Proceedings of the Standing Senate Committee on
Official Languages
Issue No. 11 - Evidence - Meeting of April 10, 2017
OTTAWA, Monday, April 10, 2017
The Standing Senate Committee on Official Languages met this day at 5:02 p.m. to study the application of the Official Languages Act and of the regulations and directives made under it, within those institutions subject to the Act; and, in camera, for the consideration of a draft agenda (future business).
[English]
Kevin Pittman, Clerk of the Committee: Honourable senators, there is a quorum. As clerk of your committee, it is my duty to inform you of the unavoidable absence of the chair and deputy chair, and it is my duty to preside over the election of an acting chair.
[Translation]
I am ready to receive a motion to that effect.
Senator Gagné: I move that Senator McIntyre be elected as acting chair.
[English]
Mr. Pittman: Are there any other nominations? If not, I declare the motion carried.
[Translation]
I invite the Honourable Senator McIntyre to take the chair.
Senator Paul E. McIntyre (Acting Chair) in the chair.
The Acting Chair: Thank you, Mr. Pittman.
Good evening. My name is Senator Paul McIntyre from New Brunswick. I am pleased to chair this evening's meeting. Before we give our witnesses the floor, I would like to ask the members of the committee to introduce themselves, starting on my right.
Senator Bovey: I am Patricia Bovey from Manitoba.
Senator Gagné: I am Raymonde Gagné from Manitoba.
Senator Moncion: Lucie Moncion from Ontario.
Senator Fraser: Joan Fraser from Quebec.
Senator Cormier: René Cormier from New Brunswick.
Senator Maltais: Ghislain Maltais from Quebec.
The Acting Chair: The committee is continuing its study on the application of the Official Languages Act and of the regulations and directives made under it, within those institutions subject to the act. We are pleased to welcome, from New Brunswick, the group Égalité Santé en Français, represented by Dr. Hubert Dupuis, President, Dr. William Laplante, Treasurer, and Jacques Verge, Secretary. We will hear from Mr. Verge by videoconference. On behalf of the members of the committee, I thank you for joining us. You have an opening statement, I believe, Doctor Dupuis.
Dr. Hubert Dupuis, President, Égalité Santé en Français: Honourable Senators, my name is Hubert Dupuis. I am the President and principal spokesman for Égalité Santé en Français. I am accompanied by two members of the administration of Égalité Santé en Français, Dr. William Laplante and, by videoconference, Jacques Verge. On behalf of Égalité Santé en Français, I would like to thank the Honourable Senator Paul McIntyre for his assistance and for his work that made possible our appearance before your committee.
Our organization, Égalité Santé en Français, is honoured by your invitation to give a presentation to the Standing Senate Committee on Official Languages about the healthcare situation in New Brunswick's francophone community. We will briefly present the current situation in our province and our organization's demands with respect to governance and management, and clinical and non-clinical care within the Vitalité Health Network, which is the health network of the francophone minority community in Canada's only officially bilingual province.
I will introduce our organization, which was provincially incorporated as a non-profit organization in 2008. Our mission is to ensure that the healthcare rights of the francophone and Acadian community are respected and that our community, through our Vitalité Health Network, can access the same range of healthcare services available from the anglophone network, Horizon Health Network, the network for the majority. First, I must point out that New Brunswick patients can choose to receive care in their preferred official language, from either the Vitalité Health Network or the Horizon Health Network. In the same breath, I have to add that it is easier for an anglophone to receive care in English from the Vitalité Health Network than it is for a francophone to receive care in French from the Horizon Health Network.
That said, our organization was created in response to a government bill establishing two regional healthcare networks in 2008: an English one and a bilingual one. What a surprise, since the Acadian and francophone community previously had a francophone health network! Our organization was incorporated, and thanks to public generosity and funding from the Language Rights Support Program, we launched a court challenge against the province to uphold the francophone and Acadian community's constitutional rights to healthcare.
New Brunswick is the only province to have enshrined recognition of the equality of the two linguistic communities in the Constitution, section 16.1. It was inconceivable for us to be satisfied with a bilingual network when our province had constitutionally recognized the equality of both linguistic communities and our right to separate institutions, and it had the obligation to protect and promote our status, rights and privileges.
After two years of legal action, the government offered to negotiate in order to avoid having to go to court, even though we were prepared to argue before a judge. We reached an out-of-court settlement in 2010. Like any compromise, we did not get everything we wanted, but it was a first step. The government gave back a francophone system and promised a remedial plan. This plan was a way to allow our network to develop healthcare services that it did not have but that were available in the other network.
