Quebec & Bill 10

Written by  //  March 9, 2015  //  Québec  //  1 Comment

Health Minister Gaétan Barrette not budging on MUHC’s seasonal bed cuts
‘It was planned that way. It was agreed upon, and that’s the way it will be. OK?’

Quebec Health Minister Gaétan Barrette is dismissing concerns about the impact of dramatic bed cuts on patient care at the McGill University Health Centre.

“The plan was the plan, and they have to abide by the plan,” said Barrette, referring to a 2007 clinical plan signed by the MUHC and the province.

Barrette’s comments come a day after it was revealed that the MUHC would have to cut dozens of beds in the summer and holiday periods – more than a quarter of the year – in order to meet the budget imposed on it by the Health Ministry.

Some surgeons predict the 14 weeks of “seasonal bed closures” could double wait times for cancer surgery and cause even longer delays for non-urgent surgeries.

2015

9 March
Fourth resignation signals deepening crisis at the CHUM
A fourth resignation at Montreal’s French-language university health complex this weekend signalled a deepening crisis at the CHUM in the wake of the stunning resignation last week of executive director Jacques Turgeon.
On Sunday, Michel Gervais, a member of the CHUM board and president of the Association Québécoise d’établissements de santé et de services sociaux (AQESSS), announced his own resignation in yet another scathing letter. … He goes on to say that this “interference and abuse of power” shouldn’t be a surprise because AQESSS has warned that Bill 10 would put a dangerous concentration of power in the hands of the minister.
9 February
Coalition of anglophone groups satisfied with ‘net gain’ in Bill 10
After three months of “intense and delicate” negotiations with Quebec, a coalition of English-speaking groups said on Monday they were satisfied with the final wording of Bill 10.
The Quebec Community Groups Network, a mouthpiece for 42 English-speaking organizations, said they obtained changes to the health-care reform that guarantee the anglophone minority a voice in each of the large geographic authorities that will oversee medical establishments in the province starting April 1.
The QCGN held simultaneous news conferences at its office in Montreal and the bilingual hospital Jeffery Hale in Quebec City.
“If in terms of explicit recognition of the need for the health and social service system to be sensitive and responsive to the needs of the English-speaking community, I think we have a net gain here,” said Eric Maldoff, a lawyer with Lapointe Rosenstein Marchand Melançon who negotiated on behalf of the QCGN.
Longtime Liberal MNA Clifford Lincoln noted that the English-speaking community’s rights have been “affirmed in such an integrated way that it would make it much more difficult for future governments to touch them anymore.”
The National Assembly adopted the bill in a special sitting that lasted from Friday morning until just after midnight Saturday morning.
Although the boards of bilingual health establishments will disappear as will all others, they will retain their corporations and control of their assets. Under the original plan, these would have been swallowed up by a CISSS.
As per the QCGN’s demands, two of five mega organizations in Montreal — for the West End and West Island — will be officially bilingual.
Anglophone leaders also persuaded the provincial government to bolster committees that will advise the CISSS in cultural and linguistic matters.

 

