Quebec health-care system overhaul gets mixed reaction

Reaction to the Quebec government's major revamp of the province's health-care system came quickly -- and was mixed.

Some groups criticized the CAQ government's 50-point plan announced by Health Minister Christian Dube on Tuesday morning, while others applauded the changes.

• READ MORE: Quebec unveils major plan to reform health-care system ahead of election

GENERAL PRACTITIONERS ANXIOUS

The Federation of General Practitioners of Quebec (FMOQ) said it was anxious about what the CAQ will do moving forward, particularly in relation to primary care.

The group said it is imperative that Quebec strengthens its first line of care, which the groups says has been "undervalued for too long in Quebec."

More than 400 family medicine residency positions have remained unfilled in Quebec for the past nine years, said FMOQ.

"Last year alone, 75 family medicine residency positions remained vacant in Quebec, compared to only one in all other medical specialties combined! One unfilled position can have negative effects for 30 years, so imagine 400 positions!" said federation president Dr. Marc-André Amyot.

"We are clearly talking about a collective tragedy that many politicians and government officials seem to have been unable to grasp for too long," Amyot added. "If new government policies reverse this trend rather than continue to exacerbate it, it will be great news,” he added, calling it a "step in the right direction."

Quebec revealed on Tuesday that, officially, there are 945,000 people on the waiting list for a family doctor across the province, but the actual number is likely closer to 1.5 million.

In Montreal, the registration rate for people with a family doctor is around 69 per cent, according to Dr. Mark Roper, a family physician who has been practising in Montreal for more than 30 years. In the Saguenay-Lac-St-Jean region, the registration rate is 92 per cent. 

Dr. Roper was skeptical of the province's plan to set up a phone line for people without a family doctor because it doesn't address the inequalities in access to primary care in cities like his.

He points to the problem of residents not living on the island receiving care in the metropolis — as is their right — as an example.

"If 20 per cent of your population is going elsewhere to go to hospitals or to see family doctors, it's unfair to the metropolis that's receiving this population. So this is a huge problem at the moment and this health-care reform does not make it any better," Dr. Roper told CTV News.

"So I would allocate hospital beds and family doctors based on where patients are receiving their care."

He also said the idea of creating a phone line to direct people without a family doctor to other health-care providers, like psychologists, pharmacists, and social workers is a good "stop gap" measure but doesn't appear to be very effective in practical terms.

"I think the best solution is for everybody to have their own family doctor or nurse practitioner who gets to know them and follows them," he said.

NURSES SKEPTICAL BUT OPTIMISTIC 

When it comes to front-line workers, nurses have felt the effects of the COVID-19 pandemic perhaps more severely with forced overtime, vacations cut and other demands of their services being particularly intense.

Natalie Stake-Doucet of the Quebec Nurses Association was concerned that Dube did not seem to understand how forced overtime actually works.

"That was concerning when you have somebody who's in that kind of position of power and proposing major changes to the health-care system who doesn't understand forced overtime," said Doucet. "He explained it as if somebody calls in sick and nobody comes in to replace the next nurse, then it's an ethical obligation for nurses to stay. That is not at all the case. If somebody calls in sick, there's many levels of governance within the health-care system that should step in and help."

Doucet said staffing needs to reflect the on-the-ground reality and that moving forward the government needs to acknowledge this in its plans.

Nurses and many health-care professionals are skeptical that things will change based on chronic problems not properly being addressed in the past.

"Is this going to fix anything?" asked Doucet. "That's, that's like the million-dollar question. We'll see if a lot of these things are put into practice. That's sort of been the experience over the last 30 years. In Quebec, the successive governments know what's wrong with the health-care system. It's no secret. We've had commissions, we've had reports, pretty much everybody knows what's going on. The problems are fairly clear and have been for many years now."

The plan, Doucet added, has the potential to fix some of what's wrong with health care in the province, but that the details about how the plan will be implemented are very important.  

PHARMACISTS PLEASED WITH INCREASED ROLE

Quebec's Order of Pharmacists was happy to get a nod to their increased role in the provincial system.

"The pandemic has demonstrated the ability of pharmacists to use their new professional activities, such as vaccination, prescription adjustment and extension," said order president Bertrand Bolduc. "Now we need to work on establishing pathways so that each patient knows where to go when they have a health need."

The pharmacists' order said it feels the main weakness in the health-care network is that each professionals' role is not clear to many patients, and a stronger triage system and better communication between professionals are needed.

"It is not normal for a patient to end up in the emergency room for a prescription refill, or for a patient to clog up the clinic for a recurring urinary tract infection," said Bolduc.

