Proceedings of the Standing Senate Committee on
Issue 7 - Evidence - Meeting of September 14, 2010 (afternoon)
QUEBEC CITY, Tuesday, September 14, 2010
The Standing Senate Committee on Official Languages met this day at 1:17 p.m.
to study the application of the Official Languages Act and of the regulations
and directives made under it (topic: the English-speaking communities in
Senator Maria Chaput (Chair) in the chair.
The Chair: Honourable senators and guests, welcome to the Standing
Senate Committee on Official Languages. I am Senator Maria Chaput from Manitoba,
and I am the chair of this committee. I am joined this afternoon by several
colleagues, members of the committee, and I invite them to introduce themselves.
Senator Champagne: Good afternoon. My name is Andrée Champagne. I am
the deputy chair of this committee. Considering that I am not quite well right
now, I think health services would be helpful to me, in either language. Thank
Senator Seidman: Good afternoon. I am Judith Seidman, a new senator. I
have been in the Senate for about a year. I am from Montreal. My professional
background before I came to the Senate was in health and social services, so I
am very interested in hearing what you have to say.
Senator Fortin-Duplessis: Good afternoon. I am Senator Suzanne
Fortin-Duplessis. I was an MP for nine years for the riding of Louis-Hébert,
here in the Quebec City region. We will be pleased to ask you a few questions
after the presentation of your brief.
Senator Fraser: I am Joan Fraser. I have been in the Senate for 12
years, which does not make me a baby in the Senate, but it I am certainly not
among the senior people, more a middle-range senator. Before that, for almost
all my career, I was a journalist in Montreal.
Senator Dawson: I am Dennis Dawson. I was born and raised in Quebec
City. I was a member of Parliament in a previous life, and I have been in the
Senate now for five years. I am a big fan of both Jeffery Hale Hospital and
Saint Brigid's Home.
The Chair: I would like to welcome the Community Health and Social
Services Network, CHSSN, represented by Ms. Jennifer Johnson, Executive
Ms. Johnson, the committee thanks you for having accepted its invitation to
appear this afternoon. You have approximately five minutes to make your
presentation to the committee, after which the members will follow with
questions. You now have the floor.
Jennifer Johnson, Executive Director, Community Health and Social Services
Network: Thank you very much. Good afternoon, ladies and gentlemen.
Madam Chair, thank you very much for giving me the opportunity to appear
before you today. I will do my presentation in English for the English-speaking
community, if that is okay with you.
Today I will give you a brief overview of the profile of health of the
English-speaking community of Quebec followed by some of the activities we have
been doing with the investments from the roadmap for linguistic minorities, the
monies that have been invested in the English-speaking community. I think that
will give you a good idea of where we are and where we are going.
I call the first part of this presentation the myth-busting presentation
because inevitably most people have a perception of the English-speaking
community that is often incorrect with respect to health and social services.
We look at health and social services from the population-health approach,
which is looking at all the determinants of health, not just health and social
services. We are looking at revenue, employment, living situation, social
inclusion and all of the other aspects that affect the health of a community.
We have spent an enormous amount of time developing a knowledge base about
the English-speaking community so that we could express to the public health
system the realities of this community. We have done that using Census of Canada
data; using the Canadian Community Health Survey, which was done in 2005; and we
also do our own surveys. We have surveyed the population of the English-speaking
community across Quebec three times now, with 3,000 respondents, and we have our
own surveys on the vitality of the community and the use of health and social
services. Most of the information I will present comes from one of those three
The English-speaking community is made up of approximately 994,000 people
across the province of Quebec, which is about 13.4 per cent of the population.
You have probably heard that already at one point in the last 24 hours. Most
important is that this is not consistently distributed across the province. You
can have a population of .6 per cent of the population in one territory and 32
per cent in another. No picture of the English-speaking community is the same in
any of the territories or regions that we have.
If you look at the slide I provided, it has an interesting profile that shows
you how varied the proportion of the population is across Quebec. It illustrates
very well the diversity that we are always dealing with when we look at the
English-speaking population of Quebec.
This is an aging population compared to the francophone community. Nine of
the territories in Quebec have 20 per cent more seniors than the francophone
population in their territories. For example, in l'Estrie, 64 per cent of the
population is over the age of 65; 40 per cent in Lanaudière; and 50 per cent in
the Laurentides. This is significantly higher than the francophone populations
in that region.
There is also an interesting phenomenon called "the missing middle." This
is a generation, 45 to 65 years of age, that actually left the province in the
1970s and 1980s. As a consequence, a smaller population is responsible for a
heavy caregiver burden for the English-speaking population of Quebec. Volunteers
that normally would be taking care of many services for the elderly are not
there, and so the ones who remain are highly burdened and have a high level of
Unemployment rates are also surprisingly higher in every territory across the
province, compared to their francophone neighbours. In regions such as Côte-Nord
and Gaspésie, we are talking about very significant differences, 17 per cent and
12 per cent higher than the francophone population of that same region; these
are very high levels of unemployment. Only the francophones in New Brunswick and
Newfoundland have higher unemployment rates.
