THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, May 1, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 5:01 p.m. [ET] to continue its study on matters relating to minority-language health services; and, in camera, to consider a draft agenda (future business).
Senator René Cormier (Chair) in the chair.
[Translation]
The Chair: Good evening, colleagues. My name is René Cormier, senator from New Brunswick, and I am currently Chair of the Standing Senate Committee on Official Languages.
Before we begin, I wish to invite committee members participating in today’s meeting to introduce themselves, starting on my right.
Senator Poirier: Rose-May Poirier from New Brunswick.
Senator Mockler: Percy Mockler from New Brunswick.
Senator Clement: Bernadette Clement from Ontario.
Senator Gagné: Raymonde Gagné from Manitoba.
Senator Moncion: Lucie Moncion from Ontario.
The Chair: Thank you and welcome, colleagues.
[English]
I wish to welcome all of you and viewers from across the country who may be watching. We are holding this meeting from within the unceded traditional territory of the Algonquin Anishinaabe people.
[Translation]
Tonight, we continue our study on minority-language health services. For our first panel, we have with us Shirley MacLean, Commissioner of Official Languages for New Brunswick.
Good evening and thank you for being with us. It is always a pleasure to have you here, Ms. MacLean. We’ll now hear your opening remarks, which will be followed by a question and answer period with the members of the committee. The floor is yours.
Shirley MacLean, Commissioner of Official Languages for New Brunswick, Office of the Commissioner of Official Languages for New Brunswick: Good morning everyone. I am pleased to have this opportunity to appear in person here today to testify in your study on minority-language health services.
As New Brunswick’s Commissioner of Official Languages and as a Canadian, there is nothing more important to me than health and the delivery of health care services.
[English]
In fact, one of the main reasons I was interested in the position of commissioner related to issues surrounding the provision of health services to our francophone linguistic minority in New Brunswick.
[Translation]
As most of you already know, New Brunswick is the only officially bilingual province. New Brunswick’s unique status is enshrined in the Canadian Charter of Rights and Freedoms. The Charter states that English and French are the official languages of New Brunswick, and also stipulates that the English and French linguistic communities in the province have equal status, rights and privileges.
In New Brunswick, everyone has the right to receive health care in either official language. Under the Regional Health Authorities Act, the province has two health networks: Vitalité and Horizon. They manage hospitals and provide various health care services.
Each network has an internal operating language, French for Vitalité and English for Horizon. However, both networks must provide services to the public in both official languages.
[English]
Issues relating to the provision of health care services are a question of security. When any of us are involved in the health system, we are in a position of vulnerability, as most of us are on unfamiliar territory. We do not speak the medical language.
[Translation]
This situation can be exacerbated for the French-speaking minority, who often face language barriers in accessing health care in their first language.
It has been demonstrated repeatedly that when it comes to health care, language is integral to the quality and safety of care. Access to health care of equal quality and in the official language of choice improves health for all.
Quality of care is also closely linked to the ability of providers to assist service users. The ability to understand and be understood is essential for an effective relationship between the health care provider and the public, and it helps to avoid dangerous situations.
[English]
Over the past six years, complaints relating to health care have comprised a significant percentage of complaints we have received, and most of these have been with respect to lack of service in French.
If I look at the overall complaints reported in my most recent annual report for 2021-22, health care is certainly the recurring theme, with almost 40% of the complaints handled relating to health care matters.
There are also new points of service to be aware of. In New Brunswick and Canada, we have seen an increased shortage of health care workers, including doctors and nurses. This shortage, as well as issues related to the pandemic, have resulted in the increased use of virtual and online health care services.
At my office, we have received complaints about these services. An online service that is accessed by persons without health care providers who require medical assistance advised francophone users that their wait times may be longer if they decided to continue in French.
In other cases, francophone users of the site who inputted a question or query received an electronic response that the service did not understand their question enough to provide them service.
This is not only a breach of the Official Languages Act, but it also poses a potential danger to a francophone user, and certainly is a barrier to accessing health care services that are of equal quality to those available to anglophones. This is just one glaring example. It was remedied. However, access to services of equal quality in both official languages continues to be a serious issue, even in our bilingual province where the institutions understand their linguistic obligations and make real efforts to meet them.
[Translation]
In addition, workforce shortages cannot be used as an excuse for not meeting language obligations. In short, in New Brunswick, all government institutions, including the two health networks, have the obligation to provide services of equal quality in both official languages. The inclusion of mandatory language clauses in federal health transfers will ensure support for official language minority communities.
Thank you very much for inviting me to join you today.
[English]
I will be happy to answer your question in the official language of your choice.
The Chair: Thank you for your opening remarks. We are now ready for the question and answer.
[Translation]
Senator Poirier: Thank you for being with us. It’s really nice to be able to talk to you this evening about topics that are important to us.
You’ve been the Commissioner of Official Languages for about three years. As we begin our study on health care services in official language minority communities, what do you see as the greatest challenge for Acadian communities with respect to health care services? Also, how could the federal government help address this challenge?
I would also like to make a comment to follow up on what you said earlier. You said that when someone registers for a doctor who speaks their language of choice, the wait may be longer if it’s a francophone doctor.
This is a real challenge in New Brunswick with an increasingly aging population. Depending on where they live, people over the age of 75 say that they’ve been waiting a long time for a doctor. For some, having an English-speaking doctor would not be ideal, as many do not understand the language. I know this because I work with people from my province, and they tell me the same thing.