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Overview from Norton Rose Bill 10: Quebec government tables major overhaul of the health and social services network (October 2014)
Le projet de loi 10: la mauvaise prescription – Bill 10: Wrong prescription
Healthcare reform bill to be forced through, anglo groups concerned
(CTV) The future of Quebec’s healthcare will be fiercely debated Friday at a special session of the National Assembly to vote on Bill 10.
Bill 10 is central to the Liberals’ push to healthcare reform. The legislation aims to overhaul regional boards that administer healthcare throughout the province. It would also eliminate hundreds of middle-management positions.
The Liberals are taking the exceptional measure of invoking closure and limiting debate to pass the controversial reform bill, meaning it will be forced into law. With a 70-seat majority in the legislature, the Liberals will have no trouble doing so.
Anglophones are worried they will lose control over their healthcare institutions, which was a key concern for groups like the Quebec Community Groups Network.
QCGN spokesperson Rita Legault said there is little hope of Anglophones retaining control.
“We’re not going to see that today,” said Legault. Health Minister Gaetan Barrette has said that option is simply not compatible with the bill.
The QCGN and other Anglo groups have met Barrette over the last few months to try effect changes to the legislation. After intense negotiations, they reached a series of compromises, which Legault said “should allow the community some level of input” within the healthcare network.
Legault added that the QCGN will be watching very carefully to see what is in the final version of the bill, which should be adopted in the early hours of Saturday morning.
20 January
Bill 10: Health minister, anglophone groups nearing compromise
QCGN spokesperson Rita Legault confirmed that her organization was close to reaching a compromise with Barrette.
“It doesn’t look like we’ll save the boards of our organizations, but we’re going to save the corporations that own our institutions and oversee their visions and missions. That was a major, major stumbling point, which seems to be resolved,” she said.
PQ accuses Liberals of insensitivity towards Anglos Oh, the irony!
Parti Quebecois health critic Diane Lamarre says the Liberal bill shows an insensitivity toward several minority groups, including anglophones.
“He must recognize the specificity of English-speaking people, the community, and how they are involved in their health system.”
Lamarre said the current structure allows everyone to feel respected in the system, and that bill 10 is moving forward too quickly.
16 January
Bill 10 amendments don’t go far enough: QCGN (Video)
(Global News) This is the first time QCGN has spoken out about Bill 10 since the amendments were first presented in the National Assembly in December.
Executive Director Sylvia Martin-Laforge told Global News that further amendments are necessary.
“We want the Minister and the Ministry to ensure that the English-speaking institutions that we have built over the last 150 years are maintained and that the community maintains their ownership and control over them,” said Martin-Laforge.
QCGN worried Bill 10 amendments will not save our institutions
While leaders in Quebec’s English-speaking community were cautiously optimistic in early December that amendments to Quebec’s health reform would allow the community to maintain an acceptable level of input and control over their institutions, that hope is fading as the Commission on Health and Social Services reconvenes today to continue the clause by clause review of Bill 10.
Despite the reassurances offered in early December by Health and Social Services Minister Gaétan Barrette, amendments tabled to date do not adequately ensure the protection of the English-speaking community’s hospitals, nursing homes and social service centres or preserve the community’s role in their governance.
The position of the Quebec Community Groups Network and its community and health and social service stakeholders is that Bill 10, and any legislation, regulations or guidelines that impact our community’s health and social service institutions, must respect three central principles: That the community maintain some meaningful involvement in the governance of institutions that were built and supported by our community over more than 150 years; that the legislative guarantees which protect English-speaking Quebecers’ right to services in our own language across the Province be upheld; and that our institutional owning corporations, where they exist, continue to maintain ownership and control of their assets.
15 December 2014
Dr. Brian Gore: Bill 10 could create chaos in Quebec’s health-care system
(Gazette Opinion) Bill 10 has been widely criticized for the threat it poses to the English community’s health and social-service establishments. But for those of us working in the health-care sector, the major damage that this bill will cause will result from the transformation of well run community and regional establishments by seasoned administrators into much larger organizations run by appointees named by the minister of health.
In my view, this amounts to placing the health-care network in Quebec under trusteeship, and without evident cause
11 December
Opinion: Bill 10 won’t fix problems caused by poor management of hospital bed spaces
Every ward of every hospital must have a bed manager (similar to an insurance agent in the U.S. who works to discharge patients quickly, primarily for monetary reasons) that is aware of every patient and has the power to make their stay as efficient as possible by communicating with a patient’s entire team so that interventions are done with minimal delays. Currently, already over-worked head nurses attempt to do this, but have little success as hospital communication is very time consuming. If Quebec had a nurse practitioner on every ward (“super-nurses” trained at the master’s level that can diagnose patients, interpret diagnostic tests, prescribe pharmaceuticals, order and interpret X-rays, all without having to wait for a physician), they would have the knowledge and power to do what Bill 10 will attempt to: save Quebec’s health-care system.
1 December
Quebec health minister softens Bill 10 to appease critics
Bilingual institutions are promised more safeguards and independence, but their boards still won’t be spared.
Quebec Health Minister Gaétan Barrette unveiled amendments on Monday to his bill that would place health establishments under the charge of administrative super-boards. Many of the proposed changes aim to ease the anglophone community’s worries about the fate of institutions that operate in English and French.
Bill 10 would replace local health agencies with mega-boards called Centre intégres de santé et de services sociaux (CISSS).
Under the rejigged version of the bill, any change to the status of a bilingual institution would require permission from a provincial committee that protects access to English health services. “Now, I imagine that it would be pretty difficult to think that there could be any threat to that status under the eventual promulgation of Bill 10,” Barrette said.
The bill would also be amended to make two umbrella organizations — Montreal’s West End CISSS and Central CISSS — officially bilingual.
Barrette added “universitaire” to the title of any CISSS that includes a university within its borders. Under the new arrangement, there would be five CIUSS, three in Montreal, one in Quebec City and another in Sherbrooke.
As promised, Barrette added a time limit to his nomination powers so that he can name board members, including the CEO, of a health establishment only once, for a three-year term.
27 November
Quebec Liberals hope to pass controversial legislation before the holidays
