agency Santé Québec. The Health Minister says Santé Quebec will be responsible for operational matters -- the management of the health care system -- thereby permitting the Minister to focus on priorities, objectives and orientations in the field of health and social services and ensure their application. Many have noted that the bill does not mention once that the health care system in Quebec is a public system. Far from it. Santé Québec will be accountable to the Minister, not the Legislature or the public. It will be administered by a board of directors composed of 13 members, appointed by the Minister. There is mention of some form of consultation with the network's internal managers and recommendations from private companies to choose the members of the Board. The wording throughout the bill is that in its role as manager, Santé Québec coordinates and supports both public and private institutions.

The section defining the mission of Santé Québec reads:

"The mission of Santé Québec is to offer, through public institutions, health services and social services in the various health regions of Québec. In those regions, it coordinates and supports, in particular by way of subsidies, the supply of such services by private institutions as well as the supply of services in the field of health and social services by certain other private providers." (Emphasis added.)

Santé Québec becomes the employer, and the sole employer, of the 350,000 workers in the health and social services network. The current employers, the Integrated Health and Social Services Centres (CISSSs) and Integrated University Health and Social Services Centres (CIUSSSs), established in the various regions of Quebec by the Liberal government's 2015 health reform, disappear as entities. Bill 15 establishes a Quebec-wide mega-health institution, as opposed to the 34 CISSSs and CIUSSSs that were each considered an institution.

In the perspective of a single Minister-Board of Directors chain of command for Santé Québec, Santé Québec is responsible for setting up a whole series of organizations governed by it. For example, Santé Québec is responsible for establishing territorial institutions and for governing them. It is also responsible for setting up, among other things, a National Watchdog Committee, a National Program on the Quality of Services, a National Users' Committee, and a Complaint Examination Regime, all of which are accountable to the Board of Directors of Santé Québec.

Not once in this 300-page bill are the voices and demands of health care workers mentioned.

Full-Scale Attack on Unions

The Minister of Health, by establishing Santé Québec as the sole employer of health and social services workers at the head of a Quebec-wide mega health institution, is imposing a restructuring of the unions. By reducing union bargaining units from 136 to 4, many union organizations are slated to simply disappear.

In 2003, the Liberal government passed Bill 30 under closure, which ordered the amalgamation of union certification units in each of the approximately 200 health care institutions. Bargaining units in each facility could only be formed on the basis of one union per category of staff. There are four categories of personnel in the Quebec health care system.

Category 1 includes nursing and cardio-respiratory care personnel. It includes nurses, licensed practical nurses, respiratory therapists and nursing and nursing assistant candidates.

Category 2 includes paratechnical personnel and auxiliary services and trades personnel. It includes, among others, orderlies, housekeepers, food service workers, cooks, service aides, mechanics and trades people.

Category 3 includes office personnel and administrative technicians and professionals. It includes, among others, administrative officers, executive assistants, medical secretaries, administrative technicians, computer technicians and personnel management officers.

Category 4 includes health and social services technicians and professionals. It includes, among others, social workers, social work technicians, human relations officers, community organizers, educators, psycho-educators, occupational therapists, physiotherapists, medical archivists, dietitian-nutritionists, dental hygienists, audiologists and speech-language pathologists.

In 2015, again under closure, the Liberal government imposed Bill 10 which created the CISSSs and CIUSSSs as institutions and employers of health and social services workers, which reduced the number of institutions to 34. This law relied on Bill 30 to impose a new restructuring of the unions. After a raiding campaign, union members in the institutions voted on which union would represent them in each personnel category.

Bill 15 goes further, requiring that there be only 4 union bargaining units in all of Quebec, one for each category of personnel, in the health and social services network, all under one single employer, Santé Québec. In addition, the collective agreements themselves will be reduced to four for the entire network. Already, unions in remote areas have denounced the fact that there will no longer be local collective agreements, which allowed workers in the regions to include clauses that corresponded to their specific conditions.

A president of a union representing nurses in eastern Quebec was recently interviewed by Radio-Canada about the impact of the bill, and said:

"As long as there is only one agreement that applies to the entire Quebec network, how will the Gaspé region, for example, fare in terms of working conditions?"

The bill is introduced in the midst of negotiations for the renewal of the collective agreements in the public which are not going anywhere because the government does not want them to go anywhere. Minister Dubé said at a press conference that he wants the principles of the Bill 15 restructuring to be incorporated into the new collective agreements, without specifying how this will be done.

Service Evaluation and Access to Services

As part of the bill's stated mandate to make the health and social services system more efficient, the government says that it is concerned about service evaluation and access to services. However, its purely statistical approach to the issue reveals an aim to establish indicator tables on the performance of different services according to health facilities and pay no attention whatsoever to the human factor. For example, in a pilot project, the government developed a table of the number of hours people are waiting in a number of emergency rooms before being seen by a doctor. Local facilities are pitted against each other on a statistical basis. The Minister of Health refers to patient experience as a measure to evaluate services and access. In addition, a patient survey regime is established to measure patient satisfaction. A national complaints regime is also established by the Bill in which people submit their complaints to Santé Québec through various bodies established by it.

This statistical approach is denounced by workers because it does nothing to improve their conditions and specifically to solve the problem of attraction and retention of the workforce which is one of the major problems of the health and social services network. Evaluating services and access on a statistical basis does not get to the heart of the matter and suggests that the government and the Board of Directors of Santé Québec could use the data to close or merge services or privatize them.

The legislation has nothing to do with the recognition of health as a right and nothing to do with the recognition of a decisive role for the voice, demands and solutions of those who provide services.

This article was published in
Number 28 - May 25, 2023

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