We all knew that the additional funding would not allow us to achieve substantive equality of healthcare services between both healthcare networks: the anglophone network still provided much better service, often double or triple. Since the out-of-court settlement, various successive governments have, through legislative, bureaucratic and financial means, reduced our francophone health network to make it subordinate to the Department of Health and the anglophone network. The Minister of Health appoints the chair of the board of directors. The healthcare network executive is also appointed by, and serves at the discretion of, the minister. The Minister of Health established joint committees under an accountability agreement between the department and the healthcare networks. Recently, the minister confirmed his intention to privatize hospital services.
Once again, we are seeing our rights as a minority language community not being respected by the Department of Health. However, in 1993, our province entrenched our community's right to separate institutions, a right that includes management and governance in a manner similar to what the Supreme Court recognized for education.
It is currently impossible for our linguistic minority community to develop and expand healthcare since we do not manage or govern our own healthcare institutions. We are constantly in survival mode. How can we progress when we have trouble keeping what we thought was already ours? A community cannot develop, make progress or grow if it does not control the levers of decision-making. Having institutions without having control over them is not recognition of our right to institutions!
Ontario's francophone community just recently celebrated the 20th anniversary of its fight for the Montfort Hospital. One of the greatest outcomes of this fight was that the hospital is an essential cultural institution for the minority community's development. We firmly agree with this outcome, which is why we have been fighting since 2008 for self-governance and the development of our francophone healthcare network.
Too many members of our community are forced to seek care in the other community's institutions because the healthcare services they require are not available in the francophone system.
Our francophone healthcare system is currently in critical condition. When one of the key institutions of a linguistic community is in jeopardy, the community itself is in danger. The vitality and development of our francophone and Acadian community has hit a wall. The message from the New Brunswick government is that French is not important and that we should assimilate into the majority community.
We are losing governance of our healthcare institutions. Management of our healthcare institutions is under the control of the Minister of Health. The Government of New Brunswick is privatizing our hospital services. We are refusing to back down before this interference. We are demanding our constitutional rights to substantive healthcare equality.
We believe that the federal government has a significant responsibility to protect the constitutional rights of linguistic minority communities. The federal government has significant leverage to enforce the rights of linguistic minority communities through healthcare funding agreements.
We thank you for this opportunity you have given us to inform you and to bring to your attention the healthcare situation of our Acadian and francophone community. We have submitted a brief and documentation that we have already published since 2010. Honourable senators, we will be pleased to answer your questions.
Senator Gagné: Thank you very much for your presentation, Dr. Dupuis. It always really fascinates me to see how different minority communities are able to structure themselves in order to make sure they develop.
I would like to understand the state of your governance better. According to your brief, the Minister of Health appoints the president of the francophone network and the president of the anglophone network. But who appoints the board members? Is it the minister?
Dr. Dupuis: Under the terms of the agreement of April 8, 2010, the understanding was that, of the 15 board members, eight would be elected and seven would be appointed by the minister. So, as well as appointing seven members, the minister also appoints the chair of the board of directors.
Senator Gagné: Okay. In your structure, you have some joint committees. Are those joint committees involved in governance? Are they committees that manage services?
Dr. Dupuis: They are both governance and management committees. They are involved in the responsibilities of the health networks in terms of patient care and in terms of the networks' accountability for funding and costs.
The government wanted an accountability framework for both health networks. It wanted both health networks to sign the same accountability framework. As the Horizon Health Network is bigger, more substantial, and English- dominated, it has established another structure called FacilicorpNB. There is also Service New Brunswick, which is also an English-dominated institution. The services it provides are described as non-clinical, but they are still hospital services that every clinician needs in order to practice. Service New Brunswick is an institution in which the health networks have little or no say. Of the 15 or so members, one represents each health network.
What is happening is that there are more and more English-dominated structures and the francophone and Acadian health network is in a vulnerable and precarious situation. The fact is that the Department of Health, Horizon and Service New Brunswick agree on how everything should be organized and Vitalité, which is only one voice, has to follow. The other bodies win by majority, if you will.
Senator Gagné: You are drowned out.
Dr. Dupuis: On paper, we seem to have the governance, but basically, we have none at all.
Senator Gagné: You have none at all. In your opinion, which governance structure would make sure that New Brunswick's Acadian and francophone community would develop in terms of healthcare?
Dr. Dupuis: You have to read our brief. Everything is explained there. We suggest that 15 members of Vitalité's board of directors be elected, all 15, that is. The chair of the board should be elected from the elected members of the board and the CEO, the director general, should be elected by the board of directors. That would be a structure that you could call "normal", a structure that would work.
At the moment, the election of the members of the board of directors is clearly a problem. For both networks, Horizon and Vitalité, members are elected on the basis of geography, not language. That is a mistake, in my opinion. As we speak, there are New Brunswick francophones, from Fredericton, Saint John and Miramichi, who cannot vote for the Vitalité health network even though they are francophone. They have to vote for the Horizon health network, which is anglophone. They have no possibility of choosing where to vote.