(Global News) Majority governments can force legislation through. The Charest Liberals did it and the Couillard government is hinting it could do the same.
“There are long discussions that sometimes we see as being too long,” said Government House Leader Jean-Marc Fournier.
Bill 10 is one of those bills the government is eager to pass. It would eliminate a level of bureaucracy in the healthcare system and save the Health Ministry $220 million.
Anglophones are particularly angry to see their boards of directors dismantled, but after spending more than 70 hours listening to dozens of interest groups, Gaétan Barrette said it’s time to move.
“There are tough decisions to be made, we are making those decisions,” Barrette noted.
The minister promised to table amendments that will satisfy the English-speaking community. But he also hinted his bill could pass through closure, if push comes to shove.
20 November
Opinion: Bill 10 health-care administrative ‘reform’ seems likely to backfire
Scientific evidence does not support the presumptions of Bill 10 that there will be a reduction in bureaucracy with the centralization of decision-making. National and international experience has shown time and time again that the proposed reform will not have the desired effects that have been announced and in fact will make health-care delivery more complex.
(Gazette Opinion) Bill 10’s objective is to improve the access and the quality of health and social services in the province of Quebec while diminishing bureaucracy and increasing efficiency. To accomplish these objectives, the proposed law merges all public health and social service institutions in a given region into an integrated centre of health and social services (CISSS). The Montreal region, due to its size, will be divided into five new distinct regions. As professors in the Department of Health Administration in the School of Public Health at Université de Montréal, we are in agreement with these objectives, however we seriously question the ability of this reform to achieve them.
Scientific evidence has shown that mergers of institutions in the health-care sector do not generate economies of scale, nor do they reduce bureaucracy, and have had little or no effect on the integration of services or an increase in accessibility. The centralization that will result from this reform will not allow for the stated objectives to be achieved and will likely have important negative consequences.
The debate surrounding the optimal size of a health-care institution has been going on for decades. This debate reached a crescendo during the 1980s in the United States and Great Britain. Experience shows that there are no cost savings in increasing the size of an acute-care hospital over 200 beds. Hospitals with over 600 beds cost more to run than those hospitals of smaller size. It is also noted that not only are costs not reduced, but that there are unexpected and negative effects on the offering of services, most notably in the delays in the development and improvement of those services. It is interesting to note that a national conference was held in 2001 in the United States on the theme “The Failure of Mergers.”
17 November
Bill 10 will have dramatic impact on English-speaking Quebecers warns Maldoff // Le Projet de loi 10 aura un impact dramatique sur les Québécois anglophones prévient Maldoff
17 November
Dozens of anglo organizations team up to say no to healthcare reform
Bill 10 will revamp healthcare throughout Quebec by merging boards and slashing the number of administrators and managers.
(CTV) “This government has fallen perhaps in the trap of cost cutting without looking at the impact on community,” said Sylvia Martin-Laforge, director of the Quebec Community Groups Network.
Bill 10 is a runaway train, says mass coalition of Anglo groups
41 groups make plea to Liberals for more time
(CJAD) Bill 10 will cut off the English-speaking community from their health care institutions and threaten even their bilingual nature, say a coalition of three dozen anglophone community groups who spoke out in Montreal today.
A table holding 41 leaders stretched out before the Monday press conference, representing organizations such as school boards, community-based organizations, users committees, institutions, auxiliaries, and foundations.
The groups said the community influence will be diluted away when bilingual institutions are merged into large regional mega-structures called CISSSs, and that even access to English health care is in jeopardy.
“I know the minister is telling us ‘don’t worry, be happy. We’ll fix it. Until we see it, in writing, in the law, we are not only going to be unhappy, but we are going to be extremely worried,” said former MNA Clifford Lincoln, who become involved in the health care system as a volunteer as the father of a mentally impaired child, who passed away a few years ago.
14 November
Dan Pfeffer: Anglophone Quebec should ride the group-rights wave in opposing Bill 10
(Gazette Opinion) compared to the powers that Quebec has obtained based on group rights, the rights that anglophone Quebec seeks are extremely modest. In this light, group rights give anglophone Quebec a powerful argument for the protection of their network of hospitals, school boards, municipalities, lobby groups and so on. Anglophone Quebec does not seek self-determination. It does not need nor desire its own parliament, revenue agency or Crown corporations. But it does need for the community to have sufficient recognition of its historic status, its right to exist and its right to articulate itself as a part of Quebec.
13 November
Quebec unions ask that Bill 10 be scrapped
The last day of Bill 10 hearings began with unions prescribing drugs for Health Minister Gaétan Barrette.
About 25 protesters stood outside the National Assembly shaking fake bottles of pills early Thursday morning. …
Since October, more than 50 groups have told the minister they’re worried about mergers to save costs.
12 November
Social media used to highlight ‘side effects’ of Quebec’s Bill 10
(Global News)  The Quebec Community Groups Network has launched a Facebook page in protest over Bill 10, the Quebec government’s planned reform of the healthcare system.
The page warns the bill is proposing to apply “shock therapy to our health and social service system.”
It goes on to ask Health Minister Gaetan Barrette, himself a physician, to consider all “possible side effects of this course of treatment before moving boldly ahead.”
11 November
Denis Lessard: Projet de loi 10: trop de pouvoirs au ministre, croient les établissements de santé
(La Presse) Le projet de loi 10 créera une centralisation dangereuse des pouvoirs entre les mains du ministre sur le réseau de la santé. Le ministre Gaétan Barrette et ses successeurs se retrouveront avec le contrôle de 50 % du budget du gouvernement du Québec.
C’est ce qu’a fait valoir mardi matin Michel Gervais, l’ancien recteur de l’Université Laval, devant la commission parlementaire chargée d’étudier le projet de loi 10, déposé par le ministre Barrette.
Pour M. Gervais, devenu président de l’Association québécoise d’établissements de santé et de services sociaux (AQESSS), le projet de loi est inacceptable et risque d’entraîner dans son sillage plus de problèmes qu’il en réglera.
«Dans son projet de loi, le gouvernement fait le choix de déplacer le pouvoir des régions pour une hypercentralisation. Près de 50 % du budget de l’État se retrouvera dans les mains d’une seule personne, soit le ministre de la Santé et des Services sociaux», d’observer M. Gervais
Peggy Curran: Why Quebec’s austerity plan makes me nervous
Yes, getting Quebec’s finances into shape and making our schools and hospitals run smoothly and efficiently are noble objectives. But there needs to be a recognition, before it is too late, of the consequences of big institutional changes — for patients, parents and students, for the people who lose their jobs, and the smaller workforce left to carry on.