Going to the emergency room to see a doctor in a French-speaking hospital isn’t the answer either, because people spend the whole day in the hospital and, by midnight, they still haven’t seen a doctor.
What is the federal government going to do to solve this problem that we are facing?
Ms. MacLean: The biggest challenge is access to health care services in French. That’s where we see the most complaints.
Obviously, the institutions understand that they have to provide this service. As you said, it’s also a safety issue.
We also often see, in certain regions, that francophones tend to… Even complainants who say they almost always insist on getting services in French decide to speak in English because they know they will have to wait several hours, and the situation is urgent.
This is a safety issue. Ultimately, it’s about the possibility of receiving services in French. It’s often a question of funds, of funding, but the problem of access to services in French is also linked to labour shortages. When I receive complaints, I make recommendations, but the representatives of the institutions will often reply that they don’t have enough bilingual employees. That’s why we receive these kinds of complaints.
Should the federal government include language clauses when it makes transfers to the provinces? Should it ensure that some funds are earmarked for the hiring of bilingual employees? I think so. The obligation is already there. Additional funds are probably part of the solution, but you have to have… Obviously, health is a provincial jurisdiction, but language clauses that would require the provincial government to insist on more employees could help solve some of the problems.
Senator Poirier: It’s a worrisome situation, especially for the elderly. Sometimes they don’t understand English. They must be able to explain what their problem is and receive the necessary information in their language.
Do I have time for a second question?
The Chair: Yes.
Senator Poirier: Okay.
Last September, the Nurses Association of New Brunswick announced a partnership with France to make it easier for nurses coming from France to obtain a work permit. Is it too early to evaluate this initiative? Do you think such an agreement should be a model for others in the country?
Ms. MacLean: I don’t know if there has been any assessment of how this agreement works. It’s probably something that the Department of Health and the Nurses Association of New Brunswick could do, because they’re the ones who govern the profession.
Any time you can remove barriers to make it easier, that’s a good thing. I’m a lawyer. The Law Society of New Brunswick has had a mobility agreement between the provinces for several years now so that lawyers can cross the border easily. It allows nurses and doctors to work in other provinces. Whenever something can be done to remove barriers, that’s a very good thing.
Senator Gagné: Welcome, Ms. MacLean.
I just wanted to verify something with you. Generally speaking, in Canada, there is a problem with access to health care services in official language minority communities, especially among francophones. There are also anglophones in Quebec. However, I want to focus on francophone communities.
It is clear that we have a labour shortage.
Feel free to comment on the way New Brunswick has decided to structure Vitalité Health Network and the Horizon Health Network. They are two health care authorities, and are therefore two different authorities. In terms of coordination of health care services, how does this work in terms of resources?
Can telemedicine and new technologies represent an opportunity to better respect patients’ language rights?
Ms. MacLean: In terms of your question about technology, I think we really need to be careful about that.
Let me tell you about an incident that happened last week. I was at the hospital in Fredericton for a blood test. I was in the waiting room, and a hospital employee was chatting with someone who was also waiting in the waiting room. Then the employee said that she had to go back to work and that she had a device with her to translate into French. Then she said this:
[English]
I have a machine that does translation. I don’t have to speak French.
[Translation]
Then the employee left. The Official Languages Act and the Charter of the French Language require that both language communities have access to quality services on an equal basis.
When we talk about translations done using a translation system, it should be a last resort in these environments, in ambulances and in hospitals. It’s important to be careful. You often hear people say that they have a lot of confidence in these systems, but it’s dangerous. You really have to be careful. When you work in health institutions, it’s really a resource of last resort, because people need to be able to express themselves in their language to talk about their health problems.
As far as the two health networks are concerned, some things are sometimes misunderstood. Some people think that in our region, in New Brunswick, we have French and English hospitals. This is not the case at all. Whether it’s the Vitalité Health Network or the Horizon Health Network, both must offer services in both languages to the general public.
In the Horizon Health Network and the Vitalité Health Network, the working languages are French and English. Of course, some of the professionals who work in this system are unilingual, but the services must be accessible in both languages for everyone.
I can’t speak for the health networks to say how they will manage their resources, but from what I understand, especially in Moncton, there’s a lot of back and forth, a lot of sharing between the Horizon Health Network and the Vitalité Health Network. I think they’re looking at that situation very closely. No matter where you go in New Brunswick, whether it’s to a hospital or a clinic, you have the right to access services in the language of your choice.
Senator Gagné: Okay.
In terms of the labour shortage, I’m aware that the Université de Moncton works with other universities in terms of training. They also have a very important program for the province in terms of field presence, for example.
If you don’t have an answer to my next question, I can understand.
Are we successful in retaining doctors and nurses in New Brunswick after their —
Ms. MacLean: The New Brunswick Health Council conducted a patient survey to gather health and workforce statistics. According to these statistics, the number of physicians has been increasing over the years, but the population has also increased significantly. Fewer and fewer New Brunswickers have a family doctor. I think it’s the same situation across Canada and around the world. There’s a labour shortage everywhere.
The Chair: My apologies, Ms. MacLean. I think I called you “Ms. MacLaren” earlier. I apologize. I wouldn’t want to rename you.
Senator Moncion: My question is about the two recommendations that you had made with respect to the Regional Health Authorities Act.
