Quebec unveiled its plan toheal itsbeleagueredhealth care and social services system over the next three years, with a focus on acceleratingaccess to front-line health services through a one-stop phone service, reducing emergency room waittimes and improvingworking conditions for nurses.
But opposition parties are slamming the document, describing it as more of an electoral platform than a detailed plan for health-care reform.
The plan, outlined in a 90-page document called "Human and Efficient — Plan to implement necessary health changes," highlights some solutions to the system's challengesmade worse by the pandemic, including lack of personnel, rising costs, and an aging population.
Health Minister Christian Dubéand Lionel Carmant,Quebec's junior health minister, rolled out the details of theplan Tuesday morning.
Dubésaid one of his key objectives is to ensure all Quebecers have "the best patient experience and that they are proud of their health system."
Among the 50proposed measures, which were leaked in adocument obtained byRadio-Canada last week, are eliminatingmandatory overtime for nurses,hiring of 3,000 new clerks by the end of the year to take on some of the paperwork,more home-care services for seniors, modernizing access to medical data and the creation of electronic health records accessible to patients.
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The new health plan document doesn't include costs, but Dubé pointed toa budget increase of 6.3 per cent for the health system in the coming year.
Last week, Finance MinisterEric Girard said that increase will be put toward therevamping of the system.
But money is only part of the solution, Dubé said.
"It takes more than money— it takes awillingness to work differently."
However,Parti Québécois LeaderPaul St-Pierre Plamondonsaid the plan is too short on details and financial commitments.
"Witha few months until the elections, they come up with all those things [that are] not measured, no figures and no precise targets," he said.
One-stop service for Quebecers without family doctors
The government plans tochangethe way family doctors are paid, from a per-act to a per-patient basis, in an effort to get those doctors to take on more patients.
There are some 945,000 Quebecers who are still on the official waiting list for afamily doctor, according to the document, but it's estimated the actual number of people without one is closer to 1.5 million.
Dubé said the government is still working on reducing the number of people on that list. But the governmentis backing awayfrom a promise made in 2018 to get everyone a family doctor by the end of the CAQ government's first mandate this year.
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The plan now calls for stepping upalternatives for front-line care, including giving nurse practitioners, paramedics and pharmacists more power to treat patients.
Under the plan, Quebecers will call a phone number which would act as a one-stop service, known as the guichetd'accèsà la première ligne (GAP), where a nurse woulddirect patients to the appropriate medical service, whether that's seeing a doctor or lining them up with some other method of care.
"It's not only theoretical. It's already started," said Dubé, who pointed to a pilot project in the Lower Saint-Lawrence region.
Dubésaid he hopes that "the majority" of people without a family doctor will be able to use the one-stop service by the end of the summer. However, that service was already supposed to be in place across the provinceby March 31.
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The junior health minister,Carmant, underlined that the servicewill be managed regionally and will be accessible in English.
The hope is that under this plan, fewer Quebecers would need to go to a hospitalemergency room for health issues that could be treated elsewhere.
But Liberal Leader Dominique Anglade saida phone line is not a replacement for a family doctor.
"That one person knows your file, knows your history," she said."They can ensure a follow up, and for clinical problems, this is really fundamental."
Federation offamily doctorswelcomes plan
The federation representinggeneral practitioners in Quebecsupports the idea of the one-stop service, saying it could help match patient needs with the professional who is best-suited to address their needs, whether that be a nurse practitioner or a social worker.
Dr. Marc-André Amyot, president of theFédération des médecins omnipraticiens du Québec(FMOQ), says with a shortage of 1,000 family doctors in Quebec, his memberscannot shoulder the entire burden of addressing all front-line health-care needs.
"Wecannot ask family physicians to do more and more and more. We have to think differently," he said.
Amyotwas pleased the document mentions the need to place more value on the work of family doctors, as he said it's not a specialty that medical students find attractive. He said 400 residency positions in family medicine have gone unfilled since 2013, with 75 open spots in the last year alone.
The government also aims to reduce the wait time in every emergency room to no more than 90 minutes, the document states.
Every hospital would have a "command centre" staffed by workers from different sectors, including the at-home care team and mental health professionals.
The centre would aim to discharge patients as soon as their condition is no longer criticalbut would ensure the patient "continues to benefit from services outside the hospital if their state of health requires it."
Improving work conditions
Many measures are aimed at creating a "more attractive work environment" for health-care professionals, particularly for nurses.
To that end, the government is promising to overstaff the system, to enable itto handle absences without relying on forcing nurses to work overtime.
Dubé said his government has been monitoring how often mandatory overtime is used, and pointed to a recent month when it happened "only 27" times that a nurse was forced to stay at work because there was no replacement for the next shift.
"There is a will, a very clear will, not to do it," he said.
The government plans toundertake a "massive" recruitment campaign, including hiring more than1,000 nurses from abroad.
Each establishment wouldalso be allowed to manage its own schedules, with input from staff.
The government also wants to reduce the system's reliance on private agencies to provide temporary nurses and nurses' aides. Right now many hospitals and long-term care homes rely on those agencies to fill positions when they are short-staffed, at a higher cost.
In a joint statement, unions representing health-care workers said Dubé's plan included "laudable objectives," but they worry it could amount to a "vast public relations exercise" ahead of the provincial election.
The unions also expressed concerns about the government's intention to turn more often to the private sector, notably to deal with surgical backlogs. They said this could make it even harder to recruit personnel tothe public sectorand called for amoratorium on "all new privatization projects."
Caroline Senneville, president of the Confédération des syndicats nationaux(CSN), said while the pandemic forced the government to work with unions and health-care workers to find quick solutions, it needs to continue to do soif it wants to fix the health-care system.
"We need the government to speak to us not only when it's in trouble, but also overthe long run," she said.
