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Heading for another reform of the healthcare network - Bill 10

In its 46 years of existence, the Pointe-Saint-Charles Community Clinic has witnessed the birth of the Québec Health Insurance Plan, the CLSC network and the regional health boards, which were replaced by the health and social services agencies. The Clinic experienced the shift to ambulatory care, the hospital closings and the 15,000 nurses who were retired in the 1990s. It saw the forced mergers of institutions, including the CLSCs, with the current health and social service centres (CSSSs). Added to these structural changes were major reforms such as the mental health reform. Throughout those years, private health businesses have carved out a prime place for themselves and today continue to lobby for a larger and larger share of the public funds allocated to the healthcare system and for permission to charge patients directly for care, supplies and medication needed for their health.

Bill 10

The latest reform being readied is partly defined in a bill made public on September 25 of this year, to which will be added at least one other bill, to be announced this December or in January 2015.

A structural reform above all

Health Minister Gaétan Barrette wants to merge 182 public institutions with different missions and keep only one institution per region: a CISSS (integrated health and social service centre), which will take the place of the regional health and social services agency. Montréal will be divided into 5 “sub-regions,” and 5 CISSSs will replace the Montréal agency and the 12 CSSSs.
The minister claims he wants to make management of the healthcare network easier by eliminating the red tape, thereby facilitating access to services for the population. However, no means or financial resources come with the reform. Quite the contrary, the minister says he will save $220 million per year. This will be the healthcare network’s contribution to achieving deficit zero. So, don’t expect to see any of these “savings” poured into care. This reform is not aimed at reducing wait lists or times, or providing access for all to a family doctor for example.
Since the Community Clinic is a private non-profit organization with a public mandate, it is not included in these mergers, but that doesn’t mean it won’t be affected by the new reform.

A reform said to be about “governance”

Bill 10 would give the minister many powers, including that of appointing the entire board of directors for each institution created under Bill 10, along with its chairperson-executive director and its assistant director. He would have the power to intervene directly in management decisions of a public institution and define cooperation ties between two public institutions. He would be the one to decide guidelines and priorities for each regional institution. So the new institutions would no longer be adopting priorities, doing strategic planning, deciding on local public health action plans, etc.

A Clinic that distinguishes itself

The Clinic provides curative and preventive first line services (CLSC) to the population of Pointe-Saint-Charles. It is reaching an increasing proportion of households in the neighbourhood and gives them access to a family doctor; it also adapts its services to the population it serves. It must be said, however, that the Clinic and the health minister don’t see eye to eye on future directions to take. For example, the Clinic relies on the power of users’, citizens’ and community organizations’ influence and decision making when defining health policies for the neighbourhood. If Bill 10 is passed, the minister will reduce users’ participation to a single individual, named by him, in each of the 28 provincial institutions that will make up the healthcare network. Another example: while the Clinic counts on the citizens’ mobilizing to improve their health conditions, the minister will do away with the local health networks that allow the CSSSs to partner with local communities.

A minister who’s powerful—and in a hurry

Minister Barrette drew up his bill in isolation. Since he is obliged to follow the procedural steps for a bill to be passed, he decided to do this very quickly, leaving little time and space for concerned actors to prepare and express their points of view. He’s aiming to implement his reform as of April 1, 2015.

The Clinic is on the watch

At this time, a number of the Clinic’s bodies are working on measuring the impact of Bill 10 and subsequent ones. Using its experience and expertise, its roots in the community and citizen involvement, the Clinic will do everything it can to defend the Pointe-Saint-Charles population’s right to health.