The Decline of the English School System in Quebec and what to do about it!
Richard Y. Bourhis
Département de psychologie (UQAM)
Presentation to the Advisory Board on English Education, MELS (PPT available on request)
Montréal, October 27, 2014
In 2014 the Liberal Government in its quest to reduce the Quebec debt load is also planning to reduce the Education budget and force mergers in French school boards and in English school boards.
English school board mergers would:
Reduce the number of Anglophones available on boards to promote local needs of English schools & their pupils
Reduce the size of English school system and the institutional vitality of the English speaking communities of Quebec (ESCQ)
Could Liberal Government go as far as abolish French and English School boards ?
Selon Julie Barlow dans l’Actualité du 15 novembre 2014 (p 42):
« … Toute tentative d’abolir les commissions scolaires se heurtera au noyau dur de la communauté anglo-québécoise, dont les taux de participation aux élections scolaires s’élève à 17%.
« Si on les abolit, ça va être le tollé! » prévient David Daoust , président de l’Association des commissions scolaires anglophones du Québec.
Car la gouvernance scolaire est le dernier bastion politique de la communauté anglophone, qui y tient au même titre et pour les même raisons que les francophones minoritaires des autres provinces.
Selon David Daoust, les anglophones contesteront l’abolition des commissions scolaires sur la base de l’article 23 de la Charte des droits et libertés, qui garantit à la minorité le droit de faire instruire ses enfants en anglais.
C’est l’arguments qu’ont fait valoir les francophones du Nouveau Brunswick après l’abolition des commissions scolaire, en 1996. Et ils ont eu gain de cause »


