On September 25, 2014, the Government of Quebec tabled Bill 10, An Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies (the Bill). This Bill reduces the number of administrative levels in the health network (the network), particularly the number of officers and boards of directors. It also centralizes certain powers related to the organization and governance of health institutions with the minister of health and social services (the minister).
With this Bill, the government is proposing to amalgamate the province's 18 health and social services agencies and 182 health institutions into just 28 institutions for the stated purpose of optimizing network efficiency: one regional institution for each of the 24 regions of Quebec plus 4 supraregional institutions for the Montreal region. The government claims the restructuring proposed in the Bill will eliminate 1,300 management positions and save $220 million a year.
The regional and supraregional institutions will enjoy all the rights, acquire all the property and assume all the obligations of the amalgamated institutions.
Centralizing governance powers
The Bill provides for the devolution to the minister of several powers aimed at ensuring organization and governance oversight of the regional and supraregional institutions. These include:
- Power to appoint members of the board of directors. The minister appoints the members of the board of directors of each institution, who come from various councils, committees and universities affiliated with the institution, for a maximum term of office of three years. The minister must also appoint independent members based on the recommendations of a committee of governance experts. The members remain in office until replaced or reappointed.
- Power to determine the
remuneration of members of the board of directors. The
remuneration, indemnities and allowances of the members of the
board of directors are determined by the government. The Bill
provides no guidance on this matter.
The Bill delineates the responsibilities of the board as follows: the board of directors organizes the institution's services in keeping with province-wide orientations and equitably distributes, within the bounds of the resource envelope allocated by the service program, the human, physical and financial resources at its disposal and ensures such resources are used economically and efficiently. The information contained in the activity report, annual financial report and report on the application of the complaint examination procedure must be presented to the public by the board members at a public information meeting.
- Power to appoint the president and executive director and assistant president and executive director of an institution. The minister appoints the president and executive director and the assistant president and executive director for a term of office not exceeding four years. They remain in office until they are replaced or reappointed. There are no specific requirements in the Act to guide the minister in making such appointments for regional and supraregional institutions.
- Power to determine the
remuneration of the president and executive director and assistant
president and executive director of an institution. The
minister determines the remuneration, employee benefits and other
conditions of employment of the president and executive director
and assistant president and executive director in accordance with
standards and scales of remuneration determined by regulation. No
person may pay them remuneration other than that set by the
minister or grant them a benefit other than those provided by
regulation, under penalty of a fine of up to $25,000 in the case of
a natural person or $50,000 in any other case. A president and
executive director who accepts such remuneration is also liable to
such a fine.
The Bill delineates the responsibilities of the president and executive officer as follows: the president and executive officer, assisted by the assistant president and executive officer, is responsible on a full-time basis for the administration and operations of the institution, sees to it that the decisions of the board of directors are carried out and ensures that the institution's clinical activity is coordinated and supervised. They are not authorized to carry out activities other than the activities related to their position, with certain exceptions.
- Power to appoint temporary replacements. Exceptionally, if the minister considers the general management or the board of directors of a public institution to be doing something incompatible with the rules of sound management, he or she may, for a period not exceeding 180 days, appoint one or more persons to temporarily replace the relevant persons or to assume some of the board's powers. The minister may extend this period by an additional period not exceeding 180 days. The person appointed by the minister to replace the president and executive director or assistant president and executive director or to assume some of the board's powers may not be prosecuted for acts performed in good faith in the exercise of his or her functions.
Minister's functions and powers
Certain functions currently assigned to the health and social services agencies under the Act respecting health services and social services (AHSSS) will be transferred to the minister, including allocating budgets to institutions, coordinating the activities of institutions, supporting institutions in organizing their services and in signing service agreements, and developing information and management tools. The minister will also be responsible for drawing up and ensuring the application of regional staffing and human resources development plans and the medical staffing plan.
A number of powers of intervention and supervision will also be transferred to the minister to deal with situations where an institution is experiencing difficulties relating to the quality of health services or its administration or operation. In particular, the minister may appoint observers who may attend all meetings of the institution's board of directors, committees and supervisory committees but are not entitled to vote. The minister must also ensure compliance with the AHSSS and the regulations by appointing someone to carry out an inspection of the institution involved. Following the inspection, the minister may direct the institution to provide it with an action plan for implementing the minister's recommendations.
The minister will also be responsible for the functions currently performed by the health agencies that relate to the identification and certification of private seniors' residences and certain resources offering lodging to vulnerable clienteles. In addition, new powers assigned by the Bill will enable the minister to compel the institutions to make certain decisions. For example, the minister may require public institutions to use in common certain goods and services determined by the minister. The minister can also oblige an institution to use the services or participate in a call for tenders of a joint procurement group. The institution may be relieved of this obligation if it demonstrates to the minister that such a decision will not achieve the desired objectives.
Continuity of services and transitional provisions
Following passage of the Bill, the terms of office of the members of the boards of directors of the amalgamated agencies and institutions will end on March 31, 2015. The minister will announce his budget on April 1, 2015. Requests, documents, information, notices, details or proposals that were to be sent to an agency will have to be sent to the minister and references to an obligation to consult an agency will not apply. Several common-interest information assets that are owned by the agencies, the public institutions, the Régie d'assurance-maladie du Québec or the Institut national de santé publique du Québec will be transferred to the minister on March 31, 2015 with the related rights and obligations. The information assets to be transferred are listed in Schedule II of the Bill. This list includes several information and management systems, SécurSanté, the Quebec Health Record, the infocentres and certain registries, including the Registre québécois du cancer (Quebec cancer registry), the Registre des traumatismes du Québec (Quebec trauma registry) and the Registre et services de gestion des consentements (consent registry and management services).
Stages before the Bill becomes law
The Bill has to go through several stages before it becomes law. The main stages are:
- Consultations before a parliamentary committee: the individuals or organizations affected by the Bill are invited to submit a brief to and/or testify before a parliamentary committee so that the members of the National Assembly (MNAs) are made aware of their opinion and actual needs. Given the nature of the Bill, this stage could take a few weeks.
- Detailed analysis by a parliamentary committee: the Bill is studied by a parliamentary committee and the MNAs consider the Bill section by section. The opposition MNAs may propose amendments.
The date provided in the Bill for the coming into force of the Act is April 1, 2015. Quebec's Minister of Health, Gaétan Barrette, has indicated that he expects the Bill to become law before December 31, 2014.
In its current form, the Bill would bring about fundamental changes in the way the health network operates. While its stated purpose, i.e. financial savings, may seem above reproach, the Bill needs to be analyzed in detail to assess its impact on the quality of care and the achievement of financial objectives. With the current government holding a majority in the National Assembly, it appears likely that the final version of the Bill will be very similar to the tabled version. It would therefore seem that, even though a date has not yet been set for the parliamentary committee, it would be in the interest of stakeholders and organizations in the health network to initiate a process of reflection with a view to taking part, alone or on a group basis, in the committee's consultations.
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