Private Healthcare Employment agencies

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To counteract the
private healthcare
employment agencies
March 2010
Executive Officer in charge
Daniel Gilbert 2nd Vice-President
Written by
Marie Eve Lepage Union Consultant, Communication-Information Service
Lucie Mercier Union Consultant, Sociopolitical Sector
Jean Villeneuve Union Consultant, Labour Relations Sector
Revision
Marie Eve Lepage Union Consultant, Communication-Information Service
Translation
Susan Millroy Union Consultant, Translation Service
Secretariat
Léona St Louis Secretary
talking points
Introduction
T
he public health network has been using
private healthcare employment agencies more
and more for staff. For all that, the shortage of
professionals is not being resolved. The public sector,
which is already suffering from under-financing, only
suffers the competition from the private sector
more.
Who profits from the privatization of care in Quebec?
The patients? The public network? No. Rather, it is the
private healthcare employment agencies because it
is public money earmarked for health that is finding
itself into the pockets of shareholders.
The FIQ denounces this strong tendency which is
weighing on health. This talking points, in the form
of questions and answers, presents the main issues
linked to the growing presence of private healthcare
employment agencies and it proposes a counterargument on the subject.
Enjoy your reading!
Talking points
What is a private healthcare employment agency?
I
t is a for-profit business whose only objective
is to make the most profit by recruiting care personnel
from different job categories in order to lease their
services to health-care institutions.
How are private healthcare employment agencies set up?
T
here were 145 private healthcare employment
agencies listed on November 12, 2009. Most of them
can be qualified as small and medium businesses
(PME). However, it is important to point out that
there are large companies, some multinationals,
which employ thousands of employees. Most of the
private agencies have been created recently, that is
after the year 2000.
What are the services offered by the private healthcare
employment agencies?
O
ver the last ten years the services offered by
the private agencies has diversified: home care, both
subsidized and not, medical imagery, vaccination
and travel health clinics and personnel training in
particular, have been added to the placement of
personnel in health-care institutions.
Which job categories are covered by the private healthcare
employment agencies?
O
ver the years, the range of job categories
covered has grown: nurses, licensed practical
nurses, beneficiary attendants, respiratory therapists,
physiotherapists, occupational therapists, even
management (head nurses).
talking points
Do the personnel from private healthcare employment agencies
need a permit to practice?
Y
es. All care professionals, whether from the
public or private sector, are obligated to hold a
permit to practice. Despite this, many private healthcare employment agencies hire their personnel by
telephone or by internet, without even meeting
the people they send to the institutions. With such
methods, the verification made at the time of hiring
by these companies must be questioned.
The care professionals in the public sector however,
must present their permit to practice at the time of
hiring and, in some cases, upon annual renewal in
order to continue to practice their profession. And
the employer can, at any time, validate this information
with the professional corporation of the employee.
The objectives pursued are to insure the public’s
safety and to see that the decisions from the
disciplinary boards and the professional inspection
services are respected.
Do the personnel from the private agencies offer the same quality
of care as that in the public network?
N
o. Considering the high rate of turnover, the
personnel from the private agencies struggle to
develop relationships with the patients and to
adequately assess their needs. Also, they know little
about the work environment, the procedures and
protocols of the institution where they are placed.
Using the private healthcare employment agencies
threatens the quality, continuity and safety of care.
Who is responsible for the quality of care offered by the personnel
from the private employment agencies?
A
care professional is always responsible for
her acts and must respect her code of ethics,
regardless of who her employer is. However, the
legislation stipulates that it is the Director of Nursing
(DON) or the nurse in charge of nursing who must
insure the quality of the care dispensed.
Talking points
Some private healthcare employment agencies are
not even aware of previous disciplinary measures
(dismissal, suspension) or of the conditions for
practice for their employees or do not take the time
to verify it. And, the institutions that get these
professionals referred by the private agencies are
not any more informed of the situation.
Do the services of private employment agency personnel cost
more than those of care professionals in the public network?
Y
es. It must not be forgotten that the main
mission of the private sector is to obtain the best
possible productivity for its shareholders. Thus,
because a private business must make enough money
and the care professionals must also see a monetary
advantage to going to work in the private sector, it
costs the institutions more to use their services.
Why do the employers use the private healthcare employment agencies?
B
ecause using the private healthcare employment agencies allows short-term management,
without any planning. Also, the employers then free
themselves from their responsibility for the employees
and no longer have to respect the collective
agreement.
Are the personnel from the private healthcare employment
agencies sufficiently trained to perform the tasks entrusted to them?