In education, for example, New Brunswick has two electoral maps for the province as a whole, one francophone and one anglophone. So francophones can choose the councillor who will represent them on the district councils. However, in health care, that system does not exist. What we are advocating is that there be two electoral maps for electing members, one anglophone and one francophone.
The Acting Chair: Shall we move to a second round of questions?
Senator Gagné: Yes, absolutely.
The Acting Chair: I would invite you to ask quick questions and provide short answers, because I have quite a list of senators who want to ask questions.
Senator Cormier: Thank you for your presentation. Since I am from New Brunswick, I am going to take this opportunity to thank you for your commitment, Dr. Dupuis, which is clear in New Brunswick. You are recognized as a staunch defender of health matters, but you are also a defender of L'Acadie, in all its complexity and diversity.
Though I am from New Brunswick, I am not fully on top of the health care issues in the province. But I read your documents with interest. I gather that there are a lot of issues at provincial level, such as in the relationship your organization has with the New Brunswick government. Your presentation listed some of the issues there.
I would like some more information about this famous remedial plan, which, I believe, is about to expire. Has the remedial plan really allowed you to establish a better balance between the two language communities so that you can have the ways and means to develop the Vitalité network?
Dr. Dupuis: The short answer is yes, and we certainly have won some services, especially in the area of secondary specializations.
Senator Cormier: Could you give me an example of that?
Dr. Dupuis: In neurology, and in the sleep laboratory, services have been added to the francophone side. That was done well. The problem is that it is still a five-year plan that will come to an end on March 31, 2018. So we are now into its final year. There is not going to be real equality, especially in specialized tertiary care.
With neurosurgery at the moment, for example, Horizon has two centres, but Vitalité has none. The current remedial plan will not close that gap. New Brunswick has two tertiary trauma centres, both with Horizon. Vitalité has none and the remedial plan will not correct that situation. On the anglophone side, there are three neonatal units; the francophone side has none. Horizon has a child psychology unit. In Campbellton, at the moment, a centre of excellence in child psychiatry is being established and the remedial plan did allow services to be provided for young people in our francophone community with mental health problems. I do not know whether it will be finished by the end of 2018, but I think that the chances are good. However, as a general rule, we will not catch up, but it is possible on the anglophone side.
Not so long ago, there was a debate about gene sequencing in New Brunswick. We had a DNA sequencer at the university hospital that could probably meet the needs of the entire Atlantic region in terms of gene sequencing. Horizon had no real need for one, but they asked for one anyway and, with few complications, the Premier and the Minister of Health gave them a DNA sequencer. We generally have to wait from five to 10 years, and it is difficult for us to get equipment, experts and expertise.
Senator Cormier: Would you say that part of the problem is to be found in the urban and rural divide? For example, is some tertiary care not available to francophones in New Brunswick because of the fact that a good part of L'Acadie is rural? There is the concentration around Moncton, of course. Is that a factor in your having no access to the care you describe?
Dr. Dupuis: Not in my opinion. That is not a good reason, although it is true that the francophone population is smaller than the anglophone population. With tertiary services, you need a certain volume to be able to do your job and be effective, efficient, and so on. The population is big enough for the services that we list in our brief, for us to have at least one of those services. The likelihood is that this is the Tower of Pisa syndrome, always leaning to the same side, and, unfortunately, it is not to the francophone side. It is much easier in communities where English dominates — with the sequencer, it just happened and everyone was happy — but on the francophone side, unfortunately, things are much slower and tougher.
When it is on the francophone side, they call it a cost, but when it is on the majority side, they call it an investment. That is often how it is. For 35 years, I have been hearing that there is not enough health care money for francophone communities. They tell us that repeatedly. We manage our institutions well, because Vitalité institutions run a surplus, not a deficit, and so there is no reason to deprive us of services. We could reinvest in Vitalité hospitals.
Senator Cormier: Thank you, Dr. Dupuis. I will have another question for you later.
Senator Fraser: Thank you for being here. I am an anglophone from Quebec and so I am 100 per cent familiar with the situation you describe. You have my complete sympathy.
When you talk about privatizing hospital services, do the plans or contracts for privatization contain anything at all to guarantee that services in French will be maintained?
Dr. Dupuis: That is a very good question. We have not seen the contracts. No one has shown them to us. The language of service is important, but there is also the whole idea of homogeneous linguistic and cultural institutions. Not only that; if you start separating out the management of food services in our hospitals, if you separate out the management of the hospital environment, such as housekeeping, landscaping and the hospital exteriors, if you separate patient transport within the hospital, you are destroying our healthcare institutions piece by piece. If your healthcare institution is in a dominant situation, that does not bother you, because things will be transferred to an anglophone institution; everything will go well and will continue to work well.
