Cuts of 1.5 billion | Santé Québec faced with the impossible

The next few weeks will be crucial for Santé Québec. The brand new organization must fulfill the government’s demanding order to make cuts of $1.5 billion without affecting services to the population.

Before I tell you the details I learned about the cuts, a fundamental question arises. Is it wise to ask the organization that took over the reins of the network on 1^is December to reduce its budget of 39.2 billion by almost 4% by March 31, i.e. in 4 months?

Are we giving the organization the chance to succeed in its mission, namely to revolutionize the way we do health care?¹

According to my information, Santé Québec has identified almost half of the sum of 1.5 billion in cuts, most of which do not yet affect direct services to the population.

By the end of January, health centers will announce the elimination of more than 500 positions, including auxiliary nurses, residential service aides and housekeeping attendants, I learned from sources safe, but not allowed to speak openly. Around forty manager positions will also be abolished.

The abolitions will take place in the CISSS and CIUSSS of Laval, Outaouais, Chaudière-Appalaches and East-de-l’Île-de-Montréal. These are positions, sometimes vacant, for day shifts or in CHSLDs, among others^⁠2.

The objective is to reorganize services to return to pre-pandemic levels. At the same time, a few dozen new positions will be posted in the coming weeks, most of them for evening or night shifts. Some of the people targeted by the 500 abolitions will be invited to apply, in accordance with collective agreements.

Impossible without touching the services

At Santé Québec, spokesperson Yann Langlais Plante did not want to comment specifically on this information.

More generally, Santé Québec tells me it wants to reduce hours worked through a reorganization of work, particularly in administrative and support services. There is also talk of abolishing certain vacant positions, putting an end to non-essential projects and reducing non-salary expenses.

Will we avoid affecting direct services to the population, as Minister Christian Dubé wishes?

“The government’s balanced budget objective is ambitious. We need to be transparent: there will be difficult decisions to make, but we are working to limit the impacts on services to the population,” Mr. Langlais Plante replied in writing.

This cautious speech hides an unavoidable reality, according to my internal information: for the management of Santé Québec, it is impossible to eliminate the other half of the sum of 1.5 billion without reducing direct services to the population.

Hence my initial question: is it wise to demand such cuts from an organization that took charge of the network on 1^is December, so in four months? Aren’t we risking making the situation worse, in the longer term, rather than improving it?

The two previous reforms (Rochon in 1995 and Barrette in 2014) were also implemented during a period of cutbacks, with painful effects on the health system subsequently. The goal was no longer to improve the quality and quantity of services on a zero-sum basis, but to do so while reducing expenses.

Of course, current savings are required by the imposing deficit of 11 billion planned for the year which ends on March 31. This spending control is essential for the Minister of Finance, Eric Girard.

The order is legitimate to contain spending, since health is the government’s main budget item. In the past, I have often defended budgetary rigor and the achievement of a zero deficit, although such rigor has its consequences.

Except that Quebec cannot afford to fail with Santé Québec. He must give the newborn time to gain strength and mature before asking him for feats.

That’s not all. The Ministry of Health oversees the main orientations of the network and cedes daily management to Santé Québec, but it must accept its decisions, otherwise the reform will be in vain.

However, a recent episode suggests that Christian Dubé’s ministry will be quick to micromanage. At the beginning of December, information circulated that Santé Québec was seeking to reduce home support.

As soon as the information reached the ears of the Ministry of Health, the deputy minister, Daniel Paré, sent an official letter to the CEO of Santé Québec, Geneviève Biron, instructing her not to reduce the number of hours of services offered to beneficiaries of employment-service checks^⁠3.

Santé Québec responded that it sought to ensure that care was adapted to the changing state of health of patients.

At the end of the day Tuesday, the office of Minister Christian Dubé wrote to me that “Santé Québec has all the necessary room for maneuver, such as the reduction of the independent workforce and the flexibility of new collective agreements, to ensure that establishments respect their budgets.”

And he adds that “at all times, the impact on services must be minimized”.

The cabinet, however, did not answer my question about its own cutback objectives for the share of the 22.7 billion health budget that remains (RAMQ, doctors’ remuneration, etc.).

In short, the next few weeks will be crucial for Santé Québec. They will allow us to see if the organization has free rein or if it is just another structure, without any real impact.

In my opinion, the CAQ government would have every interest, if it wants its reform to be a long-term success – operational and financial – to ease up on the 750 million short-term cuts which directly affect services, even if to see the deficit swell a little.

1. CEO Geneviève Biron was appointed in April 2024, like the executive vice-president of operations and transformation, Frédéric Abergel, but it is the 1^is December that Santé Québec was officially transferred responsibilities. The organization has a budget of 39.2 billion and 330,000 employees, including 860 at the head office. The rest of the Health budget, of 22.7 billion, is in the hands of the Ministry of Health, in particular the expenses of the RAMQ and those linked to the remuneration of doctors.

2. CISSS is the acronym for Integrated Health and Social Services Center, and CIUSSS also has a university component (the U of CIUSSS).

3. Read the - article “Quebec calls Santé Québec to order”