Health Minister Christian Dubé’s reform will fundamentally transform the management of the health and social services network in Quebec by grouping together all institutions, except those in the Far North, under the umbrella of Santé Québec. This new agency will become the sole employer of the 350,000 employees in the public health and social services network.
The Act respecting the governance of the health and social services system, (formerly Bill 15) introduces the biggest legislative reform since the passing of the Civil Code. It was passed in December 2023 under a gag order, an anti-democratic process that allows the CAQ government to impose its adoption. It is a particularly worrying process given the scope of the project.
As soon as Minister Dubé announced his intentions to reform the health network, the Federation stepped up its interventions to influence this reform for the 80,000 healthcare professionals it represents, but also to ensure access to safe, quality care and services for the population.
The FIQ has been monitoring this file for several months since this reform will have major impacts on healthcare professionals. To help you understand it better, the Federation is providing the information that is currently available. It is important to note that there are still many uncertainties regarding the implementation of the reform, in particular its impacts on the daily activities of healthcare professionals. This webpage will be updated regularly to reflect the government’s announcements.
Logical follow-up to past reforms
The health and social services network has gone through many reforms in the last few decades. The Couillard reform in 2003, the Barrette reform in 2015, and now the Dubé reform in 2024. Each of these reforms has made our health network more fragile by merging centres of activities with varied vocations, by further centralizing decision-making in the hands of high-placed decision-makers, by reducing access to preventive services and by creating an ever-growing dependence on the private sector.
Minister Christian Dubé is no different from his predecessors; Santé Québec is a logical continuation of the past reforms. We are witnessing the culmination of the major past reforms imposed in the health network. And there is no doubt that the last ones did not improve healthcare professionals’ working conditions, nor did they improve care conditions in Quebec.
The Dubé reform in brief
The Dubé reform allowed for the creation of the Santé Québec agency on April 29, 2024. This public corporation will be the employer of 350,000 employees in the Quebec health network, becoming one of the biggest employers in Canada, second only to the federal government. Creating this single employer will lead to the merging of institutions, and thus employers. The organization of the territory should remain intact in the form of a sub-structure of Santé Québec.
Santé Québec will also have the power to coordinate and support private institutions and other providers, thus blurring any lines between public and private. This a major and dangerous shift. Indeed, according to Minister Christian Dubé, the goal of opening up the service offer to the private sector is to improve care access, but it is well known that opening to the private sector has the opposite effect as it monopolizes the limited resources of the public network. It was with this in mind that in 2023 the FIQ joined the “La réforme Dubé, tout sauf santé” campaign led by several labour and community organizations.
The agency is separate from the Ministry of Health and Social Services (MSSS) and its mission is to coordinate activities in the field, leaving the MSSS solely responsible for political orientations and programs, which in a way removes accountability from the ministry to the network employees.
Changes are needed in Quebec’s health network, but the FIQ can clearly see that this structural reform does not respond to the most obvious needs. Civil society and the Federation issued several recommendations to reframe the reform to fit the network’s needs. Minister Dubé did not take the FIQ’s 30 recommendations into consideration. As such, the FIQ and its affiliated unions will continue to denounce this reform, which aligns with the current government’s anti-feminist, anti-democratic, and anti-union leanings.
Besides the creation of Santé Québec, this reform aligns with three other main areas :
Minister Christian Dubé claims he is prioritizing proximity management in his reform by making managers more accountable and accessible.
The Santé Québec superstructure and the revision of the composition of the boards of directors points to the opposite happening. Indeed, healthcare professionals and patients will be less represented in decision-making meetings to the benefit of the business sector. This distancing of management from care is a major concern for the FIQ. It is essential that the needs and issues in the field are heard to guarantee adaptation to local specificities, as well as to guarantee safe, quality care for the population.
This reform foreshadows a standardization of care and management practices and the FIQ fears that managers will not have much accountability.
The government is planning for services to be provided to the population from now on by public and private institutions, without distinction. Minister Dubé refused to prioritize the public network and to stipulate that Santé Québec would be a not-for-profit organization. That could put the preservation of Quebec’s public, accessible, universal network at risk.
There is no data that shows that the private sector improves access to health care, but there is an abundance of documentation that shows that interweaving the private sector into the public network will be extremely costly for the province and the population who fund public services through taxes. Private companies charge more for the same services provided in the public system, in addition to seizing the public network’s limited resources.
Care continuity will also likely be affected by the normalization of the routine transfer of patients between public and private institutions and, possibly, between regions.
The patient experience relies on complaint and risk management and service quality monitoring using satisfaction surveys. A provincial register of incidents and accidents will be created, and a provincial patient committee will be responsible for evaluating the patient experience. All of these tools will make it possible to categorize institutions based on the quality of care they offer.
A number of these initiatives are welcome, but in addition to the patient experience, it is necessary to add care indicators measured by healthcare professionals, as well as safe healthcare professional-to-patient ratios to promote access to safe, quality care.
The impacts on healthcare professionals’ rights
The Dubé reform has significant impacts on healthcare professionals’ rights, especially with regard to the defense of their working conditions. By merging healthcare institutions under one employer, the law provides for the merging of existing union certifications and one sole certification for each of the six job classes in the health network. So, in the medium term, local unions will eventually disappear, dismantling the current structures and creating major challenges for union democracy.