The problem is that health care services in the francophone system are being dismantled piece by piece. The impact is much greater on the francophone side than on the anglophone side. In addition, the reason why they want to privatize is that there is currently a problem with the kitchens and cafeterias in Horizon's anglophone health care institutions, but not in Vitalité's. Vitalité even makes a profit from its food services. The solution that the minister, the department, is imposing on Vitalité is intended to solve Horizon's problem, a problem that Vitalité does not have. Do you understand?
Senator Fraser: Completely.
Dr. Dupuis: Vitalité has the figures to show that it could operate more economically and let fewer people go than the proposal from the private organization. Despite it all, the minister has decided to privatize anyway. It defies all logic.
Senator Fraser: Were the two networks established geographically?
Dr. Dupuis: Yes.
Senator Fraser: That is a problem, because there are really not a lot of francophones around places like Saint John.
Dr. Dupuis: I don't know whether 20,000 is "not a lot". Perhaps it is. It's open to debate. There are at least 16,000 francophones in Fredericton. Do those numbers warrant? Would the Supreme Court say that the numbers warrant or not?
Senator Fraser: I am not saying that you are wrong to want to change the system. I am trying to understand.
Dr. Dupuis: It is done geographically and they wanted to make some linguistic accommodations. You are right; one of the fundamental problems is with geography and not language, but it could be done on a language basis and it would work very well.
Senator Maltais: Dr. Dupuis, you may be aware that Maurice Duplessis, the former Premier of Quebec, used your Leaning Tower of Pisa metaphor when talking about judgments of the Supreme Court: they always leaned one way, and it was never Quebec's way. He got a lot of mileage out of that.
I listened carefully to your brief and to my colleagues' questions. One thing intrigues me. Officially, New Brunswick is a bilingual province.
Dr. Dupuis: Yes.
Senator Maltais: The Constitution was even amended to say so.
Dr. Dupuis: It was enshrined.
Senator Maltais: So you have rights. What intrigues me the most is that your rights never seem to have been recognized. In education, with school buses, the anglophones are in one bus and the francophones are in another. You would think we had gone back to the days of segregation in America, which is completely unacceptable in 2017.
Does anyone recognize your rights anywhere in New Brunswick?
Dr. Dupuis: It is more a political and bureaucratic problem. To an extent, the various political parties are afraid — possibly for historical reasons — of an extremist backlash from the majority if rights are given to the francophone minority. I believe that this is a huge concern for our politicians because, at the moment, in New Brunswick, we have the most francophone government in history in terms of ministers and the number of francophones. That is not where the problem lies. The problem is that politicians are worried about a backlash from the anglophone community. That explains the city of Saint John being given a DNA sequencer so quickly. It's clear that that is what was in play. I believe that that is the issue.
The other thing is that the bureaucracy does not consider minority language rights at all.
Senator Maltais: It is the opposite in British Columbia. There are not enough francophones in a sector to influence the vote, to get a member of Parliament elected, for example, because they are scattered all over the place and have no political strength. It is the opposite for you. In the north of New Brunswick, you have a good deal of political strength. I don't think you voted for public servants. You voted for elected officials and it is up to them to ensure recognition for your rights. If that costs them their seats, so be it. In 2017, it is unacceptable that they do not protect you. You are protected by the Constitution and the Canadian Charter of Rights and Freedoms and you are not being treated on an equal footing with anglophones. That is unacceptable. You have to make that known. Federally, in the Atlantic region, the Liberal Party has 30 members of Parliament out of 30. Provincially, I do not know how many there are, but they have a majority.
Dr. Dupuis: They have a majority.
Senator Maltais: At some point, voting has to serve a purpose. I do not know how you can influence people like that. Forcing them back into a corner would not do them any harm.
Dr. Dupuis: You are right. Then we could invite you to work for Égalité Santé en Français if you want. We are certainly going to back them into a corner. We are going to wage a public media campaign and we are going to go to court to settle this once and for all.
Last time, we settled with the Government of New Brunswick out of court, on April 8, 2010. Looking back on it, I feel that the out-of-court settlement quietly faded away and I believe that it might have been a mistake to have accepted the agreement, because we are going to have to take up arms again and demonstrate once and for all the problems with the governance, the management, the clinical services, and so on. It is not right for a government to impose its will on a community in this way. It is not an acceptable way to proceed with health care.
Senator Maltais: I admire your resolve.
Dr. Dupuis: Do you accept my offer?
Senator Maltais: Yes, I accept.
The Acting Chair: Dr. Laplante, before I invite Senator Moncion to ask her questions, would you like to add anything to Dr. Dupuis' answers?
