by Jon Milton
Denyse Joseph is helping to manage a crisis team for her union. “We’re looking at everything that comes out each day, each hour, regarding this pandemic crisis,” she tells RankandFile.ca. “What are the measures the government is putting in place? Is it respecting the safety and security of our members?”
Joseph is a vice-president of the Fédération Interprofessionnelle de la Santé du Québec (FIQ), the union which represents over 76,000 healthcare workers in Quebec, including nurses, licensed practical nurses, respiratory therapists, and clinical perfusionists. For the past few weeks, healthcare workers have responded to an unprecedented public health crisis, in the form of the global COVID-19 pandemic.
Quebec declared a public health emergency on March 13, which gives public health officials significant power to adopt measures to prevent the spread of the virus. By March 25, all “non-essential” economic activity in the province was halted to encourage workers to stay home and flatten the curve of the highly contagious virus.
In his daily press conferences, Legault has taken to calling healthcare workers “guardian angels,” and praising the efforts of frontline workers. But Joseph says that his praise hasn’t been matched with action to keep workers safe.
“There’s a question about whether frontline workers should be wearing the N95 masks when seeing patients,” Joseph says. “The government keeps saying there’s enough of this protective equipment, but we’re not sure. In fact, in every department, our members are calling us and saying the protective equipment is locked up, and only one person from each department has the key.”
“If you’re in an emergency situation, and you need to have this equipment, good luck.”
Already, the lack of access to the “minimal” amount of N95 masks and other Personal Protective Equipment has led to dangerous situations for healthcare workers. When a patient in the dialysis centre of the Montreal General Hospital tested positive for COVID-19, nurses who had interacted with the patient were instructed to lie about the encounter when passing the now-mandatory security checks at the beginnings of their shifts.
“They’re putting more people at risk,” Joseph says of the incident. “This is unacceptable, and it’s a situation we’re seeing more and more.”
The pandemic comes right in the beginning of public sector negotiations in Quebec, and healthcare workers had been preparing for what promised to be a drawn-out and confrontational negotiating period. The province’s tone has been hostile towards union demands for improved working conditions and funding for public services.
This pandemic, though, is vindicating the unions’ long-term position that budget cuts and neoliberal restructuring has been bad for Quebec’s healthcare capacity.
Cuts, Cuts, Cuts
Quebec’s healthcare system is “chronically underfunded,” understaffed, and has been subject to “systematic disorganization,” Anne Plourde, a researcher at the Institut de recherche et d’information socioéconomiques (IRIS), a progressive think-tank in Quebec, tells RankandFile.ca.
These problems that have emerged and intensified as a result of decades of neoliberal restructuring—and the effects of those cuts are about to become grimly apparent in a reduced capacity to respond to the ongoing COVID 19 crisis.
“In 2010, the recommended amount of annual growth was 5.2 per cent in healthcare, just to keep up with the costs of the system,” Plourde says. “But systematically, every year since 2011, we’re well below that rate. We’ve seen rates of 3.8, or 3.3, or 1.5 per cent.”
“Since 2019, we’ve reinvested a bit, but we’re far from having caught up to the under funding of the last years.”
The opening era of Quebec’s health care cuts, Denyse Joseph says, was in the mid-1990s, when Premiere Lucien Bouchard was frantically pursuing “deficit zero.” In healthcare, that took the form of the virage ambulatoire, also known as “dehospitalization.”
“Between 1995 and 1998, around 10% of the workers in the healthcare sector had their positions abolished,” Joseph says. In 1997 alone, 3,600 nurses left the profession as part of the province’s voluntary retirement program.
This program also saw the wide-scale cutting back of hospital beds—an essential piece of infrastructure to deal with the current pandemic—despite significant population growth and aging. Hospitals across the province, particularly in Montreal, were closed in favour of clinics.
Before the virage ambulatoire, Joseph says, “if you had breast cancer, we would bring you into the hospital at least two days before the surgery, teach you everything you needed to know, and keep you for days after[…]in order for you to go home safe. Now, if you have a normal breast cancer, when you get the operation, the next day you’re out, or sometimes the same day.”