In your two recommendations, you talked about ensuring that, in any action relating to the development of a provincial health plan, the language of operation of the authorities should not take precedence over their obligation to provide all care in the official language of the patient’s choice. The second recommendation was to ensure that the provisions of subsection 19(3) of the Regional Health Authorities Act, which imposes on both authorities the responsibility to improve the delivery of health services in French, are respected in the development of a provincial health plan.
Premier Higgs does not seem to have shown much openness to these recommendations. Could you tell us if he has changed his mind since then, or if he has proposed something else to at least respect the recommendations you made with respect to work?
Ms. MacLean: No; the government has even tabled a bill that hasn’t included these recommendations, and there hasn’t yet been a debate in the legislature on the bill. It remains to be seen whether or not there will be any changes. Those recommendations were more technical, to ensure that the overarching obligations that are enshrined in the Official Languages Act, which are 26 or 27 of the obligations of core institutions, will apply to the health networks and the Department of Health.
Senator Moncion: You mentioned earlier that an employee was walking around with a computer, talking to the computer in English and the computer was translating into French. That is the height of laziness, when we know that we could very well invest in other forms of technology that would improve services in hospitals. I understand that you aren’t necessarily very happy to hear comments like that in the complaints you receive.
Ms. MacLean: I’m aware that this technology is being used with immigrants and for other languages. I’ve been told in the past that we aren’t going to park an ambulance because we don’t have translation. We’re going to use the translation of existing technologies, of course. However, I think this is still a last resort. You have to understand what’s going on and not put a patient at risk. If we start doing this as a first resort, it will continue.
Senator Moncion: It is the law of least resistance. I am going to step out of this field, because I wanted to know if you’ve had any progress on the qualifications of the health care providers. The provincial tests aren’t necessarily standardized across Canada, so there may be limited mobility in the health workforce. I believe that is a problem in your province of New Brunswick. Am I mistaken?
Ms. MacLean: The exams for the —
Senator Moncion: For example, for nurses, they have to qualify, but the federal government could intervene so that there is a Canadian system where the qualifications are the same from coast to coast to coast. That would allow for mobility of health care personnel, so there would be much more accessibility.
Ms. MacLean: Mobility of professions is an important issue. Of course, it would make it much easier for nurses or physicians to move here. Again, that is ultimately up to the professional association. The government has no control over this, because the professional associations regulate themselves. It would help a lot, but that remains to be seen. It is a really big project, and it would require approval from all the professional associations in Canada.
Senator Moncion: I understand that this isn’t necessarily an issue that’s being worked on diligently?
Ms. MacLean: I think we are hearing about it, and it’s recognized now, especially in Atlantic Canada. The premiers have started to discuss it because I think they’ve realized that something needs to be done. However, as far as official languages are concerned, even if there’s an agreement to ensure greater mobility, will this help the minority language? Francophones are more likely to be in New Brunswick. Will it improve the situation for the minority language community? I don’t know. We must insist more on services being available to these communities.
Senator Moncion: You were talking about the number of complaints, but beyond that, does the government listen to the complaints or is it just a statistic?
Ms. MacLean: The institutions I work with… Even though I only have the authority to make recommendations, under the legislation, often when recommendations are made, institutions are aware of their obligations, and they work with us to impose them. Often, though, we talk about employee shortages, but that’s not always the case.
There may be a particular organizational culture in an institution; that’s a situation where I think I need to do some promotion. Is there a way for us to work with the institution to help them enforce the recommendations and make sure that the employees recognize the obligations, the active offer, the continuity of services? That’s where I can do a little more work on the ground.
Senator Mégie: I was looking at some of the notes. It might not have anything to do with you, but at the same time, you are on the ground. I know that on the Quebec side — because I come from Quebec — there have been a lot of comments that Bill C-13 will be very frustrating for anglophones in Quebec. When you talk to all the people you consult, is the thinking along the same lines?
Ms. MacLean: About Bill C-13?
Senator Mégie: Yes.
Ms. MacLean: Quite frankly, in my office, the complaints we’ve received or the discussions we have… We don’t have the expertise in terms of the federal legislation. However, with respect to language rights, it’s true that most of the complaints filed with our offices relate to the linguistic minority and the Official Languages Act. The Charter protects linguistic minority rights. It’s there for both linguistic communities. We have two official languages, two linguistic communities with equal rights and privileges.
I’m not an expert on Bill C-13, but I think we must always be vigilant to ensure that minority rights are protected.
Senator Mégie: The other issue you discussed with Senator Moncion — the mobility of physicians — I have heard a lot about that in relation to the new legislation in Quebec.
I wonder if this means robbing Peter to pay Paul, because in fact, the workforce is still reduced; it’s not only in Quebec, because I hear about it everywhere.
If we promote mobility, that’s good, but will it really benefit francophone populations in minority regions?
Ms. MacLean: That’s the question. I think we should look at immigrants. When you look for professional immigrants who have moved to Canada… I saw it myself when my son was in daycare, because the person who worked in the kitchen was a doctor in Algeria. She could never be accepted or even be admitted to a competency exam to become a doctor in New Brunswick.
This family eventually decided to move to Quebec, and then she started practising in Montreal. We should start by making sure that there are no barriers when immigrants come to Canada, not just for doctors, but for all professions. We promise things to immigrants. They are told to come to Canada, and they are told that they will be able to practise their trade, but when they get to Canada, they face a lot of barriers, especially for health professions in general. Those are the areas where we’re going to increase the number of employees. I’m like you. If we move doctors from Quebec to New Brunswick, some patients in Quebec won’t have a family doctor anymore, and some patients in New Brunswick will gain one. Does that make a difference for all of Canada? I don’t know.
