Proceedings of the Standing Senate Committee on
Official Languages

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 Quebec).

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 you.

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 Director.

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 sources.

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 burnout.

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 Montreal.

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 Sherbrooke.

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 important indicators.

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 envelope.

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 project.

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 access.

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 services.

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 community.

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 called.

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 networks.

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 question.


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 different?

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 law?

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 services act.

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 it.

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 communities, yes.

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 necessarily easy.

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 discussed.

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 indentified.

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 not-for-profit?

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 receive.

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 English.

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 CSSS partner.

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 federal investment?

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 government.

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, Ms. Johnson.


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.

(The committee adjourned.)