Dr. William Laplante, Treasurer, Égalité Santé en Français: When Senator Maltais was asking for the reasons behind this illegal way of doing things that runs counter to our constitutional statutes, my answer would be that it is because, in society, when you break other laws, a police force is going to act. You can imagine that it is not easy for a group like ours to fight to have the law applied. It means a lot of work, a lot of money, and people know it. That is why they can drag the matter out for as long as possible.
The Acting Chair: Mr. Verge, welcome to you. You are the secretary of Égalité Santé en Français. Do you have any comments too?
Jacques Verge, Secretary, Égalité Santé en Français: No, it's fine. The president summed up everything I wrote.
The Acting Chair: Great. But if you want to comment, feel free.
Mr. Verge: No problem.
Senator Moncion: I found your presentation extremely interesting. Thank you for being here. Let me go back to the matter of governance because we know that the heavy lifting is done by the people who represent us. If your leadership team is not chosen by the board of directors but is appointed to represent your group and the Department of Health, generally, they are not people who are going to work in your interests. Inside your organization, that probably must cause a huge problem in terms of the board's trust in the leadership team. Am I wrong?
Dr. Dupuis: At the moment, the board is into a new mandate; the first year ends at the end of June. The previous board had basically abdicated its role as a watchdog, to keep an eye on the CEO, to challenge his decisions, and so on. I can tell you that the current board of directors is much more active and responsible. I think that most on the board understand the issues of a minority language community much better. They are ready to act. They have actually unanimously rejected — three times to date — the minister's decision to privatize. They rejected the idea of privatizing the hospital out-patient program, including home care, not just housekeeping services. The current board of directors is gutsy and I believe it is doing its job. I know there have been some quite firm discussions with the CEO so that he understands who is in charge of the ship and I believe that the message was received loud and clear.
Senator Moncion: But that still leads to discussions about the people appointed by the government. We have much the same system in Ontario, in hospitals. There's a language problem everywhere. Some francophone communities have francophone hospitals, so the boards are more francophone. But you have, I think, seven people appointed by the Lieutenant-Governor in Council or something similar, probably like in Ontario. Do those seven people come from recommendations that you make to the department, or are they people that the department really does impose on you?
Dr. Dupuis: The minister appoints them. He has to consider some criteria established in the legislation about interest groups, like First Nations. He has to appoint a First Nations member.
Senator Moncion: But they are all francophones.
Dr. Dupuis: Yes, they are all francophones. At Vitalité, they are all francophones; at Horizon, they are all anglophones. But it is not a matter of Vitalité's board of directors making recommendations to the minister, who then confirms them, or chooses them from a list. They really are his own choices. In addition to those seven people, he chooses the chair of the board of directors.
Senator Moncion: He chooses the chair and the CEO.
Dr. Dupuis: Yes.
Senator Moncion: So you are at a disadvantage right off the bat.
Dr. Dupuis: You are getting it.
Senator Moncion: Having done my share of governance, I get it. What shocks me even more is that you represent 31.5 per cent of the population, whereas we in Ontario are a tiny little group. There are a good number of us, but compared to a population of 13 million, one million francophones and francophiles in Ontario is not much in percentage terms. But I do not want to trivialize.
Dr. Dupuis: In absolute terms, there are more of you than of us at home.
Senator Moncion: True, but you still represent 31.5 per cent of the population, which is huge in a population like New Brunswick's.
The Acting Chair: Mr. Verge, did you want to comment?
Mr. Verge: No, it's fine. I feel that Senator Moncion has understood the board of directors' situation very well.
[English]
Senator Bovey: I'm going to apologize for speaking in English.
I'm interested in the governance question, too. You mentioned wanting to be treated as education. May I ask how the university boards are appointed and how the other education boards are elected in New Brunswick?
[Translation]
Dr. Dupuis: I will let Mr. Verge answer that.
Mr. Verge: For schools, school trustees are elected by the public, in both the francophone and anglophone systems. Representation is appointed by the minister, at the student level, on the recommendation of the various school boards, but all school trustees are elected by the people of New Brunswick.
[English]
Senator Bovey: And for the universities?
[Translation]
Mr. Verge: For universities, I think that some are appointed by the department, but the majority are people who have been recruited, who are from the faculties or federations of students, teachers, and so on.
[English]
Senator Bovey: One other quick question, if I may. I would be really interested to know how we can help. What is the role of the federal government in this, given that health is essentially a provincial responsibility? What can we do?
[Translation]
Dr. Dupuis: I think you can do a lot of things. I believe that the federal government doesn't usually promote minority communities, and it should be more engaged. It could happen with agreements in health. Recently, there have been agreements on health funding with the provinces. Special envelopes for mental health and home care were wanted, and that's fine, that's a good idea. But it could also have been decided to grant special envelopes for minority communities. Unfortunately, I don't think that New Brunswick has applied for it. I'm not sure that other provincial governments have, but I think that it would be quite appropriate to do so and that the federal government should intervene in that respect. The federal government could use specific agreements, either with New Brunswick or Ontario, or with Quebec for the English-speaking community, to enter into agreements in which it would fund part of the percentages to reach true equality of the health institutions in our communities.