Senator Mégie: Thank you.
Senator Clement: Good morning and welcome. I’m francophone, and I’m a patient at a community health centre. Ontario has seen fit to invest in community health centres that have different vocations; mine is for francophones. I think the province should have continued to invest in these types of services. I’m trying to figure out if this exists in New Brunswick. A lot of disciplines are offered in these francophone health centres, and it’s a great way to go.
[English]
The next question I have is about collaboration with provinces. New Brunswick is such a great province to look at. I appreciate you always being here.
Do you monitor policies of other provinces? Do you need to discuss official languages with other provinces? I know your neighbours are there, but do you talk to other provinces about this, about health care and about official languages? I’m curious about provincial.
Ms. MacLean: We don’t. I do meet with Ontario, with the French-language services commissioner and the federal commissioner, but we are the only officially bilingual province so I don’t have any counterparts to discuss a lot of those issues with, with respect to any topic or health in particular, as you are referring to.
[Translation]
It’s something we’re looking at closely because of the number of complaints. These are things that interest me, because it’s about people’s safety. The clinics you’re talking about are pretty rare. I know that in the capital region there have been initiatives like this in the French community centres, but they have had staff shortages. There were a few family doctors, and they left. They don’t even have a nurse practitioner on site. They’ve tried, but they’re understaffed.
I’m familiar with the subject you’re talking about, because I had a niece who worked at one of those clinics. It makes perfect sense to me, but I think the government has a hard time making different decisions, “thinking outside the box,” if you will.
Senator Clement: That’s why I asked the question: for collaboration and inspiration from what is being done elsewhere. We hear in Ontario that clinics and community centres have more capacity to recruit staff because the new generation of professionals like to work in teams.
Ms. MacLean: They’re also going to work less, because the more people you have, the less work you have to do. I’m a patient of a doctor who is part of a clinic that is made up of herself and two young couples. I consider myself lucky. I may not be able to get an appointment with my doctor, but it will be with one of the four. If I decide to go to the emergency room, after three times, they can ban me from their practice. I am not allowed to go to the emergency room or any other point of care. I absolutely have to go to my clinic.
Senator Clement: Things are happening, but not in a formal way with the government.
Ms. MacLean: That’s right.
Senator Clement: Thank you.
The Chair: Before I turn it over to Senator Mockler, I’d like to ask you a question as well. You made certain comments in the brief you submitted to the commissioner responsible for revising the Official Languages Act, including on the ambiguities regarding the offer of service and the issue of bilingual signage. You proposed adding language obligations for nursing homes. You indicated that you had received complaints about access to medical records in the language of choice.
Actually, my question is quite broad. Obviously, we think a lot about hospitals when we think about care, but in the complaints that you’ve received and that we’ve been able to identify in New Brunswick about ambulance attendants and the supply of health care, can you give us more details on the challenges related to these different aspects? Obviously, your recommendations were received in the report, but not by the current government.
How could the federal government help with the Official Languages Act? We know that Bill C-13 identifies health as a critical sector. Do you think this could strengthen federal-provincial agreements to ensure that the issue of access to services in both official languages is reflected throughout the system, including in organizations such as health care agencies?
Ms. MacLean: It’s something formal, and it would go a long way to helping provincial governments recognize their obligations. The obligations are there for governments. However, formally recognizing that this is there and the funding that would be attached to it might help the province retain more employees.
As for health care in nursing homes, I have to say that there are almost no complaints for the extramural health care that is provided in nursing homes and facilities. It’s going quite well. Nursing homes and extramural services are governed by Medavie, which is a third party by law, and it’s going well. Since I’ve been here, it’s been the same with the ambulance attendants: There are no complaints, it’s going well. There have been a few complaints for nursing homes, but that was more about continuity of service for patients. I see more complaints about hospitals, clinics, and so on. That’s where the majority of the complaints are.
The Chair: Do you see any regional disparities in complaints? Are there areas that are more targeted or more affected than others?
Ms. MacLean: It’s often said in New Brunswick that the complaints are in the larger regions. It’s a little different for health because the government institutions are in Fredericton, Saint John and Moncton.
It’s true that most of the complaints come from the more populated areas, but some also come from the central region of New Brunswick, from Fredericton, from Miramichi. We also get complaints from anglophones who live in the northern part of the province.
The Chair: Thank you, Ms. MacLean.
Senator Mockler: Ms. MacLean, I certainly want to be among those who want to congratulate you, both for the work you are doing for the two communities and for Indigenous peoples. There are a number of things I’d like to talk about. I’d also like to congratulate you on the opinion piece about understanding the Official Languages Act, which you wrote in our newspaper Acadie Nouvelle in January 2023. You say here, and I quote, “. . . I have no difficulty obtaining services in my official language.” That was courageous. However, you say:
This is not something that concerns me in New Brunswick. This is not the case for francophones.
Can you elaborate and give examples, other than having someone you’ve met tell me, as a parliamentarian, “I have a computer that does the introduction”?
Ms. MacLean: Obviously, the majority of the complaints we receive are from francophones. This affects all areas of health care, such as the active offer of services or what we call the continuity of services. We have seen situations, especially since the COVID-19 pandemic, where unilingual francophones were hospitalized, elderly people who had no one with them who could speak English and who had difficulty understanding what was going on. These people had difficulty communicating their health situation.
