The QFL and its major affiliates in the health and social service sector, the Canadian Union of Public Employees (CUPE) and the Syndicat qubcois des employe0073 et employs0020de service (SQEES-298), endorse the value of the consultation and deliberation process performed over the past months by the Commission, led by Michel Clair. The Commissions final Report contains a number of strong and positive points, including its emphasis on the need to improve the organization of first-line care, while giving serious consideration to social services, the psycho-social approach, the needs of persons with disabilities and those experiencing a loss of autonomy and concentrating more efforts on the needs of youth.
A Welcome Shift Toward Prevention and an Overall Approach to Health
“The Clair Reports emphasis on prevention, within the scope of a public health approach extending beyond the framework of the network, responds to demands we have been making for decades in a debate which has too often resulted in strictly curative or stop-gap measures.
“In the wake of the Walkerton tragedy and the concerns regarding the reliability of the installations and controls in our water treatment and distribution network, in our opinion, the Reports inclusion of parameters such as the quality of water, air and the environment in general, as well as health and safety in an overall assessment of health appears to be eminently responsible. It now remains to see this approach translated concretely in the actions that must be taken by the players and government departments not directly responsible to the Health sector,” said Henri Mass,0020President of the QFL.
Groups of Family Physicians: An Interesting Approach to First-Line Care
“Although the effects of this formula will have to be assessed, the concept of establishing groups of family physicians offers an interesting solution to improve access and the follow-up process in first-line care. Nevertheless, the Government will have to ensure that each regional board makes efforts to ensure that these groups are established on a voluntary basis, within a one-year period. At the end of the year, the Government will have to take serious stock of the experience, without waiting the 5 years provided in the Clair Report and, where necessary, take a more coercive approach.
Again in terms of first-line care, although we recognize the importance now assigned to the Community Health Centre (CLSCs) in regard to their role in psycho-social services, we must deplore the decision to consolidate the family medicine groups (FMG) in private clinics rather than in CLSCs. This decision will put an end to the CLSCs role as the preferred gate of entry into the health network,” added the President of the QFL.
Affiliated Clinics: Privatization a Done Deal
“As public debate amply demonstrated during the last federal election campaign, the comfortable installation of the private sector in our health system is already an accomplished fact, but if more attention was focused on Ralph Kleins Bill II and Albertas privatization process, it would be clear that the project to introduce specialized affiliated clinics in the Clair Report sanctions privatization in Qub0065c.
“It proposes emptying the hospitals of a certain number of specialties while concentrating them in these private affiliated clinics, funded by the public purse, while the sole obligation on the part of the participating specialists is to be registered on the medical board of an institution. This measure will open the doors to the development of other private initiatives, outside the public system.
“The members of the Commission could have taken note of another very interesting, but public initiative introduced by the Centre hospitalier ambulatoire rg0069onal de Laval (CHARL) (Regional ambulatory hospital in Laval in drawing up their recommendations concerning the development of public specialized resources grouped around the hospitals,” added Claude Gnreux, President of CUPE-Qub0065c.
Priority on Youth: Its About Time!
“With the turn-table syndrome ever more present in our already overloaded youth centres and the increasing weight of the case load profiles assigned to the psycho-social practitioners who work for the Youth Protection Department, often criticized for letting young people slip through the assessment net, the annual injection of $20 million over the next 5 years can only be welcomed with great relief.
“Nevertheless, the responsibility assigned to the CLSC for less critical cases reported which are not taken on by Youth Protection, must be regularly evaluated to allow intervention strategies to be readjusted and discussion to ensure the right balance between distribution and allocation of resources and the true needs of youth. We cant just be content to say that we will inject $100 million and check back to see whats happening in 5 years for a post mortem of the experience,” said Daniel Boyer, Secretary General of SQEES -298.
Everyone Must Contribute to Loss of Autonomy Insurance
“We can only applaud the objective of this measure, designed to remove the burden from todays young people, once they reach the job market, of funding a major plan to support persons experiencing a loss of autonomy in 15, 20 or 30 years, when the number of our elderly will have doubled at the same time as the active population able to contribute to this plan will be decreasing. Nevertheless, presenting this project as an insurance, rather than as a tax measure poses more questions than answers.