Pharmacists working in health-care institutions agree.

"Institutional pharmacists are part of the solution for effective health care and services. It is important that the government work to increase their number in both acute and long-term care," explained association of pharmacists in institutions (APES) president François Paradis. 

BETTER COMMUNICATION

The organization pointed out the need for improved communication and updated IT systems.

APES said it wants to move Quebec out of the age of faxes, phone calls and lags caused by poor communication and tech.

"It is no secret that information technology in the health-care system is deficient," said Paradis. "We need to update and standardize systems, including databases, to improve our performance throughout Quebec. The automated and robotic drug distribution systems (ADRS), which are at the end of their useful life in many institutions, also require investment."

Transplant Quebec agreed that the system needs to be updated and modernized, and welcomed the government's seeming willingness to do so.

"In order to ensure a reform of organ donation that will save more lives in Quebec, it is essential to consolidate and modernize our health system," said Transplant Quebec executive director Louis Beaulieu. "The revision of the legislative framework and the simplification of consent, in particular, will ensure that we improve our performance in organ donation."

Transplant Quebec said it has seen a "significant and unprecedented increase" in patients on waiting lists for the past decade, and that innovation is needed. 

Doucet from the nursing association that an improvement in data availability will help.

"Data is fundamental to understand where the problems are, to be able to fix them where they are," she said. "For example, knowing how much forced overtime is actually happening in the health-care system right now, we don't have access to that data. It's very important for us to be able to see where are things managed better, and where things managed maybe with a little bit more difficulty, and how can we expand the good management practices to places that have a bit more challenges."

COMMUNITY-BASED CARE

The order of social workers said it would like to see the government use the new plan to place greater emphasis on prevention and community-based social services.

The Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec welcomed some of the government's 50 measures -- the Laurent Commission recommendations on improving youth protection services for example -- but said the plan "reserves too little space for general social services and prevention."

"In order to turn the system around, we must be able to count on social services that are easily accessible and adapted to the needs of each community," said the Order's president Pierre-Paul Malenfant. "Unfortunately, this is not what is being presented to us today."

FOCUS ON HEALTHY LIVING

The Canadian Cancer Society said it was pleased with Dube's announcement that the government would focus on healthy living and prevention.

"Placing prevention at the heart of the health recovery strategy is essential," said CCS vice president Diego Mena. "Acting upstream of the disease to have a healthier population and optimize access to screening programs, as well as acting in prevention during the disease to improve the prognosis of people with cancer and their quality of life, will reduce the pressure on the care system. This is a necessary long-term investment that must be accompanied by research." 

MOVING TOWARDS PRIVATIZATION

The Quebec group advocating for public medicine - the MQRP – said last week it is concerned about the CAQ's leaning towards private medicine in the new health-care plan.

"The trend towards privatization in recent years is a slippery slope that we must avoid," the MQRP said in a release on March 22. "The Quebec government has been making a dangerous shift towards the commodification of health care for more than 15 years: duplicate insurance, for-profit clinics, activity-based funding of institutions, a business-inspired management model; the private sector is relentlessly taking over."

The MQRP added that privatization jeopardizes accessibility for all Quebecers and increases total health-care costs. The group adds that $82 million was given to private clinics in the first year of the COVID-19 pandemic and that many clinics are expanding their infrastructure to allow for more services.

"The problem of waiting lists for surgery in Quebec is glaring," the MQRP said. "However, using the private sector as a parallel system only further drains resources and personnel from the public system."

• LISTEN ON CJAD 800 RADIO: Christian Dubé joins Elias Makos live with a health-care system overhaul update

OPPOSITION PARTIES RESPOND

Opposition parties reacted to the health-care plan after it was announced. 

Parti Quebecois leader Paul St-Pierre Plamondon said the CAQ has no courage, and that it should have been working on health-care issues since it was elected in 2018.

"It's shallow," said St-Pierre Plamondon. "It's communication that is not backed by precise amounts, sometimes by amounts that do not fit the narrative such as for health-care at home."

The Quebec Liberals said the reforms will not address the problems at the heart of the issue: the lack of family doctors.

"I don't think it will fix the first line and the first line is what really matters at this point.," said leader Dominique Anglade. "We have a million people waiting to have access to a family doctor, and it's not going to go away."

Quebec Solidaire health critic Vincent Marissal said the CAQ plan will “socialize the cost, privatize the benefits.”

“The minister bought a thesaurus but I’m still waiting for the real plan,” he said. "Let's be clear, this will cost more."

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