N
o. In many cases, the training and integration
into the centres of activities only lasts a few hours
upon arrival. talking points
In what areas of Quebec are the private healthcare employment
agencies used the most?
T
he regions that have recorded the largest
increases since 2004-2005 are Lanaudière (120%),
the Laurentians (68.2%), Outaouais (63%), Laval
(46.9%), Montérégie (38.5%) and Montreal (32.7%).
Do most of the public health network institutions use the private
healthcare employment agencies?
Y
es. According to the information published
in different journals, nearly 60% of public institutions
have used private healthcare employment agencies
in 2008-2009. In some institutions, it seems that the
personnel from these agencies have worked up to
40% of the total hours worked.
If this tendency continues, what can we expect?
A
s previously mentioned, the majority of the
private healthcare employment agencies are small
and medium businesses, but some of them are
multinationals. The possibility of the larger companies
buying the smaller private ones is very real. These
types of situations could lead to the creation of a
monopoly or quasi-monopoly for the offer of care
professionals’ services from the private sector to the
public network on a more or less long-term basis.
The creation of a monopoly or quasi-monopoly
would have real consequences on the fees charged
by the private sector, because competition would
become pure fiction.
Will the use of private employment agencies lead to resolution of the problem of the care professional shortage?
N
o. The increasing use of personnel from
private agencies by the public network exacerbates
the problem of the exodus and the shortage
and generates other problems harmful for care
Talking points
professionals. The care professionals note, in particular,
a lack of mutual aid, especially when the situation gets
complicated and requires additional commitment. In
spite of the presence of personnel from the private
agencies, the care professionals suffer the following
negative effects:
■
■
■
■
They take on the heaviest and most complex
cases;
They must orient the personnel from the private
agencies without any assurance that these people
will come back to work on their unit;
They must work mandatory overtime in order to
insure the continuity of care;
They must supervise and support the private
agency personnel so that they can provide care
on their unit.
It is therefore false to think, contrary to what private
healthcare employment agencies pretend, that the
personnel from the private sector are going to “save”
the public health network and give a breather to the
care professionals who are constantly faced with a
work overload.
Why do some care professionals leave the public network for the private employment agencies?
T
o try to give themselves working conditions
perceived as being more advantageous in the short
term. Furthermore, the private agencies bombard
the members and the public with publicity to convince
them that the private sector offers better working
conditions and that care professionals in the private
sector are happier than those in the public sector.
The right to choose her own hours and her place of
work and not being obligated to work overtime are
indeed attractive conditions. However, it is necessary
to ask the question of what would happen if all the
care professionals left for the private sector. Would
they still have such latitude in their choices?
talking points
Are there advantages for a care professional to remain in the public health network?
Y
es. The feeling of belonging, team work,
the development of expertise, access to a quality
pension plan (RREGOP), the recognition of seniority,
13 statutory holidays, annual vacation and sick-
leave days, job security, group insurance plans, rights
stipulated in the collective agreement, union protection
in the case of a dispute with her employer or her
professional corporation, ongoing training, etc. There
are numerous advantages to staying to work in the
public health network.
Does the use of private healthcare employment agencies cause injustices in the working conditions?
Y
es. The employers in the public network
negotiate different working conditions with the
representatives of the private agencies than those
stipulated in the Decree in lieu of a collective
agreement that the Charest government imposed on
the unionized workers of the network in 2005. Yet,
this same government provided a clause in Appendix
1 of the FIQ Decree that forbid employers from any
departure from the list of job titles, descriptions and
the salary rates and scales.
Does the use of private healthcare employment agencies have an effect on the climate at work?
Y
es. The administrators in the public network
who promote the use of personnel from the private
agencies are responsible for the deterioration of the
working conditions and the climate in their institutions.
The increase in the injustices in the treatment of the
same group of care professionals, whether in the
private or public sector, causes conflicts, tensions
and ruins solidarity.
Talking points
What are the government’s arguments for allowing the use of private healthcare employment agencies?
O
fficially, the MSSS makes speeches urging
the institutions to reduce the use of personnel from
the private healthcare employment agencies. In reality
however, they are acting the complete opposite. In
spite of their public statements, they still have not
given written directives to the regional agencies or
the public institutions.
What can be the government’s motivation?
N
ot to take concrete measure to counteract
the disturbing increase of private healthcare
employment agencies fits right in with its ideology of
reducing the size of the State. By using private
agencies, the government is contributing to the
weakening of the union movement in addition to
getting rid of the social responsibilities intended for
the quality of life of its employees.
10
What could be the impact of the increasing activities of the private healthcare employment agencies on the FIQ?