I have a slide to illustrate that. Unfortunately, you have black-and-white
copies, so it is not as easy to see as on coloured paper. The next slide has an
illustration of the differences in unemployment by region. You can see the
enormous difference between many of the communities in North Quebec — Côte-Nord,
Abitibi and even l'Estrie, a region where you would think unemployment would not
be as big an issue — with higher levels of unemployment for the English-speaking
community. Also Capital-Nationale, Bas-Saint-Laurent, Gaspésie; all these
communities have important differences.
This also translates into the low-income cut-off, LICO. I do not know if you
are familiar with that term, but it is an indicator that is generated based on
income, where you live, how much money you spend on food and rent, et cetera.
English-speaking Quebecers across the province are 38 per cent more apt to have
incomes below the low-income cut- off. A significant difference exists between
the English-speaking community and the French-speaking community.
Ten out of the 17 regions are 10 per cent more likely to be below the
low-income cut-off than the francophones who live next to them. Seventy-four per
cent of the people in the English-speaking community who are below the
low-income cut-off are on the Island of Montreal. Therefore, there is a high and
important level of people below the low-income cut- off on the Island of
In March of this year, we did a survey of 3,000 anglophones across Quebec. We
asked questions about the use of health and social services. In our preliminary
analysis of this information, we have some interesting data: 57 per cent of
those surveyed had not received information about services in English provided
by the public health and social service institutions in their regions in the
last two years. That is still a significant number of people not receiving
information. This number is down from the previous survey done in 2005, but our
thoughts are that this drop could be related to the H1N1 event of last year.
Many people did receive the H1N1 information.
Fifty-six per cent of the respondents who used a CLSC — centre local de
services communautaires — service were served in English; this is down from 65
per cent in 2005. Fifty-nine per cent of respondents who used Info-Santé were
served in English. This is very disappointing because if you were to think of a
front-line service that should be available in English, Info-Santé could easily
be the first step that people take to receive health care. We know for a fact
that the structure is there to provide services in English. Info-Santé is well
organized to provide services in English, but still the people using it are not
receiving services in English.
Again, I want to emphasize that everything varies greatly between regions,
even within Montreal, where you have three different types of availability. The
East End of Montreal is a completely different reality from the West End of
Montreal, and the same applies throughout Quebec. Receiving services in Gaspé is
very different from receiving services in Quebec City or l'Estrie or near
When we looked at the Canadian Community Health Survey, one of the most
important analyses we made was that compared to the other three official
language groups — francophones outside Quebec, francophone Quebecers and
anglophone Canadians — English-speaking Quebecers have the lowest rates among
all the groups for important indicators of their access and indicators of their
health — having access to a regular doctor, satisfaction with the care they
received, utilization of hospital and doctors' services, et cetera, the
Looking at these primary indicators for health and social services in the
community, we realize that some serious demographic challenges and very varied
access to public health and social services for the English-speaking communities
exist in a number of regions. The discrepancies vary greatly from region to
region, and even within areas such as Montreal, they vary significantly.
I will now switch over to the investments that CHSSN and McGill University
have received through the federal roadmap. These monies are going to basically
four different areas. The CHSSN is responsible for a four-year project until
2013, which is a total of $19.5 million, and we have four programs in that
The first is the Networking and Partnership Initiative, NPI, which I will
explain in more detail in the next slide.
The second is an adaptation program where we give monies to the public health
system in each of the territories to improve access to services in their
regions. They define how it is done, what is done and they implement the
The Community Health Promotion Projects Program, HPP, is the third and
involves funds to assist communities to become more involved in health promotion
activities in their communities. This money goes principally to the health
networks that we have established across the province.
We have also been working with the Institut national de santé publique du
Québec, INSPQ, to increase the use of language as an indicator when they do
their research with respect to health and access to health services. Prior to
this, language really was not used. They know more about the comparisons of
Quebec to people who live in France than they do about French-speaking Quebecers
to English-speaking Quebecers. This is the first time that we have included
language as a variable in the work that the INSPQ is doing.
The other envelope is $19 million that McGill University has received for
training and retention of health professionals. Unfortunately, I do not have the
expertise to explain this project to you, but the key elements are training
health professionals to be able to better serve the English-speaking communities
across the province. They have been training approximately 3,000 to 3,500
professionals a year in language training so that they can better provide
services to the English community. Of course, there is also a retention
component in that, and that is encouraging bilingual students to practise and do
their internships in the regions to improve access.
I want to give you a quick description of the Networking and Partnership
Initiative. This is CHSSN's, I think, most important success story with respect
to approaching better access to services. It is all about empowering the
communities themselves to develop the knowledge they need to know about the
community so that they can speak to the public partner to express the needs of
the population and then perhaps even help with solutions in providing better
With the monies invested from the federal roadmap, we have been able to
create 18 health and social service networks across the province. There is a map
in your presentation. Also, there is a map in here that has a red dot where each
of the networks are located. They are from one end of the province to the other.
