In the News April 19
Human-Centred Public Services Are Urgently Needed
Quebec Government’s Pay-the-Rich
Health Care Action Plan
On March 29, the Quebec government launched its health care “action plan” entitled “Human and Efficient – Plan to Implement Necessary Health Changes.” The 90-page document seems to have thrown the word human in there as a spoon full of sugar to make the medicine go down, another word which further down the road turns out to mean its exact opposite.
From the onset, the report states that the time is not for “balance sheets” but for “action.” In French, the word “bilan” comes from the Italian “bilancio” meaning “balance.” It is used in financial terms as in “balance sheet,” but also in the general sense of taking stock of a situation. The financial “balance sheet” meaning clearly applies to the Quebec government which, as all the governments of the rich, evaluates health care in the strictest sense of establishing ways of redirecting public funds into the pockets of various private interests, be they hedge funds or pharmaceutical giants.
The Quebec workers and people, on the other hand, are coming out of the past few years of the pandemic with their own balance sheet based on their experience at all levels. This is the case for seniors’ and long-term care home workers, residents and their families who, having experienced the trauma of the spring of 2020, have reached the conclusion that society must defend the dignity of our elderly. It is the case with health care workers who have waged one struggle after another to obtain proper protective equipment and to put forward specific key solutions to such pressing problems as staff shortages, all with the aim of defending the rights of health care workers and those of the population. It is the case of migrant workers who, having selflessly provided much needed care under most difficult and dangerous circumstances, are now demanding full immigration status. These are but a few examples.
The Quebec workers and people have come out of this experience more convinced than ever of the need to organize a modern society with a human-centred healthcare system which considers health as a fundamental human right above all other considerations. The Quebec workers and people are increasingly drawing the conclusion that they must have a say on their own working and living conditions, that the systematic destruction of the system must be turned around so that the space filled by narrow private interests is reclaimed by those who are essential to society and to the economy and that society takes up its responsibilities towards its members.
The Quebec Action Plan is a call to pursue and to increase the handing over of public funds to private interests in the form of private clinics, while calling for the “collaboration” of workers and their unions in giving up their rights and their struggle for a human-centred health care system.
The report states the obvious, that “long-term care homes are outdated, hospitals all ill-adapted to modern needs and are incapable of effectively meeting prevention and infection-control norms,” but never raises its own role and that of former governments in pushing the health care system to the brink of collapse. The conclusion it draws, on the other hand, is that the pandemic gave rise to “innovations” and “lessons” that everyone must build upon in the same spirit of collaboration which allowed everyone to “get through the pandemic.” (Just to note that when the Action Plan was announced, the pandemic had entered its sixth wave.) With regards to collaboration, the report speaks of freeing itself from “administrative restraints and collective agreement rigidity so as to apply creative solutions within a more humane organization at the workplace.” This suggests further ministerial orders, the suspension of collective agreements and other measures to impose inhumane working conditions such as mandatory overtime (MO), against which the Quebec Interprofessional Health Federation (FIQ) has filed a formal complaint to the United Nations, on the basis that the MO is a form of enslavement.
Among these “innovations” is the use of private clinics for surgeries, a measure which was increased during the pandemic, under the claim they are needed to catch up on the surgeries which had been suspended because of COVID-19. This is in line with what the report calls “patient experience,” which is a reference to “customer experience,” a marketing term which deals with “customer” (patient) perceptions of the services provided in the same way a “customer” evaluates his “experience” when going to a shopping centre. The report refers to a 2014 Quebec government-led task force presided over by Wendy Thomson, a former Chief Advisor to British Prime Minister Tony Blair on public service reform, set up to examine ways to establish “patient-centred financing.” As if this group of so-called experts pulled this idea out of a hat, the report says they concluded that “resources must now be allotted on the basis of the type and volume of services provided, as opposed to the traditional system based on financing per facility.” This Pay-for-Performance model has also been promoted at the federal level, whereby, for example, hospitals, physicians and other healthcare workers are given financial incentives for meeting performance objectives.
These private clinics are forms of Public-Private Partnerships in which ownership is private — in certain cases run by hedge funds — but all the rest is public: doctors and staff as well as public funds are made available through lucrative contracts with clinics such as Chirurgie DIX30 — which holds the largest private operating block in Canada — Rockland MD and Groupe Opmedic. Whereas from the perspective of the struggle for a human-centred healthcare system, health workers themselves are the bulwark in defending the public system, the report claims that it is these private, publicly-financed clinics which will “save the system.” According to the report, during the pandemic, 29 agreements were reached with 15 private clinics for 85,000 operations, and it is stated that what is needed today is to “open a smart space” for more such specialized medical clinics.
Quebec Action Plan – Defend the Dignity of Seniors
Whereas the workers and people have drawn conclusions based on their own experience, especially in the context of the pandemic, the report states from the get-go that it is not the time to take stock of the situation but to act. In this respect it skims over the tragedies in the long-term care homes and seniors’ homes and does not take stock of the conclusions of the various reports and inquiries, which pointed out, among other things, that most seniors’ homes were ill-equipped to deal with age-related problems, let alone epidemiological prevention and problems such as long-standing staff shortages made even worse by medieval working conditions imposed by ministerial decree in the various facilities. Other inquiries openly questioned the relevance of private ownership of these homes and clearly expressed the need to humanize seniors’ social environment in these institutions.
With regards to Coroner Géhane Kamel’s ongoing investigation, the report claims that her report will be made public in the upcoming months when, in fact, she has already presented a very elaborate preliminary report which also makes the aforementioned observations. Instead, the Quebec government draws its own conclusions from the report of the Commissioner for Health and Well-being and interprets one of her recommendations as being the need for “performance or results-based management.” Not surprisingly then, for the government it is not the time to “take stock” of what is actually needed but to “act” according to an antisocial, pay-the-rich agenda dictated by the financial oligarchy.
One Union’s Response: We Are Not Partners!
Having been criticized for not participating in the government’s publicity event to launch the action plan, the president of the Quebec Interprofessional Health Federation (FIQ), Julie Bouchard, immediately published her initial response. What follows are excerpts from her statement on the FIQ’s refusal to participate as “partners” in what she refers to as a cheap publicity stunt.
“It is not at government press conferences that our health professionals want to see us, but sitting at consultation and negotiating tables. As we have not even been consulted in this plan, it is to underestimate our intelligence to think that we will let ourselves be manipulated. Must we recall that the government has imposed at all levels terrible working conditions on health professionals for the past two years? And we are the problem if the system is failing? What is happening to the system did not begin last Tuesday. It is the result of decades of drastic cuts made under the guise of innovation. The only constant in these past years has been union mobilization in refusal of the attacks waged on our public services which foreshadow its demise if these years of neoliberalism are to persist. Unfortunately, these past four years have confirmed our fears …
“The true story behind minister Dubé’s announcement is not that the FIQ was not at the press conference but rather that the union was not consulted in spite of the fact that nurses, nurses’ assistants, respiratory therapists and clinical perfusionists are those who best know what changes are needed in the system so that it doesn’t endlessly derail… In his plan, there are no concrete proposals to once and for all eliminate mandatory overtime or to pass legislation to determine ratios.
“We are sick and tired of paternalistic attitudes that suggest that we do not have the ability to know what is good for us … We reclaim our right to say no, especially when all that is wanted from us is to be extras, even though we are key players in the reconstruction of a system which has crumbled before our very eyes. Our one and only motive is to improve the working conditions of our members so as to provide the population with quality care and services which are safe and accessible.”
Workers’ Forum, posted April 19, 2022.