I think the fact that you're talking about it tonight is important. I think the federal Minister of Health should also be approached. I am speaking for Egalité Santé en Français, and I think we will certainly try to reach her, as well as the Minister of Justice. I think there are things that can be looked at from the perspective of the current legislation. We maintain that under Part VII of the Official Languages Act, at the federal level, the protection and promotion of minority language communities must be ensured. I think you have a typical case here.
The Deputy Chair: I would like to make a comment before we go to the second round of questions. Dr. Dupuis, in stating your concerns, you make 29 recommendations that deal mainly with governance, health institutions in New Brunswick, clinical and non-clinical health services, and the university network. That being said, I would like to draw your attention to recommendations 24, 25 and 26. In recommendation 24, you are inviting the Province of New Brunswick, the Université de Moncton and the Vitalité Health Network to create a development plan to establish a genuine academic health centre, as well as a network of university-affiliated hospitals for clinical care, research and teaching of health care.
Could you briefly clarify these recommendations?
Dr. Dupuis: At present, there was a designation in New Brunswick; it is one of the things we gained in April 2010, namely that the Minister of Health had the right to designate university hospitals.
Dr. Georges-L.-Dumont University Hospital Centre and affiliated university hospital centres have been designated in Edmundston, Campbellton and Bathurst, but the problem is that this designation did not result in additional financial resources, and there was no planning or development. This is why we are talking about the development of a true university hospital centre. Yes, there is a university hospital in Moncton, as indicated on the sign at the entrance and on the billboards, but that's about it, because there was no additional funding. If we look at what the federal government could do, the development of a university hospital centre and the network of university affiliated hospitals would be one that could greatly help the Acadian and francophone community in the field of health in New Brunswick.
The Deputy Chair: It was noted that the partnership includes New Brunswick community colleges and existing research centres. Is that correct?
Dr. Dupuis: Yes. If you're talking about research, you have to include the Université de Moncton, and if you're talking about education, you have to include the Université de Moncton. It is very difficult to think of university hospitals without academic affiliation to a university hospital centre. You have to find universities that are in the same jurisdiction as the hospital and the university, so it almost has to be in the same province.
Senator Gagné: I would like to come back to the issue of the organization of services and human resources development. Human resources development stems from the entire infrastructure related to training. I know there is an agreement with Quebec relating to training. In fact, I think there are several for training various health care professionals. The Université de Sherbrooke is an important partner for medicine. Do you still have development plans for New Brunswick in order to take over training for the vast majority of the health professionals you technically need to support your organizations?
Dr. Dupuis: As far as medicine is concerned, an agreement with the Université de Sherbrooke covers undergraduate education, that is, the four years of medicine itself. There is also currently an agreement with the Université de Sherbrooke with respect to family medicine residency.
In addition, there aren't many formalized agreements for the development of other specializations by the Université de Sherbrooke or any other francophone university in New Brunswick. Compared to the Centre de formation médicale du Nouveau-Brunswick, where undergraduate education is offered, I believe that this centre must break away and become a medical school associated with the Université de Moncton in the near future. This would create a driver for training in, for example, pharmacy, occupational therapy, physiotherapy and respiratory therapy. Training could be provided for a large number of medical specializations other than medicine. This would encourage the development of specialty residencies in New Brunswick, if there was a faculty of medicine as such.
One of the problems of the university hospital is precisely that; normally, the university hospital centre and the university-affiliated hospital centres should be associated with the faculty of medicine at the Université de Sherbrooke — and not because the Université de Sherbrooke has bad intentions — but since it is out of its territory, it is not part of its concerns, and that is normal. So we have to find a solution that involves the Université de Moncton and that means we can develop a real faculty of medicine. New Brunswick's needs in human resources in health could then be met. But I think we can also do this for all the Atlantic provinces on the francophone side, and even on the Ontario side and the western provinces, and so on. I think we could become a champion in this field. Since we are an official language minority community, we understand francophones in minority situations elsewhere in Canada.
Senator Cormier: I would like to follow up on Senator Bovey's question and hear more about strategies in collaboration with the federal government. Do you have ties to the Société Santé en français?
Dr. Dupuis: No, not at all.
Senator Cormier: We talked earlier about a health agreement that was signed on December 22, which provides $229 million for New Brunswick over a 10-year period. What I would like to say is both a comment and a question. If federal-provincial agreements are not an opportunity to negotiate a specific envelope for official languages and for the recognition of minority rights, when would it be possible? Have you thought about strategies in relation to this type of arrangement in your dialogue with the province or with organizations like the Société Santé en français that are active at the federal level?