It is similar to the Community Learning Centre, CLC, in a way because we
basically hire one coordinator whose role is to develop the knowledge base,
contact the public partners, contact the private and volunteer organizations in
the community and develop a more cohesive approach toward developing better
access to services at a local level. This has been very successful. We began
this project in 2003, so in the last seven years, they have gone from zero
communication with the public health system in many communities to actually
being a partner and sitting at the table on health and social service committees
in the public sector.
This has been a huge success with respect to a sense of capacity for the
English-speaking community, actual benefit to the community and creation of
services for the community. There has been a very direct impact on access to
I also want to point out that the CHSSN has developed an implementation
agreement with the Quebec health ministry. They have agreed, in collaboration
with us, on how the monies that we give to the public agencies across the
province will be spent. This is a delicate affair, a community organization
providing funding to public organizations. We have successfully negotiated an
implementation agreement with the ministry with which they are satisfied and are
supporting because they see the benefits that this funding has provided with
respect to the public partners and the community that are involved and their
actual knowledge of the community.
You have to realize that, in terms of the setting, the Quebec Health and
Social Services System is under enormous pressure just to provide services to
all Quebecers, regardless of their language. One third of Quebecers believe the
health system has deteriorated since 2003; 44 per cent are dissatisfied with
hospital emergency services; and 38 per cent say that they have difficulty
finding a family doctor. This was a Léger Marketing poll in 2007. This is the
context in which we are working, trying to get the francophone-majority
population to provide more services in English for the English-speaking
The head of the Order of Nurses of Quebec stated in 2008 that 1.5 million
Quebecers do not have a family doctor. Two thirds of Quebec nurses are over the
age of 50 and are expected to retire early, within the next three years, and
Quebec will have a shortfall of 5,000 nurses in three years. This is not a
system that has time on its hands, nor money, so it is complex to ask them to do
more and to provide more.
This is why federal support is so valuable to the work that we do because it
gives oxygen to the system to be able to provide better access and to do better
work for the English-speaking community.
To conclude, the long-term challenges facing the Quebec Health and Social
Services System, such as system costs, human resources recruitment, replacement,
changing demographics, et cetera, all require an ongoing commitment from the
federal government to the official language minority communities in this area.
The Quebec English-speaking communities will be submitting the new priorities
for access to Health Canada for 2013-18 in March of next year, so this is a very
important time for us. We are building for the next roadmap, whatever it will be
The Senate committee can contribute to this effort with its support of the
new priorities for federal investments, so supporting the good work that has
been done in the past and the success we have had, et cetera. The Senate
committee can also help the English-speaking communities by ensuring that the
community-designated organizations, such as us, are exclusive beneficiaries of a
new federal contribution program for health. In this way, the federal resources
that will help adapt Quebec's public system to serve English-speaking
communities will flow through a current successful partnership agreement that we
have signed between Quebec and the community.
This is an important element. This is something we worry about frequently
with respect to the delicate relationship that we have with the provincial
government and federal funding. We believe that it is important that a community
organization is the beneficiary of this funding and that it is not given to the
province. That way we can ensure the funds are working on issues that the
English-speaking community believes in and has identified as priorities.
Senator Dawson: You have three maps.
Ms. Johnson: It is all the same map.
Senator Dawson: It is all the same map, but in some they are called
"health regions." Does that refer to the regions of Quebec?
Ms. Johnson: There are 18 health regions in Quebec, and we have 18
health networks that we have created with the federal funding. The health
regions are territories that are defined by the provincial government, and we
have health networks.
Senator Dawson: I see places on the map such as Mauricie and Central
Quebec, and Saguenay-Lac-Saint-Jean where you do not have anyone. Do you have
sub-regions somewhere else?
Ms. Johnson: Yes, that is right. It is not by region. For example,
Gaspé has three.
Senator Dawson: That was my confusion. I was trying to understand the
relationship between the 18 regions of Quebec and the 18 regions of your
We have been looking at education for a day and a half and, more often than
not, realize that some of the problems the anglophones have are the same as the
problems the francophone have except accentuated by the fact that you have fewer
numbers or geography problems.
With respect to retention, you spoke about a special project with McGill
University that prepares people to do health services with the anglophone
community and about retention programs. How would they compare with retention
programs in the francophone health network? How successful are they?
Ms. Johnson: It would be the same type of internship, et cetera, that
would be for anyone in the province of Quebec. The difference is that we set up
relationships with the English-speaking community in the region. We encourage
studying students to go to the regions versus staying in Montreal and doing
their internship at an institution there. We encourage them by telling them to
come and visit the Gaspé, that we have a wonderful community, that the English-
speaking community is there and would love to welcome them.
We make it a much more interesting and enticing experience versus telling
them to just go and do their internship in Sherbrooke or wherever.
Senator Dawson: It is more of an outreach.
Ms. Johnson: We call it "la grande séduction," the same as the
movie. That is literally what it is.
Senator Dawson: You mean "la petite séduction," do you not?
The grand seduction is another thing. I might come back for a supplementary
Senator Fortin-Duplessis: First of all, I would like to congratulate
you on the quality of your presentation. Even though you used transparencies, it
was very clear and very well explained. Could you expand on the specific
challenges faced by each of the three vulnerable groups identified in the
Roadmap for access to health care, more precisely the challenges faced by
children, youth and seniors?
