Quebec tables bill to limit the use of private health agencies

Quebec plans to limit the use of private agencies and subcontractors in the health and social services sector within the next three years.

Tabling the bill on Wednesday morning, Health Minister Christian Dubé said it would grant the government the power, under certain conditions, to determine how long an organization can resort to personnel placement agencies or independent workers.

The government has given itself three years, until 2026, to eliminate the systematic use of private agencies and independent workers in the health-care network throughout Quebec.

Dubé said the government wants tighter oversight of the use of private agencies and, in the long term, to free itself from its dependence on them for staff. Organizations that fail to comply with regulations could be subject to financial penalties.

"This bill is part of our commitment to becoming an employer of choice in the face of the immense challenge of workforce shortages," said Dubé, adding that this comes as part of the CAQ governments's plan to make the health network more humane and efficient.

Dubé wants public sector to be 'employer of choice'

Dubé said the public system's move away from the use of freelance or subcontracted workers will be accomplished in three phases across the province.

It will start with institutions in large urban areas by 2024, then expand to mid-sized cities near major centres by 2025, and finally apply to remote regions — often struggling with severe workforce issues — by 2026.

All this comes during a labour shortage in the province and following a significant exodus of nurses from the public system.

For some, the poor working conditions in the province's public health-care system have pushed them into the private sector, which can offer better pay and flexible hours.

"That's the problem we've had for several years. We don't just have a problem attracting people, we have problems with retaining them," Dubé told reporters. "We should be focused on being the employer of choice."

Changing 'status quo' in public system 

In doing so, he said he wants to change the status quo.

Despite the worker shortage, and the province needing 125,000 employees over the next five years, Dubé said the use of private agencies is not a solution.

"It's costing a lot. It doesn't make sense that they pay a nurse at a certain price and sometimes they double or they triple the price they're charging to the system," said Dubé.

"Now the issue is: can we give the working condition to the nurse that she has in the private [system]? The challenge is always the same."

'Completely dependent' upon agencies, say critics 

Joël Arseneau, the health critic for the Parti Québécois, says this bill is baby steps "to solving a problem the government created."  

"We've created and fed the monster and now we are completely dependent upon it," said Arseneau.

André Fortin, the Liberal health critic, said it will be difficult to improve the working conditions and regulate the private sector when "the CAQ has let it grow so much." 

"Now entire regions are dependent on these agencies. They cannot function without them," said Fortin. 

"None of this can work. You cannot reduce your dependency on agencies unless you have better working conditions," said Fortin.

"Put yourself in the shoes of a nurse who decided … months ago to leave the public health network and to go work in an agency. She did that because the salary is better, the hours are better, family life is better," he said. "Nothing in this bill will change that."

He said the real changes will come during the collective negotiations between the Treasury Board President Sonia LeBel and health-care workers' unions.

Magali Picard, president of the largest labour federation in Quebec, the Fédération des travailleurs et travailleuses du Québec, is ready to negotiate in the coming months with the Treasury Board. 

"As soon as we can start to negotiate with this government we can find solutions. We've got people who worked in this environment who know exactly what it means," said Picard, whose federation represents 500,000 workers. 

"That's important that we sit and look at some conditions to maybe try to retain some people, being more attractive for new workers. And I'm pretty sure that if we stopped [using] the agencies… it will help our system" 

'Nurses aren't numbers on an Excel spreadsheet'

Natalie Stake-Doucet, a registered nurse who left the public health-care system about a year ago, compared the public system to a sinking ship with a hole in the centre. 

Stake-Doucet says for the past 30 years, the government has done "everything except" improve working conditions in the profession. 

"If you don't fix the structure you will sink and that is what's happening right now," said Stake-Doucet, who teaches full-time at McGill University and Université de Montréal.

"They dance around everything. Instead of giving us decent pay, decent working conditions, safe staffing ratios. It's like 'no, let's limit their options. Let's make them prisoners within the health-care system and see if that fixes anything.'" 

She says she was disappointed but not surprised at Wednesday's announcement. 

"I mean to think nurses from the agencies are just going to waltz back into the health-care system … is that ignorance? Is that arrogance? It's really mind-boggling to me that one would think that just by banning the agencies all the nurses are just going to come back."

"Nurses aren't numbers on an Excel spreadsheet. You can't just move us from one column to another." 

While Stake-Doucet says she doesn't think the government means any harm by proposing this kind of legislation, "when it comes to nurses and most female-dominated professions, politicians are absolutely clueless."

She said those employed in the health-care system often have to advocate for better working conditions, unlike other professions. 

"When they did overtime for nursing during COVID, we had to fight an incredible uphill battle just to get a small percentage [increase] … For hazard pay," said Stake-Doucet. 

"It really isn't rocket science … [nurses]  have the same needs and wants that many other industries and jobs have. We want flexible schedules. We want decent pay. We want respect."