We saw a situation recently where a son was worried about his father. He said, “I’m going to the hospital at such and such a place, and my father only speaks French. What’s even more dangerous about this situation is that even if someone says something to him, the way he reacts is to always say yes, yes, yes, yes.” So, people on site believe he understands, because this gentleman, who wants to be nice, always says yes. In the office’s opinion, this is a safety situation. The majority of the complaints we receive regarding health are from the francophone service. It is dangerous.
Senator Mockler: Thank you. I have a couple of other quick questions. I would like to hear from you to follow up on Senator Moncion’s questions. In New Brunswick, we have a problem with the French exam for nurses who want to write their exam in French. I’d like to know, if you can help us understand, why this exam comes from the United States. Why can’t we have an exam that’s of the same quality that comes from Quebec?
Ms. MacLean: I can’t answer that question. We have a case before the court, and it has to do with the nursing exam.
Senator Mockler: Thank you. I have another question. You also have, in your opinion piece to readers, and I would like to hear your thoughts on this. The government is currently considering… We remember the senator who was minister at the time; I was also there in 2002, when we created the Office of the Commissioner of Official Languages.
You are our second commissioner. I would like to know if you have looked at what the government is proposing. The debate is coming up in the legislature; do you have any views on the Official Languages Secretariat that they are proposing? How do you think it will improve services to the people of Acadie, and do you think it will allow us to work together with all communities, be they anglophones or Indigenous peoples?
Ms. MacLean: It was my predecessor, Michel Carrier, and I who recommended creating a secretariat. It’s a tool for centralizing the work within government to move forward. It will advance the recommendations of my office. Currently, each department has obligations. When I make recommendations, I work with a department, an official languages coordinator or the deputy ministers to ensure that this work is done. We have determined that the best way to ensure that this work is done effectively would be to centralize the work in one place within government. This is a central part of government policy to ensure that our recommendations are imposed or accepted. They also have the ability to do advocacy.
In the last budget presented by the premier, $500,000 was allocated to promote the secretariat — in other words, to promote both linguistic communities. That’s good news. It’s good to have a number of people expressing pride in having a bilingual province. Let’s hope that it will be done through them with those funds. I would assume so. So we’ll see. Nobody knows how it’s going to work, but it’s the only recommendation that was accepted in the bill. In the report of Commissioner McLaughlin and Commissioner Finn, when they reviewed the Official Languages Act, they made many recommendations, and they included our own recommendations. They adopted the creation of the secretariat, and they rejected the mandatory review of the Official Languages Act every 10 years.
The Chair: Thank you. I’ll ask a supplementary question. Are you concerned that there will be confusion between your role and that of the secretariat if the functions aren’t well defined and promoted? Do citizens understand the distinction between the two, or are you concerned that there will be confusion?
Ms. MacLean: Possibly. It’s up to us to make sure that the public understands the difference. We don’t have the funds to promote the secretariat, but we will try to do that.
The Chair: Thank you. We want you to have the necessary funds.
Senator Dalphond: Welcome, Madam Commissioner. I’m looking at your 2021-22 annual report. I see that there are just under 100 complaints that have been dealt with as such; half of them are rejected because it’s not in your mandate.
In the complaints that are related to health, I see that there are 8 complaints for the Horizon Health Network; 10 complaints for the Vitalité Health Network; and 13 complaints for health. That’s a total of 31 health-related complaints.
I’ll have a question later on about how complaints are handled. I see the heading “Resolved Informally.” We’re talking about 31 complaints for a province with a population of 800,000 or more. Many times, people use health services more than once. You go to the hospital, you go back, you see the doctor before you go to the hospital, you go back to the doctor for follow-up. Is that number worrisome? Historically, has it been increasing? At first glance, this number seems rather low. Is this the tip of the iceberg, because many people don’t file complaints?
Ms. MacLean: There are many people who don’t file complaints. You have to include the Department of Health and the clinics related to that. I think the numbers are a little higher — I don’t have the data in front of me — but it is concerning. We know that many people don’t file complaints.
I’ve been in the hospital a lot, so I have personal knowledge of the health care system. I could file a complaint every time I go to the hospital, but I don’t. I’ve seen things in hospitals that surprised me. This year, almost 40% of the complaints are health related.
Senator Dalphond: I see “Resolved Informally.” Most of the complaints end up there, but others are more substantiated. In health, there were 16 treatment complaints, 14 of which ended up in informal resolution with Horizon, and 9 out of 10 complaints are in health and vitality. What is informal resolution?
Ms. MacLean: In emergency situations, we try to resolve issues as quickly as possible. For example, in the telemedicine situation, where the question is whether the person is sure they want to continue in French, I contact the deputy minister. Such a situation is unacceptable. The investigators will then contact people within the institution to ensure that the problem is resolved. This is something that’s easily resolved.
It’s not that the complaint isn’t admissible. We follow up in writing to make sure it doesn’t happen again and to find out how the problem was resolved. In very urgent situations, we react as quickly as possible. In the case where we have just received an investigation report with solutions, if we receive a complaint about a factual situation, we won’t conduct another investigation; we’ll give the institution a chance to resolve the problem, and we’ll see if it has been resolved or if the problem persists.
Senator Dalphond: So I understand that if the complaint is under the “Resolved Informally” heading, it means that the institution has responded positively to your suggestion.
Ms. MacLean: That’s correct.