Ms. Johnson: Especially for seniors. . .
Sorry, I switched to French.
With seniors, I think this is the best-understood area and probably the area
where we have had the most work with the issues that they face. It usually
begins with isolation, lack of knowledge of the services and no support network
to help seniors stay in their homes as long as possible. These are the primary
problems facing the seniors that we see in most of the communities. Of course,
there are some exceptions to that.
With respect to services for seniors, that is another area that needs to be
developed. Many regions have few services; not all regions but in many regions.
There are no day centres in English and very few home care services available in
English. Some of the key and core services that seniors need to stay independent
for as long as possible are not accessible to them, particularly in the regions
and in smaller populations where the health system is unable to respond to them
at this point. Sometimes they do not even know that the seniors exist. In many
communities, when we first started out with our networks, the public partners
did not even know that these senior populations were there; they were invisible.
For youth and the population under 5 years of age, it relates more to the
families' access to services and their economic and unemployment situation, I
believe. We have not done a significant amount of research on the issues facing
these communities. However, through the work that our networks have done in the
regions across the province, they focus on programs after school to encourage
not dropping out of school, food programs in the morning before school and the
like, especially in some of the regions that have high levels of low-income
families. For example, Côte- Nord and the Gaspésie are areas where these types
of programs have been a priority for the community; they have not necessarily
been studied but have been identified as important issues by the communities.
We have not done any research on these two groups and their access to
services particularly, but I believe they have the same problem with access to
health and social services that an adult would have.
Senator Fortin-Duplessis: So, you are not able to give us solutions to
improve access to health care for these two groups. What solutions do you see
for these two groups? Since you are telling me that no research has been done,
it is a little bit difficult. Despite that, in your personal opinion, how can we
make improvements for these groups — not necessarily for seniors, but for youth?
Ms. Johnson: We rely very much on community-based analysis of needs. A
community in the Gaspé will do an inventory or a survey of their population and
identify the priorities and needs for their community specifically. That is
basically what we rely on to create solutions. It is a good way to ensure that
it is a priority the community has identified and for which it is interested in
working with solutions.
The solution varies from community to community. For example, you spoke
yesterday to Kimberly Buffett from the Lower North Shore. They have a fantastic
example of how they responded to youth issues in the North Shore area, where
they have created an after-school program, a community breakfast program and
student-based planning groups. They have developed an entire approach on how to
respond to the needs, particularly the health needs, of the younger population
in that community.
As an organization, CHSSN is not looking at a solution province wide; we are
encouraging, at a local level, responses to those types of issues.
The Chair: I would like to add to Senator Fortin-Duplessis' questions.
What about the young families? What about prevention, as an example, a good
diet, what they should do to be healthy? Does the English-speaking community
receive services in their own language? Do you have seminars or brochures? Is
there anything in their language to help them to do the right thing?
Ms. Johnson: Certainly it depends on what community you are in. If you
are in a community in Montreal, it is probably easier to access those resources.
If you are in a community off the Island of Montreal, it is much more difficult
to access those resources.
With the McGill University project, we had a small envelope that was devoted
to using video conferencing to provide health promotion activities to the
communities across the province. For example, we will have someone in Montreal
speaking on bullying prevention who will link up with five communities across
the province and have an interactive discussion and presentation on that
subject. We do this not just for youth obviously but for people suffering from
cancer or lung disease, et cetera, all the health promotion activities that you
could possibly imagine. It is always the communities that decide the subject
matter. The communities put forward their needs, and we find the resources,
usually in the Montreal area, to provide the presentation. That is one of the
ways we have been addressing this issue of access to health promotion activities
across the province.
On a local basis, the communities also do the same and try to get their local
health provider to become involved in health promotion activities. If they have
decided that diabetes is a topic that they want to spend a day on, they will get
the local health and social services centre, CSSS, to provide the health
professional. If that person is not bilingual, they will bring in someone from
the outside who speaks English. However, they want the CSSS person there so that
there is a follow-up and an understanding locally that the English-speaking
population has a need to receive services on this topic from their public
partner. We are always encouraging the public system to be involved in most of
the activities that we do on health promotion.
The Chair: There is really no link, or not much, between your regional
networks, because you do get monies, if I understand correctly, for linking.
Ms. Johnson: Yes, and they do link.
The Chair: There is some linkage?
Ms. Johnson: Yes.
The Chair: Do they share some information and services in English?
Ms. Johnson: Yes. For example, the video conferencing piece I just
spoke of, they share services and participate together. They have had a joint
diabetes project. I think there were five or six projects involved at the same
time on one project. They do communicate. We physically meet twice a year, all
of the networks together, and share best practices on what is working in each of
the communities so that they can learn from one another.
Senator De Bané: In this brochure, the page about unemployment rate,
since it is in black and white, with no colours, we cannot differentiate. Would
you be so kind as to do something about it, maybe make one of them dotted so
that we can understand? I have no idea which one is which.
Ms. Johnson: I will ensure that you receive an electronic copy that
has the colours.