“The decline is hospital beds has never stopped,” Joseph says. “Every government since then has cut in the budget of the healthcare system.”
Along with cuts to infrastructure and frontline staff during the virage ambulatoire, the past decades have also seen a dramatic level of centralization of healthcare governance. The Liberal Party of Quebec, particularly former health minister Gaétan Barrette, slashed and burned much of the governance infrastructure during the party’s last tenure in government from 2014 to 2018.
The “Barrette reforms,” as they’re known, redirected much primary care towards private practice family doctors, rather than public clinics and hospitals. Family doctors were mandated to dramatically increase the amount of patients, and governance in public health institutions was centralized.
“It was another way to cut in services, cut budgets, and cut positions,” Joseph says.
“Before the 2000s, there were hundreds of public institutions in Quebec,” Plourde says. “Each one was autonomous, with its own board. Each board was elected with representatives from each professional body, from users, and from the community sector.”
Today, there are less than 30 public governance institutions in the province, each one grouping together multiple hospitals, clinics, and eldercare facilities. The boards of these institutions are, for the most part, appointed by the provincial health minister.
“It was a huge loss in democracy,” Plourde says. “There’s no local anchoring for services. The decisions are made so far away from the base that the capacity to respond to needs on the ground is handicapped.”
The Unions were Right
“The FIQ has been fighting, always, every cut,” Joseph says. During the Deficit Zero years in the 1990s, the union engaged in multiple illegal strikes to improve the deteriorating situation of the healthcare system. Against the Barrette reforms, nurses and other healthcare workers have been engaging in direct action at work since 2015.
Joelle Dussault, a PhD candidate in sociology who studies Quebec healthcare workers mobilization, says that since 2015 “nurses, as professionals, have often mobilized in a way that’s creative, that you don’t find elsewhere.”
“A lot of initiatives that come directly from workers in their workplace” rather than from the formal structures of the union, Dussault says. Faced with successive intransigent governments, healthcare workers have taken to workplace direct action.
“We’ve seen a lot of sit-ins among small teams of workers,” Dussault says. “And there have been really important gains regarding the number of nurses hired, on how mandatory overtime is managed. They’re gains for working conditions, and also for the quality of care.”
The FIQ has also been declaring days of action, where members systematically refused forced overtime. “We were nice to advise the institutions a week in advance,” Joseph says. “Our members sometimes find out an hour, or 15 minutes, before the end of their shift that they have to stay.”
Nurses in Quebec have also been producing “black books” for healthcare in the province, detailing the ways workers are prevented from providing adequate care to patients because of quotas, mandatory overtime, and burnout. Testimonies were gathered anonymously, because of provisions in the collective agreement which punish workers for speaking out against their employer.
“We asked our members to explain what care they can’t give because there’s not enough staff, what are the cares that they have to give too fast because there’s not enough staff,” Joseph says. “We received many, many forms.”
The most pressing issue is to need for a “proper ratio of workers to patients” Joseph says. The province needs to hire more healthcare workers. This was already the case before the COVID 19 pandemic, and will become exponentially more so as the crisis accelerates. And in order to attract workers to the field, healthcare workers need a raise.
“The salary right now hasn’t even followed inflation,” Joseph says.
As a result of the COVID 19 crisis, Quebec is attempting to dramatically fast-track negotiations with the entire public sector—attempting to arrive at tentative agreements for all 550,000 public sector workers by Sunday, March 29.
While the FIQ has agreed to take part in the accelerated negotiations, Joseph says that “even though the government wants to sign right away, we will not let go of things that our members need to absolutely see in their contracts this time.” The union is demanding premiums and hazard pay for members, expansion of the definition of full-time employees, and a better patient-staff ratio across the sector.
“The key for us,” Joseph says, “is that we need to make sure that everything is put in place for staff to give safe care to the population.”