It seems to me that a lot of work is being done on health in our respective provinces, but not enough attention is being paid to the federal-provincial agreements that require accountability. In the context of the federal-provincial agreement between Canada and New Brunswick, is New Brunswick accountable for the issue of the Official Languages Act? Are those questions you're asking?
Dr. Dupuis: It is believed that if there was a specific agreement in the area of health with respect to the rights of the minority language community, the federal government would be well placed to demand accountability. However, as far as I know, this aspect has not been discussed, either provincially or federally. I think the provincial government should make that request, but the federal government could also certainly contribute to this discussion, if it is on the lookout.
We may have missed an opportunity, but I don't think it's too late to recover. There may always be specific cases to be dealt with, and this would be one for which an agreement could be reached. We could start with agreements on a pilot project or something like that. We could start with one province to see if it works and then continue the development with other provinces. I think we should do that. As far as I know, I have never heard that this has been discussed, but I may not have been invited to the table. Certainly the province is expected to make that request. When you present 29 claims to the province and it can't keep one — that would be the 30th claim — the gap is enormous. We aren't there yet.
What is distressing is that, to the provincial government, health is not an issue for a minority community. That is what we can say now. It was an issue in 2010, because the government was in a situation where it was going to go to court. The date and the judge were chosen, everything was going to move forward. The government officials sat down, and we negotiated. It's a funny way of doing things, when you have to have the knife at your throat to get there. The provincial government has obligations, but it does not respect them. The provincial government is at the heart of the problem. If it wanted to discuss and negotiate with us, we could reach agreements.
The Deputy Chair: Dr. Dupuis, I'm going to ask you to be brief, because other senators still have questions for you.
Senator Moncion: Could you to talk a bit about privatization? You mentioned the privatization of hospital maintenance services, in particular. But there is also the creation of nurse practitioner clinics that can be found here. We are starting to see them in the smaller municipalities, here in Ontario. It frees up the hospitals. We know that sending people to the hospital is extremely expensive. People are starting to go to nurse practitioners. There is another economy being created in the health care sector.
These small groups are being formed in francophone communities. We even sought out one of your students, a nurse practitioner who works in Northern Ontario. There are a number of doctors and nurse practitioners who come from your region to work in Ontario.
Dr. Dupuis: Are you telling me that you have nurse practitioners who work in the private sector?
Senator Moncion: Yes.
Dr. Dupuis: This concept doesn't currently exist in New Brunswick. I haven't heard about it.
Senator Moncion: It's a bit like the CLSCs in Quebec. In Ontario, community health care centres with nurse practitioners are being created.
Senator Gagné: Are they private?
Senator Moncion: They're paid for by the provincial government, but the community must be very involved. There's a whole operation. The system is making progress, and we are seeing it increasingly in minority communities, anglophone and francophone. Services are provided. It's something that works.
Earlier, when you spoke about privatization, you were instead talking about the laundry and so on, but I'm talking about auxiliary medical services.
Dr. Dupuis: I'm not aware of this kind of privatization in New Brunswick, but I know that there have been discussions about privatization of mental health psychology. I find it a bit extraordinary that New Brunswick just signed an agreement on mental health care, and that one of the things that the province wants to do with this money is to privatize psychology when there is a need for mental health services. It surprises me a little.
There is also talk of privatizing lab services and clinical home care in New Brunswick. It's the extramural hospital program, and there was talk of privatizing the three hospital services I mentioned to you. I think that's where —
Senator Moncion: Perhaps "privatization" isn't the right word. There are partnerships between the provincial government and various communities, which has the effect of freeing up the hospitals. It may not be privatization as such. That's why I wanted you to talk a bit more about privatization.
Dr. Dupuis: How are nurse practitioners paid, exactly?
Senator Moncion: By the Government of Ontario.
Dr. Dupuis: Like the doctors?
Senator Moncion: The doctors, yes. I'm not sure whether the communities contribute financially, but I know that the communities have to —
Dr. Dupuis: Where I'm from, we have nurse practitioners who work in the community. They're salaried but aren't paid through the New Brunswick health insurance system.
Senator Moncion: Like the doctors, it's different.
Dr. Dupuis: Like the doctors.
The Deputy Chair: Would you like to say something, Senator Cormier?
Senator Cormier: Yes. In walk-in clinics in New Brunswick, such as Dr. Blanchard's in Caraquet, there is a public- private partnership. Of course, the public pays for certain services, but the clinic as such is a private clinic, isn't it?
Dr. Dupuis: Yes.
Senator Cormier: It's a private clinic, isn't it?
Dr. Dupuis: That's how many doctors in Canada operate. That is the private aspect of the Canadian system. Some doctors are paid by the government, the hospitals, and so on, but most doctors are private entrepreneurs who are paid when they submit their health insurance invoices. If I understand correctly, it's a little bit like what's happening in Ontario.