Senator De Bané: Yes, or to use another background.
Canadian Heritage has transferred essentially $175 million to Health Canada
so that Health Canada can help the official language minorities with health
services. You said that McGill University received $19 million out of it. What
did your network receive?
Ms. Johnson: We received $19.5 million.
Senator De Bané: Is that jointly with McGill University?
Ms. Johnson: That is in addition to the amount received by McGill
University. It is a separate contribution.
Senator De Bané: McGill University received $19 million, and your
network received $19.5 million, is that correct?
Ms. Johnson: Yes.
Senator De Bané: In your brief, you say that this is where you would
appreciate the assistance of our committee in supporting the new priorities for
federal investment. Can the federal government, with the type of
federal-provincial relations we have, move in that field without the blessing or
the concurrence of the provincial authorities, or is it the conclusion of
agreements between the two levels of government?
We were dealing this morning with education, and essentially what I
understood is that the provincial government negotiates with Ottawa through the
Ottawa-Quebec agreement for education. However, the different education networks
in Quebec have no authority to deal directly with Ottawa. In health, is it
Ms. Johnson: Yes. The way it is structured is that Health Canada has
signed a contribution agreement with CHSSN for the $19.5 million. In order for
us to invest in any public organization, we created an implementation agreement
with the ministry. We worked for about a year, negotiating an implementation
agreement with the health ministry of Quebec. This implementation agreement
identifies how, when and where we can invest those monies into the public health
system. We have to have the blessing from this and the provincial advisory
committee to the minister. They have to review the projects. The minister then
gives the okay. We have to also get decrees from the ministry to invest the
money into the agency. It has to pass through cabinet. There is a
well-established process right now that allows us to make those investments into
the public system.
The ministry has nothing to say really about the monies that go to the
community organizations at this point. With the monies that we are investing in
the communities at this point for the networks, the province is not involved in
at all. Any time monies go to a public organization, that is when we have to
have these important agreements, and we have the implementation agreement with
the ministry to manage those relationships.
Senator De Bané: You have told us that, in your best estimation, the
English-speaking community in the province of Quebec is about 1 million people.
The budget of the health department of Quebec of course is a great chunk of
their budget, billions and billions. Besides working to help that network around
the province, how do you ensure that, for this population of 1 million people in
Quebec, their health and social services are taken care of by the huge budget of
the education department?
This morning, for instance, we have learned that the directorate in the
department of education in Quebec that deals with the English-speaking students
is sent a team of roughly 30 people for a department that I assume is over 1,000
people. Those 30 people become a conduit to shuffle papers to other directorates
in the department.
What about the English-speaking community's health needs? Is the department
set up in such a way that the needs of the community are really being taken care
of, or is it similar to the situation of the francophones where the system is
not taking care of all their needs? Is it fairly distributed at least?
Ms. Johnson: Legally, the English-speaking community in Quebec has the
right to receive services in English. They have set up access plans for each of
the 18 territories in Quebec, for how that region will respond to the demand for
service in English in that territory. The Montérégie has a plan, l'Estrie has a
plan, Quebec has a plan; each region has an access plan. How well that access
plan is implemented is another story. Some territories do a very good job, some
territories jump through the hoops to develop the plan, and then it sort of
slips under the table after that.
The obligations that are fulfilled with respect to improving access to
services are a mixed bag. The work we are doing at the grassroots level is
greatly helping those people at the government level to understand the
importance of fulfilling those responsibilities in the access plans. For once
the communities are self-identifying; they are saying, "We are here. We have an
important seniors population that has no access to services in English in this
territory for day centres, home care services, et cetera."
There is still a great deal of work to be done, but the structure is a good
step. The structure is there; it is just a matter of being vigilant in ensuring
that each of the agencies — we have these regional coordinating bodies in the
province called les agences — are making it a priority to live up to the plans
developed for the territories.
Senator De Bané: Excuse my ignorance, but those regional bodies that
exist in the different regions, are they the prime movers of issues related to
health, or is it the department in Quebec City?
Ms. Johnson: No, I would say that it is the agencies that develop all
the plans, give mandates, provide funding, et cetera. Of course that is all in
discussion, so we do not know the future of the agencies right now. They are the
deciding bodies locally.
Senator De Bané: Finally, your second request to our committee is to
ensure that community-designated organizations are exclusive beneficiaries of a
new federal contribution program for health, the one that Canadian Heritage has
transferred to Health Canada to take care of. As far as the exclusive
beneficiary, you just said that it is okay to give to McGill University also.
Ms. Johnson: They are a community.
Senator De Bané: They are a community?
Ms. Johnson: We consider them a community.
Senator Dawson: You said that legally anglophone Quebecers are
entitled to health services in English. Where is that written, and what is the
Ms. Johnson: Section 15 says something to this effect: Every
individual has the right to receive services in the language of their choice
depending upon the resources and the availability of services in that territory.
Therefore, they do have a little back door.
Senator Dawson: Is that in the health act?
Ms. Johnson: Yes, it is section 15 of the Quebec health and social
Senator Fraser: I will betray my abysmal ignorance here. I looked at
your very pretty map, Quebec's English- speaking community health networks, and
I naturally looked first at the region where I live, which is Central Montreal.