Alex K. PatersonOpinion: Bill 10 will weaken our health care institutions

I write not only as a health-care lawyer, but as someone who has been involved for over 40 years in Quebec in the development of a variety of changes and reforms in the health structures and their applications, and a volunteer with health-care institutions since 1990.
I am firmly convinced that the Quebec government’s statements about the need for substantial cost cutting are justified, and therefore the intent, in Bill 10, to implement a two-tier management is understandable.
However, it does not follow that the boards of the institutions need be creatures of the government instead of the voices of the communities they will represent.
The strength of our health institutions comes in part from the knowledge and experience their directors have concerning the problems and issues they are appointed to solve, and not from their language or the location of their residence alone. Pediatric hospitals require people with an interest and experience with children’s diseases. Institutions dealing with mental health need a close connection to and compassion for those suffering from the issues these institutions struggle to solve, clinically and through research. Other institutions in the system do not necessarily have the experience or knowledge to offer those with special needs what they require. Specialization will therefore continue to be a necessity. …
The communities’ interests are reflected in the views of their directors and the work of their foundations. If these directors become government appointees and the foundations’ involvement is only recognized by a token observer role, I doubt that the communities will retain the interest they now have, which would obviously weaken the institutions.
A reduction in the recognition of the foundations would reduce funding from the private sector at a time when there is a crying need for increased giving.
3 November
Castonguay prévoit une catastrophe
Le projet de loi 10 doit être retiré, dit le père de l’assurance maladie
(Le Devoir) Dans une lettre adressée à Philippe Couillard, l’ex-ministre libéral demande au premier ministre de rappeler à l’ordre Gaétan Barrette et d’amender le projet de loi 10.
Vous qui avez été ministre de la Santé, vous savez qu’il est impossible pour un ministre de vouloir gérer à distance un système aussi vaste et complexe que celui de la santé. Vous avez aussi été en mesure de constater l’importance de dépolitiser le système, compte tenu des difficiles décisions qui doivent être prises malgré les pressions », écrit Claude Castonguay, ministre libéral de 1970 à 1973, et ex-président du Groupe de travail sur le financement du système de santé, dont les travaux se sont achevés en 2008.
Sans une révision importante du projet de loi 10, ce projet « digne des ex-régimes socialistes de l’Europe de l’Est » risque de « donner les mêmes terribles résultats que dans ces pays », avance-t-il dans une courte missive adressée au premier ministre, dont Le Devoir a obtenu copie.
Il est maintenant évident que votre ministre a l’intention de faire adopter son projet de loi 10 malgré l’opposition généralisée qu’il suscite. La nécessité d’alléger les structures administratives du système ne justifie aucunement le changement majeur projeté par votre ministre. Ce projet de loi, s’il est adopté, va enfermer de façon définitive notre système de santé dans une bureaucratie étouffante. »
Yves Bolduc says ‘transformation is coming’ to Quebec school boards
Quebec Minister of Education, Yves Bolduc, says the government will propose significant changes to the school board system in the next few months.
His comments come after Sunday’s school board elections.
Going into the election, Bolduc said voter turnout would be crucial in determining the future of school boards.
While the voter turnout for English boards in Montreal was up, turnout was down for the French boards.
With an estimated province-wide election participation rate of five per cent, Bolduc says the “status quo” is no longer acceptable.

Quebec Minister of Education, Yves Bolduc, says the government will propose significant changes to the school board system in the next few months.
His comments come after Sunday’s school board elections. Going into the election, Bolduc said voter turnout would be crucial in determining the future of school boards.
While the voter turnout for English boards in Montreal was up, turnout was down for the French boards. With an estimated province-wide election participation rate of five per cent, Bolduc says the “status quo” is no longer acceptable.
30 October
QCGN presents its brief on Bill 10
(Telbec) The government must find a way to ensure that Quebec’s English-speaking communities continue to have some degree of control and management over the institutions that it built and has supported for generations. It must also ensure that institutions designated to provide bilingual services are not abolished by the provincial government’s sweeping health care reforms.
Those were among the messages the Quebec Community Groups Network and its partners and stakeholders delivered to Health Minister Gaétan Barrette during public hearings on Bill 10 at the National Assembly in Quebec City.