Senator Moncion: Yes, and it's the same thing for nurse practitioners and midwives. More and more hospitals in Ontario allow midwives to be with mothers during childbirth, but others do not.
Dr. Dupuis: This still isn't done across the board in Ontario. There are things like that, but not on the medical compensation model. Rather, it is a model of compensation for nurse practitioners.
The Deputy Chair: Okay, Senator Moncion?
Senator Moncion: Yes. I'll have another question in the third round.
The Deputy Chair: Very briefly, please, Senator Maltais.
Senator Maltais: Could you give me, from memory, the budget allocated to health in New Brunswick?
Dr. Dupuis: $2.6 billion.
Senator Maltais: With respect to the federal-provincial agreements, I wish you luck. We have agreements with the Department of Heritage on services related to the Francophonie in each of the provinces. However, we aren't in a position to say whether this money paid to the provinces goes directly to the Francophonie. The President of the Treasury Board, Mr. Brison, came to testify before us, and he said, "I have no way of asking for accountability." He told us that when he comes back, there would probably be a bill on this. Could we do the same thing in the area of health?
Dr. Dupuis: You're asking whether the federal government could request accountability from the provinces in the area of health? It's all in the negotiation. There are already federal-provincial health agreements that seek to reduce the wait times for radiation treatment and some surgeries. I think the provinces, with some exceptions, have been somewhat accountable. If we ask for it, we'll get it. The problem is that if you don't ask for it, you're certainly not going to get it. It has to be negotiated, and both parties at the table have to agree that this will be done.
Senator Maltais: I you had only one recommendation to make to our committee, what would it be?
Dr. Dupuis: It is imperative that the federal government promote minority communities with respect to health, and it must do so through federal-provincial agreements. These agreements must be as specific as possible, and the goal is to ensure that minority communities achieve real equality when it comes to health care. That's the objective. Someone somewhere must correct it. The provinces are often reluctant to do so, but if the federal big brother was willing to support and help them, I think it could be done. If that could be put on the agenda of discussions with the federal and provincial governments, I think it's likely to work.
Senator Maltais: Thank you very much, Dr. Dupuis.
Senator Gagné: I'm fine. My questions have been asked.
Senator Moncion: My question is about young people. We realize today that young people don't have the same battles that we or our parents have had in terms of services in French. I know that a study was done by the Fédération des caisses populaires acadiennes on the exodus of young people from New Brunswick. Do you know if your young people feel concerned by the language battle you are fighting to keep French-language services in New Brunswick?
Dr. Dupuis: We were supported in the first round by the Fédération des jeunes francophones du Nouveau- Brunswick. The Fédération des étudiants et étudiantes du campus de l'Université de Moncton, the FÉÉCUM, has also supported us. We had the support of several youth organizations. They made us feel their support. Currently, the FÉÉCUM supports us. We are in the process of seeking support in other communities of young people, and we think that they will support us as well.
The problem with youth in New Brunswick has less to do with the exodus and more to do with our population's birth rate. I think young people, especially in New Brunswick, are very motivated and well-organized. There are wonderful communities, they participate, and it works.
Senator Moncion: I have a little supplementary question. Perhaps it's a little piece of advice. I believe your premier, Brian Gallant, is francophone.
Dr. Dupuis: Yes.
Senator Moncion: I believe he supports francophone communities. Perhaps you should try to take advantage of the help of the young people in FÉÉCUM to influence your premier, who is young. I think he isn't even 35 years old. Sometimes, understanding is easier among young people. Young people sometimes think that the issues of older people and young people are different.
Dr. Dupuis: Senator, with all due respect, the premier of New Brunswick, is currently violating the rights of francophones in the area of health, period. It is his government and his Minister of Health who are involved, so he is aware of all this.
Senator Moncion: Oh, really? I'm sorry to hear it.
Dr. Dupuis: The Minister of Health is francophone as well.
Senator Moncion: I find that such a pity.
The Deputy Chair: One last quick question.
Senator Gagné: Dr. Dupuis, you mentioned earlier, and also on L'Heure juste, I think, that you are considering the possibility of appealing to the courts if the government doesn't respect its constitutional obligations regarding official languages.
Dr. Dupuis: That is clear. As clear as —
Senator Gagné: — crystal —
Dr. Dupuis: — clear water. We won't tolerate this situation for a long time. I would like to say that if the provincial government doesn't do anything, we won't tolerate the situation. We have put up with it, but it's over. The matter needs to move forward, and that's sort of how it is seen.
The Deputy Chair: Since the question period is over, that concludes the meeting. We would like to warmly thank all our guests this evening. Your presence and input is valuable.
(The committee continued in camera.)