I expected to see there McGill University Health Centre and the Ville Marie
health centre. What I find is the African Canadian Development and Prevention
Network, ACDPN, which I believe I know something about and believe it is a very
good institution. However, what about all the others?
Is this organization the point organization that then sets it out? How does
this work? Tell me more about your organization and what you are.
Ms. Johnson: Montreal is a relatively new territory for us. We created
three of the four networks that are in Montreal in the last fiscal year. The
exception is the original network in the north end of Montreal, which is
sponsored by the Canadian-Italian Community Services of Quebec Inc.; the others
are relatively new.
The one that is sponsored by the Catholic Community Services, CCS, covers the
territory of Dorval-Lachine- LaSalle. The ACDPN covers five different
territories and is specifically oriented to the Black community of those
regions. It is the first time that we have ever had a network that was
culturally specific. However, it is a community that has significant need and
very important health and social services issues. They fortunately have an
organization — ACDPN — that is able to start a network. One of the priorities
was that there must be an organization that can receive this network and manage
Senator Fraser: Forgive me, a network of what?
Ms. Johnson: I am referring to a health and social services network.
The principle of the health and social services network locally is to create a
network of organizations locally that are focused on developing better access to
English- language health and social services. They bring together public
partners, private volunteer organizations, schools, the police department,
whatever organizations will have an impact on the issues the communities are
facing. They build a network around that.
Senator Fraser: That helps. It is still, in some ways, uncharted
territory for Montreal. I presume also that, although gaps exist in the services
in Montreal, Montreal has more services than anywhere else.
Ms. Johnson: Montreal has much better access to services than in most
Senator Fraser: With access to English-language services, years ago we
used to have a Catch-22, which was that anglophones were entitled to receive
service in their language, but no individual could be required to provide
service in English. Is that still a problem?
Ms. Johnson: The right to work in French is still very present; it is
not going anywhere.
Senator Fraser: That, I assume, is partly responsible for that gap
that we find.
Ms. Johnson: Yes, that is definitely the case. I was having a
discussion this week with the person responsible at the provincial advisory
committee to the health minister about this, about designated positions and the
barriers to creating these designated positions. It is all about the labour
laws, the right to work in French, and the union's ability to basically contest
any organization that wants to develop bilingual positions in their institution.
An employer really has to go to bat and have excellent evidence to negotiate
the bilingual positions in their institutions — unless they are designated, and
that is a different story.
Senator Fraser: However, getting a designation established is not
Ms. Johnson: That is a different story.
Senator Fraser: You can tell I have been focused on other issues for
some time. It is not that I have not been interested; I just have not been
immersed for a while. It used to be a problem that, for example, in the east end
of Montreal you might have a psychologist at a CLSC who was anglophone or who
spoke English and could provide service in English. However, if that person
retired, you were out of luck. There was no inherited assumption that that would
be a designated position. Is that still a problem?
Ms. Johnson: Certainly. It is tied to the other idea that we just
Senator Fraser: I could go on for hours, but, out of deference to
colleagues, this will be my last question.
Yesterday, we heard from education people about the difficulty in remote
areas that do not have a huge anglophone population. For example, to access a
school psychologist, they only have the resources and mandate for 20 per cent of
an anglophone school psychologist. Who will go to work in Chibougamau for 20 per
cent of a full-time job? Are there any special programs, funds, anything, to
compensate for that problem in the health sector?
Ms. Johnson: Are you talking specifically about schools?
Senator Fraser: No.
Ms. Johnson: With any professionals, whether ocular, dental or
whatever, to the best of my knowledge, no special funding is available to make
those services accessible as English-language services.
Rather, if you had a patient in the Gaspé who needed a specific specialty
service and who wanted to receive the service in English, the patient would be
referred to Rimouski or Quebec or Montreal, where a specialist would be
Senator Fraser: Who pays to get that patient from Gaspé to Rimouski or
Quebec City or Montreal?
Ms. Johnson: There is a stipend that is paid for transport; however, I
believe it does not cover all the expenses that the individual usually incurs.
Senator Seidman: I will continue where Senator Fraser left off. I find
this fascinating. I have worked in the health and social service sector for many
years and am unfamiliar with your organization. I would like to ask you some
questions about structural things, if I might, and continue.
Where do you fit within the structure of the health and social service
network? From whom do you receive your mandate?
Ms. Johnson: We do not receive a mandate from the provincial structure
at all. We are a community-based organization. The province actually considers
us a federal organization.
Senator Seidman: Are you a non-governmental organization, NGO, or a
Ms. Johnson: We are a not-for-profit, community-based organization.
Senator Seidman: You created your slot; you saw a need and filled it,
is that correct?
Ms. Johnson: That is right.
Senator Seidman: Now I understand. Are you an officially designated
partner in the system? Has anyone given you any type of official status?
Ms. Johnson: Yes. We have, as I mentioned earlier, an implementation
agreement with the ministry. They recognize us as the recipient, the beneficiary
of the funding from Health Canada. We sit on tripartite committees with the
ministry and the INSPQ — Institut national de santé publique du Québec — to work
on what we will do with monies that we invest in the INSPQ.