Editorial: Bill 10 would be ‘catastrophic’ for English-speaking Quebecers

Testifying before a committee of the National Assembly, the QCGN said it is not opposed to the objectives of Bill 10, which are to improve efficiency, slash bureaucracy and save an estimated $220 million annually in the health system. But it ardently opposes the plan that would see 128 existing facilities like the Jewish General or St. Mary’s hospitals technically cease to exist in law and be made “installations” of 28 new super-boards called Centres intégrés de santé et services sociaux (CISSS).
This is a move that in effect threatens the status all but one of the institutions currently designated to provide bilingual service under the Charte de la langue française. Only the McGill University Health Centre would remain untouched. Bill 10 does not explicitly contain any threat to English services, but making “installations” of independent institutions would weaken the legal protections that recognized hospitals, rehabilitation centres and long-term care homes currently have allowing the use English as a language of work, internal communications, patient files and signage.
And as the QCGN pointed out, the bill’s threat to the English minority goes beyond language of service. It also would sever crucial links between minority communities and their institutions, links of involvement and investment that reflect and reinforce the vitality of the communities themselves. No longer would each institution be governed by its own board of directors, many of whose members are prominent community members who volunteer their time. Those grassroots boards would be disbanded, and members of the mega-boards would be appointed by the health minister.
A loss of attachment to public health institutions could also have a financial fallout, as support for hospital-affiliated foundations dries up amid feelings of alienation or confusion. These foundations raise huge sums that are then reinvested in the public health care system and their loss could cancel out other cost savings.
As well, as the QCGN has pointed out, health-care institutions designated to provide English services are also a major source of sometimes-scarce employment for the anglophone community. As institutions merge, bargaining units consolidate, and jobs are shed, it is unclear what, if any, protections Bill 10 would provide for retaining bilingual employees and positions — another indirect threat to English services. As well, anything that increases anglophones’ unemployment is a blow to the future of the community.
23 October
Anglos in Townships, Quebec City seek protections under health reform
Two English-language groups urged Health Minister Gaétan Barrette on Thursday to protect anglophone minorities in his sweeping reform of the health-care bureaucracy.
Speaking after a parliamentary commission on Bill 10 on behalf of the 14,500-strong anglo minority in Quebec City, Taylor Ireland of the Voices of English-speaking Quebec pointed out that, for his community, the city’s bilingual hospital is more than just a place to go for treatment.
“It’s an identifier for our community, a source of pride,” he said.
The VEQ squeaked into the list of more than 60 groups invited to the commission at the last minute with the help of local MNAs. Originally, the Quebec Community Groups Network was supposed to be the only Anglophone voice at the commission.
20 October
Bill 10 hearings begin in Quebec City
Concern is mounting over Bill 10, the government’s proposed health-care reform.
Hearings into the new piece of legislation began Monday in Quebec City and anglophones are paying particular attention.
Jean Robert, President of the Jeffrey Hale Hospital Foundation told Global News the 150-year-old Quebec City establishment is suddenly feeling very fragile.
“We’re a small, small partner here,” he said. …
Sylvia Martin-Laforge will be responsible for voicing all of these concerns and more at the National Assembly.
Her Quebec Community Groups Network (QCGN) is the only anglophone group invited to take part in the consultation.  Watch: Sylvia Martin-Laforge on Bill 10
25 September
Gaétan Barrette tables bill to overhaul Quebec’s health care system
Health minister’s Bill 10 would eliminate entire layer of bureaucracy, cut 1,300 management jobs
If passed, Bill 10 would eliminate an entire layer of bureaucracy — namely, the province’s 18 regional health agencies.
Right now, the agencies act as middlemen between the minister and the province’s Health and Social Services Centres (known as CSSS).
Many CSSSs — which manage hospitals, clinics and long term care facilities — would also be merged.
Instead of the 182 that exist today, there would be 28 which would become integrated health centres (CISSS).

Bill 10 Recap:
the creation of integrated health and social services centres (CISSS) with one CISSS in each of the province’s 16 health regions — except for Montreal, which will have have 5 CISSSs;
the elimination of Quebec’s 18 health agencies
the elimination of 1,300 management positions
the merger of 182 health and social services centres (CSSS) into 28 integrated centres (CISSS)
The reduction of administrative boards from 200 to 28.
No changes for Montreal’s MUHC, CHUM, Sainte-Justine Hospital and Montreal Heart Institute

One Comment on "Quebec & Bill 10"

  1. référencement naturel November 14, 2014 at 11:09 am · Reply

    J’ai découvert ton blog il y a peu… et j’adore lire tes articles ! Merci

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