The Chair: We don’t have much time left, so I’m going to ask you to go directly to your question and keep the answers brief.
Senator Poirier: I’ll try to group my questions. We discussed new technologies, telemedicine with the use of a camera and what can be done. You mentioned that translation can be done by computer.
I had a situation last fall when I went to the hospital for an MRI. It was a more anglophone hospital used by people from all over the province, as it was not very busy. Many came from the Acadian Peninsula. Situations were as mundane as a lady trying to fill out a form. People didn’t understand each other, and no one could translate. So I offered to do the translation, even though I was a patient waiting for treatment, and I did it.
This situation made me think. I’m thinking particularly of places where there are only English-speaking doctors. When there is a shortage of staff, would it be possible to have someone do the translation? It would be a little friendlier than a machine that translates.
I’d like to come back to New Brunswick’s aging population. These people aren’t as comfortable with new technologies and cameras because they don’t use them. They need to be better served. What do you think of my suggestion?
Ms. MacLean: This situation reflects a lack of obligation on the part of the hospital. There needs to be a contingency plan. If someone fills out a form, you need to be able to give them the information they need. If you don’t speak English or French, you need a contingency plan and someone on site to help people. Institutions have tried to find solutions. They have used fly-in teams to go into hospitals and provide these services. But that didn’t work well, and there weren’t enough people. Especially with COVID, it fell through because we didn’t have the staff to do that kind of work. The obligation is still there. We get a lot of complaints like that.
Senator Mockler: Madam Commissioner, I would like to hear from you as well, if you could provide some more details. The official languages bill will be debated in New Brunswick. You mentioned some very worrisome situations, and you spoke to the commissioner about them. What recommendations were made to the commissioner who was responsible for the Official Languages Act of New Brunswick in 2021? Isn’t it a mistake to eliminate the 10-year review?
Ms. MacLean: There is a danger in eliminating the requirement to review the act every 10 years. Some people say that you can review it as needed. However, as you know from your work, reviewing legislation isn’t easy, especially when it comes to official languages. Whether we like it or not, this file is like a hot potato — at least, that’s the case here. For this review, two commissioners made recommendations. In 2013, it was a committee of the legislature. The revisions that time passed unanimously. Without a system in place to make sure the review is done, in my opinion, the review will not happen.
I’m also a lawyer. I have worked on the review of legislation and bills. I can assure you that this work isn’t easy. It’s also not easy to get people to commit to a review. When it is in the law, the clear obligation is there and the review is done.
Senator Clement: I know you are the Commissioner of Official Languages. Do you know if there are any requests for service in Indigenous languages?
Ms. MacLean: I don’t receive complaints, but I am sure there are complaints. The institutions are doing their best to ensure that those services are in place. I know there are plans to do that. I also volunteer in the oncology department with patients. I know that there are projects in place that are aimed at Indigenous people. I have no idea how many complaints there are, but there are definitely gaps. I know that because there is a lot of talk in the news about gaps in services for Indigenous people.
Senator Moncion: In 2022, New Brunswick concluded an agreement that allows graduates to be licensed after writing the Quebec exam rather than the National Council Licensure Examination (NCLEX). Are we seeing an increase in the francophone workforce since this agreement was reached?
Ms. MacLean: I have no idea. That’s a good question.
Senator Moncion: Thank you very much.
The Chair: Madam Commissioner, I want to thank you, both as Chair of the Official Languages Committee and as a citizen of New Brunswick, for the outstanding work you do. You help ensure that New Brunswick meets its constitutional obligations and you play a very important role in our province. Thank you and your team for your commitment and generosity.
With that, colleagues, we will suspend briefly to welcome our next witnesses. Thank you again, Ms. MacLean.
[English]
For our second panel this evening, we are pleased to welcome Jennifer Johnson, Executive Director, Community Health and Social Services Network; Danielle Lanyi, Executive Director, Connexions Resource Centre; Tania Callender, Executive Director, African Canadian Development and Prevention Network; and, by video conference, Jessica Synnott, Executive Director, Vision Gaspé-Percé Now.
Thank you for being here. We will hear your presentations and then we will go to the question-and-answer period.
Ms. Johnson, the floor is yours.
Jennifer Johnson, Executive Director, Community Health and Social Services Network: Mr. Chair and all members of the Senate committee, thank you very much for this opportunity to come and speak to you about the challenges of the English-speaking community of Quebec in accessing health services.
The Community Health and Social Services Network, or CHSSN, was founded in 2000. Our mission is to improve access to health and social services for the English-speaking community in the province of Quebec. We do this through the promotion of partnerships and the development and promotion of an evidence base to support the needs of the community. The CHSSN has been a community beneficiary of five Health Canada contribution programs since 2003, recently signing a new five‑year agreement.
In a nutshell, there are three things that I want to transmit to you today in the five minutes that I have.
First, the English-speaking community has a socio-demographic status that makes it more vulnerable than the general population. Very limited access to health services in English has an impact on the health of our population, and vulnerable populations within the English-speaking community have even more challenges in accessing services.
The English-speaking community in Quebec has a surprising demographic profile. The level of unemployment is significantly higher than the French-speaking majority: 10.9% versus 6.9%. Since the last census in 2016, this rate has increased in the English-speaking community by 2%, while the francophone majority stayed the same, at 6.9%.
As these numbers would suggest, the English-speaking population has a higher proportion of the population living below the low-income cut-off, 12.1% versus 7.1% of the general population.