“Another inherent problem is how the pool of contributors for such a plan is to be determined today. At the very least, it is aberrant that this funded plan should be financed solely by an obligatory tax on personal income from all sources. Why, from the very start, have corporations been excluded from this pool of contributors, particularly since, today, companies are required to participate in a wide range of public measures through payroll taxes, including home-care and services for persons who are disabled or experiencing a loss of autonomy?
“Companies in Qub0065c benefit a great deal from public programs to maintain a healthy workforce, while our corporate neighbors to the south have to subscribe to private and costly insurance plans to retain their qualified workforce. It would be the very least they could do to participate in this new plan, no matter what its form,” remarked Mr. Mass.003cP>Provincial Funding Duty
“We would like to specify that we do not adhere to diverting speeches on the limited ability of the State to pay, claims that have not changed since the crusade for deficit zero and which today are at the very least questionable, with surpluses often underevaluated by various levels of government. The Government of Qub0065c has a priority task ahead, to demand that the Federal Government assign additional and substantial reinvestments in the CST, or even transfer tax points.
“Having said this, we can only agree with the investment priorities drawn up in recommendation no. 27 of the Clair Report. Hotel services (laundry, kitchen, cafeteria), maintaining real estate assets (increasing them, particularly in regard to the long term care facilities), information and communications technologies and medical equipment will all require new and large-scale funding during the next few years.
“But why, in one case, for example hotel services, should be turn to the workers funds and in another, such as high technology equipment, should we expect to create a large foundation with tax exemptions of as much as 120%. An appropriate funding model could be drawn up, applied to all needs and not on a piece-meal basis. No matter which model is retained, it must not be an attempt to let privatization in by the back door for certain activities”, warned both Boyer and Gnreux.
“We are aware of the fact that an operation as encompassing as that proposed in the Clair Report will require discussions between the parties and serious consideration of current practices in organization of the workplace. But it appears that ex-Minister Clair forgot to hang up his employer-negotiation hat before dealing with this delicate portion of his Report.
“In addition to old platitudes concerning the rigidity of collective agreements, which were nonetheless freely negotiated between the parties, a number of incongruities appear in the Report, particularly in the treatment of matters at the local level, such as staffing, and at the provincial level, network seniority. The Report also refers to the necessity to review the organization of work while, since 1993, we have provided the mechanisms required for this task, mechanisms which were literally frozen by a large number of local administrators, jealous of their prerogatives.
“The large majority of the topics mentioned in the Clair Report as requiring bargaining between the parties are already provided for in the collective agreements in force. If, by omission, they were not, we would have a new round of bargaining to remedy them well before the 5 year term provided for in the full application of his recommendations and proposals,” explained Gilles Gigur0065, QFL Coordinator for public and parapublic sector bargaining.
“It is by giving the personnel a greater role in the decision-making process and by reinvesting significant funds in the network that we can hope to overcome the sluggishness which currently permeates our institutions. But it is important not to forget that this climate is a direct result of the major withdrawal of funds from the health and social service system over the past few years. In this regard, the Treasury Boards intention to slash forecasted expenses of $900 million by half in 2001-2002 does nothing to remobilize employees,” added Mr. Gigur0065.
Take it Step by Step and Evaluate the Situation
“If there is one constant which recurs throughout the Clair Report, it is the 5-year horizon for implementing the recommendations contained in this voluminous report. This timetable should not be taken as a license to let things slide in the meantime, on the contrary. We consider it essential that evaluation, consultation and readjustment mechanisms are provided on an annual basis if possible, so that the possible problems can be identified and corrected promptly.
“But we also cannot insist enough that, as quickly as possible, the Government of Qub0065c should adopt a framework legislation in health and social services which will guarantee access to free, universal, accessible and quality services,” concluded Mr. Henri Mass.003cP>The QFL, the largest Union Central in Qub0065c represents close to half a million members, more than 50,000 of whom are employed in the health and social service network.
SOURCE : QFL
Louis Cauchy, (514) 235-3996
Louis Fournier, (514) 862-5236