Senator Seidman: That relates solely to that $19.5 million that you
Ms. Johnson: That is correct.
Senator Seidman: You are not the officially designated agency to
deliver or ensure delivery of services to the anglophone community in Quebec.
Ms. Johnson: No.
Senator Seidman: I want to be clear on this. It is not an official
designation; there could be other organizations doing it. You do it in relation
to this $19.5 million.
Ms. Johnson: Yes.
Senator Seidman: Do you have a relationship with McGill University?
Ms. Johnson: Yes, we do. We are the designated community partner on
the McGill University project. We sit on their advisory committee and also
receive funding in that project for the video conferencing project that we have.
Senator Seidman: Do you receive funding from their $19 million?
Ms. Johnson: Yes. Out of their $19 million, last year we received a
budget of $85,000 for the video conferencing project across the province.
Senator Seidman: Are you linked with the CLSCs at all?
Ms. Johnson: CHSSN is not linked with CLSCs, no.
Senator Seidman: Typically, the CLSCs have coordinated networks.
Ms. Johnson: On a local basis, each of our networks would be connected
with their CLSCs.
I use the term "our" networks a little incorrectly. They are not
necessarily CHSSN satellites. They really are independent networks of which we
were involved in the creation. I wanted to clarify that.
Senator Seidman: These are already existing community resources that
you link together in a network and help people communicate with each other.
Ms. Johnson: Yes, that is correct.
Senator Seidman: I would like to know how you relate to the regional
health boards, hospitals, educational institutions, private institutions and
anglophone community organizations. Does a formal arrangement exist for sharing
and disseminating information?
Ms. Johnson: Each of those local networks has usually created a
network with the public partners. They usually have someone from the CLSC or
CSSS sitting on their network and someone from the school, locally, sitting on
their network — sometimes the school board but usually the school. They have
created their network with those institutions locally. CHSSN, the organization I
work for, does not have that relationship with CSSS or with local resources. We
work mostly with the ministry. Principally our role is to act as the bridge
between the community and the ministry.
Senator Seidman: I would like to look at the four packages that you
talked about more specifically. You receive $19.5 million, which is divided up.
Could you give us a few examples from each of those categories to give us a
better idea of the work you are doing?
Ms. Johnson: Yes. The document you have has more description as well,
when you have time to look at it.
Senator Seidman: I would like it on the record though.
Ms. Johnson: Yes. In relation to networking, I think you have a good
idea about what the funds are doing.
Senator Seidman: Yes, I do.
Ms. Johnson: I will leave that one then. With respect to adaptation,
some of the more typical activities of the agencies have varied enormously from
one region to another. One region may decide to translate its guide for all of
the cargivers in the CHSLD — Centre d'hébergement et des soins de longue durée.
In the Outaouais, they translated their guide for training people to be a
caregiver in the CHSLD so that they can use this material with their new
employees. That way they can create employees who provide better services in
Another region would actually be doing training of its personnel to provide
better services to the community and just making them more aware of the needs of
the community. They have training sessions devoted to that.
Another activity in a region could be translation of key documents, such as
consent forms, outpatient material at the hospital, et cetera, because, believe
it or not, every hospital seems to have their own consent form. It is not a
generic form of which everyone can get a copy. Therefore, they have decided to
translate these important documents at their hospital.
Each region identifies the priorities on which it wants to work and invests
those monies directly in that area. The regions are supposed to develop those
priorities in collaboration with their English-speaking community committees.
Many institutions have a committee that is supposed to help them identify their
priorities. The agencies use them to help them identify priorities.
With the community health promotion, this is to give the opportunity for the
community to become involved in health promotion activities and get the public
institution involved in those activities. This can be, for example, a diabetes
program in the Gaspé where they are addressing diet training courses for people
recently diagnosed with diabetes, and they do it in collaboration with their
These are very concrete health promotion activities on the ground. The beauty
of it is that we are giving the money to the community so that they have a very
active role in the health promotion activity instead of it just coming from the
public sector. However, it is a requirement that they are involved with the
public sector organization, so the CSSS or the CLSC.
Are you familiar with Santéscope? It is a section on the web of the INSPQ,
and it is the statistics for the health determinants for the population. Prior
to these investments, there was no information on anglophone or allophone
communities in the province of Quebec; it was just the province of Quebec versus
the rest of Canada or another variable.
We have now created, on the INSPQ website, with this funding, all the same
statistics but now broken down by language for anglophones and allophones and by
Montreal and off-Montreal statistics. Therefore, it is a really rich database
that is now available to all public institutions, et cetera. That is the type of
work they are doing.
Senator Seidman: That is great. I really appreciate that. Am I right
in saying that, from what I am hearing, basically you receive this $19.5 million
from the government, you have an arrangement with the provincial government and
then you almost transfer those monies to other organizations? You are a funding
agency, in a way.
Ms. Johnson: Yes, in a way.
Senator Seidman: You transfer those monies to groups who present good
proposals to you?
