The Advantages and Disadvantages of Using Private Healthcare Employment Agencies

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1 w n q o m k i c p c c a P r i v a t e D n d m b e p H e a l t h c a r e c q f t p d f f f f f d T a l k i n g n b j m v b h y v n f p o i n t s c i m w o g m v c k t q e m p l o y m e n t u r s k o l a g e n c i e s To counteract the private healthcare employment agencies March 2010

2 Executive Officer in charge Daniel Gilbert 2 nd 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

3 Introduction The 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

4 What is a private healthcare employment agency? It 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? There were 145 private healthcare employment agencies listed on November 12, 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 What are the services offered by the private healthcare employment agencies? Over 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? Over 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

5 Do the personnel from private healthcare employment agencies need a permit to practice? Yes. 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? No. 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

6 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? Yes. 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? Because 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? No. In many cases, the training and integration into the centres of activities only lasts a few hours upon arrival. talking points

7 In what areas of Quebec are the private healthcare employment agencies used the most? The regions that have recorded the largest increases since 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? Yes. According to the information published in different journals, nearly 60% of public institutions have used private healthcare employment agencies in 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? As 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? No. 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

8 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? To 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

9 Are there advantages for a care professional to remain in the public health network? Yes. 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 sickleave 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? Yes. 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 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? Yes. 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

10 What are the government s arguments for allowing the use of private healthcare employment agencies? Officially, 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? Not 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? The 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

11 How is the FIQ denouncing the use of private healthcare employment agencies? The 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. 11 Talking points

12 Conclusion The 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

13 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; 13 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

14 The FIQ demands that: The 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: /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 14 The FIQ president s blog: At a turning point, the FIQ launches a publicity campaign /presidentsblog.php#at-a-turning-pointthe-fiq-launches-a-publicity-campaign Publicity produced by the FIQ: /stop-using-private-healthcareemployment-agencies.php FIQ Facebook page: FIQ Twitter account: talking points

15 FIQ Montréal Head Office 1234, avenue Papineau Montréal (Québec) H2K 0A Fax : FIQ Québec 1260, boul. Lebourgneuf, bur. 300 Québec (Québec) G2K 2G Fax : info@fiqsante.qc.ca