T
he FIQ represents 58,000 care professionals
in Quebec. It is the legitimate and recognized
organization to negotiate the working conditions of
these professionals. The increase in the activities of
the personnel from private agencies in the public
health network can be a clear threat, in the medium
and long term, to the representative character of the
FIQ with the employers and the Quebec government.
The Federation would therefore gradually lose its
bargaining power and see its negotiating power
reduced.
talking points
How is the FIQ denouncing the use of private healthcare
employment agencies?
T
he FIQ launched a publicity campaign in
order to make the population of Quebec and its
members aware of this critical issue. First and
foremost, a television campaign was in full force
during the month of February and March throughout
Quebec. A poster campaign ran at the same time as
the television campaign. The population of Quebec was
exposed to this anti-private healthcare employment
agencies promotion on city buses and the advertising
bill boards along the highways. The theme: “Private
interests are profiting from public healthcare. The
Ministry of Health is letting it happen. We’re all paying
for it”.
The Federation also produced a leaflet and a FIQ
Special Report: Private Healthcare Employment
Agencies in pursuit of the same objectives. Also, the
issue of using the private agencies is a regular subject
in the President’s Blog on Facebook and on Twitter.
Lastly, several motions have been submitted to the
Commission des relations du travail in order to have
the employees from the private sector recognized as
being part of the FIQ certificate of accreditation.
There have already been some victories to its credit.
Talking points
11
Conclusion
T
he issue of using private healthcare
employment agencies is of significant interest for the
FIQ. In fact, this issue goes beyond the simple
question of union accreditation. It is a question of the
quality of professional care and services, patient
safety and protection of the public against the
potential abuse of the private sector which, in many
cases, is not subject to the same regulations as the
public sector.
The fight against the presence of the private
healthcare employment agencies in public institutions
also fits in with the fight aimed at avoiding, in a more
or less short term period, that care professionals
become a labour force to be leased, like any other
item of medical equipment would be leased. Making
the population of Quebec and the FIQ members
aware of this is of primary importance.
12
talking points
Considering that:
■ The expeditious hiring methods of the
private healthcare employment agencies bring into
question the verifications they do on the history of
their personnel;
■ The private healthcare employment agency
personnel are not able to offer the same quality of
care of that of the public health network;
■ The services of private healthcare employment
agency personnel costs more than that of the public
network personnel;
■ The use of private healthcare employment
agencies indicates short-term management by the
employers;
■ The health-care institutions are using
personnel from private healthcare employment
agencies more and more;
■ The increasing use of private healthcare
employment agency personnel by the public network
exacerbates the labour shortage problem and
generates other problems for care professionals;
■ There are many advantages for care
professionals to remain in the public health network;
■ The use of private healthcare employment
agencies causes injustices in the working conditions
and has negative effects on the climate at work;
■ The government is trying to weaken the
union movement by its lethargy regarding the
increasing use of private healthcare employment
agencies by public institutions;
■ The increasing activities of the private
healthcare employment agencies personnel can be a
clear threat in the medium and long term to the
representative character of the FIQ;
Talking points
13
The FIQ demands that:
T
he government take concrete measures and
give clear written instructions to the regional agencies
and the public health-care institutions in order to ban
the use of private healthcare employment agencies.
Useful links:
FIQ Special Report on Private Healthcare
Employment Agencies:
www.fiqsante.qc.ca/documents_publications
/documents/fiqdossierspecial
/fiqDossierSpecial_0301_f.pdf
Video of the FIQ president:
Entreprises privées – Le ministère de la Santé
doit passer de la parole aux actes www.youtube.com/FIQSante
14
The FIQ president’s blog:
At a turning point, the FIQ launches
a publicity campaign www.fiqsante.qc.ca/blogue/english
/presidentsblog.php#at-a-turning-point-
the-fiq-launches-a-publicity-campaign
Publicity produced by the FIQ:
www.fiqsante.qc.ca/lecompteurtourne
/stop-using-private-healthcare
employment-agencies.php
FIQ Facebook page:
www.facebook.com/FIQSante
FIQ Twitter account:
www.twitter.com/FIQSante
talking points
FIQ Montréal | Head Office
1234, avenue Papineau
Montréal (Québec)
H2K 0A4 |
514 987- 1 1 41 | 1 800 363-6541 |
Fax : 514 987-7273 | 1 877 987-7273 |
FIQ Québec
1260, boul. Lebourgneuf, bur. 300
Québec (Québec)
G2K 2G2 |
418 626-2226 | 1 800 463-6770 |
Fax : 418 626-2111 | 1 866 626-2111 |
www.fiqsante.qc.ca | [email protected]