Ms. Johnson: Yes, that is correct.
The Chair: Does the money come from the roadmap?
Ms. Johnson: Yes, it does.
Senator Fraser: Could you please, for the record, explain what a CLSC
is and what a CSSS is?
Ms. Johnson: It is similar to a pyramid in the Quebec health system
structure. We have the 18 territories I spoke of earlier. Each territory has one
agency, a regional organization board. Within each territory, you have smaller
territories called centres de santé et de services sociaux — the health and
social services centres — CSSS. The CSSS is usually a compilation of the local
hospital, the local long-term care facility and the local CLSC, which is the
centre local de services communautaires, or local community service centres. The
CSSS is the compilation of those three organizations in that territory.
Senator Fraser: Thank you very much.
For people who read these proceedings, I thought it might be helpful.
Senator Champagne: I have a very quick question because most of my
questions have been asked by Senators De Bané and Fraser.
We were talking about communication with the English-speaking community. You
did mention at one point that, for example, people had an opportunity to hear
about the H1N1 problem and so on.
Is the vaccination program something that you promote, make people aware of,
for children of course and then for travellers? Is that something that you would
promote to ensure that people are aware that those vaccines do exist, where they
can get them and how much they cost, et cetera?
Ms. Johnson: It is the public system's responsibility to do that
public awareness campaign. Our responsibility is to ensure that they take into
consideration the English-speaking community and, on a local level, that the
information is disseminated to those communities. Sometimes we use our community
organizations to disseminate that information; sometimes it is through the
school network and sometimes through the regional associations that are involved
with our networks. They participate in those important health campaign
promotions such as the H1N1.
From past experience, so far, we — when I say "we" I am talking about the
community networks — have not been overly involved in those campaigns. Perhaps
it is something that they may identify as a priority in the future, but to date
they have not focused on that as being one of their priorities.
Senator Champagne: You say that we can help by being supportive of the
new priorities for federal investment. Who will name those priorities? Are you
being consulted? Will you be part of the determination of the priorities for the
Ms. Johnson: Yes, we are, thank goodness.
Actually we are starting a process right now with Health Canada. We are
setting up, in collaboration with the Quebec Community Groups Network, QCGN, a
consultation process with a third-party consultant who will be doing the
consultation to set the new priorities for the next roadmap or whatever it is.
Of course, CHSSN is developing our own messaging for what we think are the
priorities for the next five years, the five-year programming.
Senator Champagne: I will end by suggesting that, once you have
established your list of priorities, you inform this committee of what you are
doing. We can always ask questions to our minister responsible for official
languages and to our health minister to ensure that you are not forgotten.
You are not being ignored.
Senator Seidman: I will continue because this is very exciting
actually. I am really pleased to meet you and hear about this.
I know you say that you are in the process of developing priorities, but I
would like to ask you what you think are the two greatest challenges from your
perspective when you look at the health and social service network as it exists
now in Quebec for anglophones. What would you say?
Ms. Johnson: Maintaining the investments has been, I think, one of our
biggest challenges. When something is invested, we try to ensure it carries
forward into the next year and the next. Even if staff changes and the
institution has changes, the investments that have been made in that institution
must carry forward. That will require a more firm commitment to the access plans
and to the delivery of health and social services in each of the territories.
That is about working on making this system more aware of the community and
aware of their obligations to respond to those communities.
This is an important challenge that will continue into the future as well.
Also, I am not sure if this is the right type of challenge you are talking
about, but I see maintaining the balance in the relationships with the ministry
of health and the community and the federal government as an important
challenge. That is a very precious, very important relationship that we have,
and we need to ensure the longevity of that relationship. That is a very
important role that we, CHSSN, take very seriously.
With respect to the community level, we are not covering all the territories;
we are not covering every English- speaking community out there. We need to
address Saguenay, we need to address Mauricie and Central Quebec, and we need to
address Lanaudière. We still have many territories in which we are not really
well established or connected. We have to ensure that we connect with those
communities as well.
Last but not least, I will address the short-term nature of it. Even though
five years seems as though it is a long time, the reality is that we did not
receive the money until the end of the second year, and now we are looking at
three years of operations. The fact that in five years all the funding could
disappear is always something that concerns us, and we would like to ensure that
this type of funding becomes long term and also is a priority for the federal
The Chair: Once you have the funding and once you connect, as you say,
with those English-speaking communities, what do they have that they did not
have before you were in place and you had the funding? What do they receive? Is
it a service? Do you have an example?
Ms. Johnson: They are, first, visible to the public system, whereas
prior to that, most of these communities were invisible. Second, they have
actually created services locally to respond to their community, such as day
centres and home care for seniors, school programming, et cetera, that did not
exist before. They have also created a sense of community. More than a sense of
community, it is a sense of empowerment of their ability to influence and have
an impact on their own community and the life and vitality of their community. I
think these networks have created that.
The Chair: Thank you on behalf of all the members of the committee,
Thank you very much for taking the time to answer all of our questions and
for your presentation.
Honourable senators, we have to be on the bus at 2:45 p.m.; we are going to
Jeffery Hale Hospital.