Here is a general timeline with the major steps of the implementation of Santé Québec that will impact the defense of healthcare professionals’ working conditions. Please note that these dates are approximate and are subject to change at any time by the government.
Fall 2024
Administrative merging of employers
Santé Québec will become the employer of almost all healthcare employees. The union certification units will continue to exist, and the provincial and local collective agreements will continue to apply until they are renegotiated.
Fall 2025 to winter 2026
Period of union allegiance voting
A period for union allegiance voting is planned for the members of the six new job classes. Each one must choose the labour organization that will represent them across all of Quebec.
Winter 2026
Certification of new unions and merging of certifications
The Administrative Labour Tribunal (TAT) certifies the union that obtains the most votes from each of the classes to represent all members in that class. It’s the merging of union certification units, but the collective agreements will continue to apply as they are for 18 months, until they are renegotiated.
Winter 2026 to summer 2027
Negotiation of the “local” collective agreement
The newly certified union negotiates a single “local” collective agreement with Santé Québec for all of the public health and social service institutions in the province, except for the Far North.
Fall 2027
Seniority list mergers
The seniority lists for all members in public institutions within the same job class will be merged within Santé Québec. That is when we will be able to talk about a real “network seniority.”
From four to six job classes
With the Dubé reform, the job classes in the health network will change. Class one will only include nurses and licensed practical nurses. Respiratory therapists and clinical perfusionists will be grouped with specialized support and cardio-respiratory care technicians and professionals in class six. That includes, for example, medical imaging and radiation oncology.
The government decided to split class one, even though nurses, licensed practical nurses, respiratory therapists and clinical perfusionists have an expertise and a complementary organization of work in direct patient care. This split will be damaging to the organization of work and team stability.
The FIQ spared no effort trying to make Minister Dubé back down to maintain class one in its current form and will continue to fight for this. A petition was submitted to the National Assembly. However, if the transfer to class six goes forward as provided in the law, the FIQ will be part of the labour organizations that can be on the voting ballot for this class. Ultimately, the members will vote for the labour organization they want.
FAQ
No. The bill creating Santé Québec was passed under a gag order on December 9, 2023. As such, it is no longer a bill but a law that is in force and the timeline for deploying Santé Québec is underway.
No. Santé Québec was created on April 29, 2024 through the appointment of Geneviève Biron as the president and CEO and Frédéric Abergel as the executive vice-president of operations and transformation. It is therefore not possible to prevent its creation.
Health Minister Christian Dubé and Treasury Board Chair Sonia LeBel have repeatedly stated that the mobility of healthcare professionals is essential to improving care access in Quebec. However, several studies and much research show that care stability and recognition for healthcare professionals’ expertise are essential to ensuring quality care.
For several months, the FIQ has been endeavouring to understand the employers’ needs with regard to mobility to be able to propose adapted solutions that respect healthcare professionals’ rights and ensure quality of care for patients.
The FIQ is actively fighting to keep respiratory therapists and clinical perfusionists in class one. However, if the transfer to class six goes forward as provided in the law, the FIQ will be part of the labour organizations that can be on the voting ballot for this class. Ultimately, the members will vote for the labour organization they want.
The merging of institutions under one employer does not immediately implement network seniority. According to the current timeline, the merging of seniority lists is planned for the fall of 2027. That is when accumulated seniority will be transferable to the whole network.
It is not possible to answer this question with the information that is currently available. How will scheduling, payroll services and benefits be managed in the new Santé Québec structure? We can expect changes and a standardization of management methods in institutions. Rest assured that the FIQ is actively seeking answers to these questions and will use every platform to represent its members.
The goal of the current negotiations is to agree on the provincial provisions of the collective agreement. These terms and conditions, once adopted by the members, will apply until the parties renegotiate them (in 2028), so, even after the implementation of Santé Québec.
As such, even if respiratory therapists and clinical perfusionists change job classes and unions, the current negotiated provincial collective agreement will still apply to them until 2028 at the very least.
A number of feminist organizations, including the FIQ, have denounced the Dubé reform as anti-feminist. Women will be the most affected by the negative effects of this reform. They will be affected as employees, since the reform does not tackle healthcare professionals’ poor working conditions, and as care givers and patients, since they will be the first affected by the network’s blatant failings in providing care.
Moreover, an open letter was published to denounce the exploitation of women in this reform.
Since 2005, with the Couillard reform, healthcare professionals’ working conditions have been negotiated on two levels: locally, which excludes monetary terms and conditions as they are exclusively handled in provincial negotiations. Local negotiations include the concepts of a centre of activities and reassignment, posting and elements of positions, schedules, days off and vacation. With the current reform, there will be a single “local” collective agreement with Santé Québec for all of the public health and social service institutions in the province, except for the Far North. The only thing local about this agreement will be its name, which is why the FIQ is demanding that these matters be reintegrated into provincial negotiations.
The legal framework of local negotiations is very different from that of provincial negotiations and entails much weaker bargaining power for workers and the union party. For example, the right to strike is prohibited in local negotiations.
This suggests that the government would like to use this different legal framework to its advantage, even if it creates significant inconsistency. It is definitely strange to qualify this collective agreement as “local” when it will be a single agreement that will apply to all of the members of the public health and social service institutions in the province, except in the Far North.
That is why the FIQ is denouncing this anti-union opportunism and demanding that these matters be reintegrated into provincial negotiations.