There are two elements that make the English-speaking population very different from the majority population. There is a much higher proportion of recent immigrants compared to the general population: 9.9% of our community are recent immigrants versus 2.8% in the general population. The English‑speaking community has a much higher percentage of people who are visible minorities: 29.8% of our population are visible minorities versus 9.7% in the general population.
These two realities have an important influence on accessibility and culturally competent health care services. Vulnerable populations like visible minorities, the LGBTQ community, people suffering from mental health problems or recent immigrants who must access the health system face multiple barriers that compound their experience.
This committee has a particular interest in the experience of seniors in accessing care. English-speaking seniors face a multitude of additional barriers when it comes to accessing services. In the 2001 census, there were 185,000 English speakers over the age of 65, representing 14.9% of our population. According to a 2019 survey, English-speaking seniors are less likely to have a regular place to go when sick than francophones of the same age.
That cohort also has lower levels of bilingualism. Language barriers contribute to poor patient assessments, misdiagnoses, delayed treatments, increased medication errors, et cetera.
A recent study by Dr. Tanuseputro demonstrated that elderly francophone patients were much less likely to die when treated by a French-speaking physician, and I believe the same could be said for an English-speaking population in Quebec.
The availability of services in English for seniors is extremely limited and depends upon location. Designated institutions are very rare off of the island of Montreal or outside of urban centres. Home care and long-term care in English are not accessible for most English-speaking seniors who live outside of urban centres. Many seniors cannot afford to cover the cost of private caregiving as an alternative to public resources, as there is a higher proportion of English-speaking seniors living in poverty compared to francophones.
Persons dealing with mental health issues are also likely to be more susceptible to social isolation as they age. Older community members living with mental health issues need more community resources aimed at reducing social isolation and providing services in English.
As research begins to reveal the extent of the impact of COVID-19 on the English-speaking communities, addressing barriers to access to mental health programs, including prevention and treatment, is emerging as a key priority. In a province-wide survey of men in Quebec in 2021, English-speaking men reported higher psychological distress: 22% versus 12% of the francophone majority. In a 2022 survey of English-speaking youth, 90% of the over 400 respondents stated that they experienced feeling mentally unwell within the previous two weeks. In a 2020 survey by the University of Sherbrooke, the three most affected groups of the COVID pandemic were young adults, health care workers and anglophones.
In responding to these challenges, the CHSSN will continue to promote its evidence-based development model that has successfully mobilized English-speaking communities and created an enduring partnership with Quebec’s health and social services system. With the contribution from Health Canada through federal action plans, the CHSSN will implement measures that aim to strengthen communities, adapt the health system to better respond to needs and create the strategic information required to address new priorities and the challenges facing communities in the public system in the period ahead. Thank you.
The Chair: Thank you, Ms. Johnson.
We now will go to Ms. Lanyi. Thank you.
Danielle Lanyi, Executive Director, Connexions Resource Centre: Thank you very much, chair and members of the Standing Senate Committee on Official Languages, for the opportunity for us to present. Our organization’s mission is to promote the health, vitality and well-being of the English-speaking population in the Outaouais region, which is right across the river from us, through empowerment, participation and collaboration.
I will give you a bit of a smaller snapshot than Ms. Johnson just provided. Our region covers more than 33,000 square kilometres, and we have a population of more than 396,000 people, where English-speaking residents represent 20.7% of the population. We have four regional county municipalities that are rural as well as the City of Gatineau. Two thirds of the population reside within the City of Gatineau, and the English-speaking population represents 17.5%, whereas in the Pontiac area, it is 56% of the population. Our community is very diverse.
As well, income is an important health determinant. Although our region does fairly well in terms of income compared to the rest of Quebec, we do have rural regional county municipalities that are deemed as being disadvantaged, with high levels of poverty and unemployment, and where statistics show that English speakers are even more disadvantaged than their francophone counterparts. We can also find pockets of poverty within the City of Gatineau and other areas.
We are still working to dispel the myth that the English-speaking community is wealthy and to reinforce that language is well researched in terms of being a barrier to accessing services.
Our proximity to Ontario is also another unique characteristic. Historically, English speakers from our region would access services in Ontario — not just Ottawa but all around. One, it was easier to access services in English, and two, because they had the perception that services were better.
However, the impact of that was that their needs were not known by the health institutions, nor were they addressed in our region. Subsequently, over time, the situation has changed. English speakers in the region now want to receive services in their community, in their language. Also, Ontario has now limited access to many of their services in order to meet the needs of their population.
Early childhood is a really near-and-dear dossier for us. The result of the Enquête québécoise sur le développement des enfants à la maternelle in 2017 provided valuable insights into the development of children aged 0 to 5. In the Outaouais, there is a higher proportion of English-speaking children who are vulnerable in the areas of physical health and well-being: 23.5% of English-speaking children compared to 12.6% of French-speaking children. The situation is the same in regard to communication skills and general knowledge: 25.8% compared to 21%.
Clearly, additional resources are needed to better understand and address these disparities.
Other vulnerable populations, such as seniors; the LGBTQ community; and persons with mental health issues, addictions and special needs, all face important barriers when it comes to accessing basic information on existing services and navigating a complex health system in another language.
Connexions plays a vital role in supporting the development and adaptation of services in English in our region through its participation on the Regional Access Committee. In Quebec, as you know, the Act respecting health services and social services states that English-speaking persons are entitled to receive English service in health and social services in keeping with the organizational structure and “human, material and financial resources of the institutions providing such services and to the extent provided by an access program . . .”
