Quebec healthcare reform failing one year in, report warns

Tashi Farmilo

One year after the creation of Santé Québec, the central agency formed under Quebec’s sweeping healthcare reform, the Alliance du personnel professionnel et technique de la santé et des services sociaux (APTS) says the public system has seen no meaningful improvement. Representing over 60,000 workers, the APTS is one of nearly 500 organizations that signed an open letter on December 2, warning that the government’s approach is pushing the system toward further deterioration rather than recovery.

According to Maxime Clément, communications advisor for the APTS, “We have not seen improvements in accessibility or service quality. What we have seen are cuts imposed without discernment or impact assessment. Decisions are being made farther from the ground, based on purely financial considerations.”

While the government framed the reform as a way to make the healthcare system more humane and efficient, the APTS says working conditions have remained unchanged since Santé Québec was launched. The most recent collective agreement was signed in June 2024, but the union sees no shift in day-to-day practices. “There have been no improvements in practices,” said Clément. “The cuts contribute to a negative work climate in institutions.”

The union is also raising alarms over the increasing presence of private companies in areas like medical imaging and laboratories. Clément said the long-term effect of the reform could be “a disconnect between service organization and population needs, as well as significant privatization of public services.”

In place of centralization, the APTS is proposing a return to regional decision-making and more stable funding. The union is calling for “a decentralized organization of care and services to meet the needs of communities,” along with “a budgetary shield to protect funding for health and social services, adjusted to follow the evolution of population needs.”

In the Outaouais, the consequences of the reform are felt even more acutely. Local staff shortages are being aggravated by competition from across the Ottawa River. “The proximity to Ontario is very problematic in Outaouais,” said Clément. “Better working conditions offered on the other side of the river contribute to the staff shortage.”

To address these pressures, the provincial government has introduced targeted bonuses, but the union says these are temporary fixes that avoid dealing with structural issues. “The government has implemented bonuses to respond piecemeal to crises, without addressing the core issue, which is working conditions that do not retain expertise in the public network,” Clément said.