Despite this guarantee in the law, there remain significant challenges in terms of accessing services. To begin with, there is the lack of bilingual personnel, which is accentuated in our region due to our proximity to Ontario where salaries are higher and there is a demand for bilingual personnel. If you do not have the staff to deliver the services, then you do not have a service.
The lack of awareness of access programs within health institutions results in staff being unaware of their legal obligations and responsibilities to provide services in English. As well, the institution’s capacity to hire bilingual professionals or staff is becoming increasingly difficult to justify, especially in the current political context. In our region, each bilingual position that is posted undergoes close scrutiny and justification and often results in grievances by the unions. This even applies in institutions that are designated bilingual.
Access programs also do not extend to services such as ambulances, groupes de médecine de famille, private clinics, palliative-care homes or service agreements that the institution has with community organizations for services.
The reform of the health care system in Quebec in 2015 led to the abolishment of the regional and provincial access committees for four years and impeded the adoption of the 2015 and 2018 access programs. We have been waiting since 2020 for the new access programs to be adopted by the Government of Quebec. In addition, this reform significantly reduced the number of health boards, which makes it even more difficult to have a voice as a minority community.
Currently, we are looking at another major reform in the health care system, which we will obviously be monitoring closely, but in our experience, each reform in the health care system has brought some type of erosion in terms of access to services in our language and also in terms of our ability to be able to participate within the health system.
The Chair: Will you conclude, Ms. Lanyi?
Ms. Lanyi: I will conclude very quickly with two points.
First, language needs to be a health determinate. It needs to be officially recognized. We do not track statistics or the utilization of services, so how can we know what services they are accessing or receiving services in?
Second, resources for our organizations where we really need to have stability and sustainability given the complex system that we work in and the emerging priorities and needs.
Thank you.
The Chair: Thank you, Ms. Lanyi.
Ms. Callender, the floor is yours.
Tania Callender, Executive Director, African Canadian Development and Prevention Network: Good evening. Thank you, Mr. Chair and committee members, for the opportunity to weigh in on this important issue.
My name is Tania Callender, and I’m the executive director of the African Canadian Development and Prevention Network, also known as ACDPN.
Founded in 2008, ACDPN was created to provide leadership in increasing access to health and social services for members of the English-speaking Black community in Montreal. As double minorities, we face particular challenges with respect to both language and ethnicity, and our community members face barriers that are unique when accessing health and social services. There are real challenges finding resources that are not only available in English but are also culturally relevant. We work to foster solidarity and inter-organizational collaboration across sectors that influence the health and wellness of the English-speaking Black community.
According to a 2016 Census, there are over 50,000 English-speaking Black Montrealers, and we serve community members across 12 boroughs, offering support services, bridging gaps in the public health sector and creating a sense of community.
I have worked in this field for almost 10 years, and while I understand the focus on data and legislation when discussing health care systems, I am here today to make a plea. It is for us to remember that each data point represents a parent, a child, a senior or a youth trying to access care.
I am appealing to you, Mr. Chair, committee members and everyone present today, to think of yourselves, your children, your parents, and think of how scared we all feel when our health is at risk. Imagine what it would feel like to not fully grasp the information that a doctor is sharing about your prognosis or treatment options that are available to you.
ACDPN aims to reduce these instances because they have real-world consequences. In these moments, when we are at our most vulnerable, we need the health care system in which we put our trust to live up to its mission to deliver strong health outcomes for all Quebecers, which is not possible without access.
Minister Duclos himself said that we should be striving for highest standard of accessibility possible. The fact that these services are available in English at certain institutions in Montreal may lead some policy-makers to deem this care adequate. However, these services are not sufficiently available across the island, and to expect that patients can travel long distances across multiple boroughs to access services is not reasonable.
I ask, is adequate access an acceptable standard of care? While the saying goes that nothing is perfect, I submit that when it comes to health care, perfection and not adequacy should be the goal, especially for the most vulnerable amongst us.
Ms. Venita, who is an active participant of our Sunshine Seniors Club, lives alone and does not have any family members living in Montreal. Ms. Venita, a diabetic, went to a hospital to have a routine test, and after being unable to get directions in English, she left feeling both frightened and helpless. The very next day, she was rushed to the hospital, having suffered a hyperglycemic episode.
Unfortunately, her story is one of many stories that we hear. On behalf of Ms. Venita and others like her, I would like to say one thing: In that moment when she was asking for directions in English, she was not making a political statement on language politics in Quebec. She was simply trying to access the care that she needed.
On a human level, we can all empathize with a senior trying to get to her doctor’s appointment, and, as such, we should strive to have a system that puts the human experience at its core. At ACDPN, as we work to reduce barriers to access for community members, we have found effective approaches that yield results.
First, the health care system should invest in community institutional partnerships using community organizations to reach those who are the most marginalized. Also, to improve outcomes, there should be a commitment to developing adapted approaches that meet the particular needs of the diverse populations that we serve.
[Translation]
In closing, I’d like to share my background with you. I was born in Canada, and I am of Barbadian descent. My parents came to Montreal in the 1970s; neither of them spoke French. Despite this, because they wanted their children to be bilingual, they decided to send us to elementary school in French.
Today, I’m married, my husband is francophone, and we’ve made the same choice for our two boys, who also go to elementary school in French. At home, we speak good Franglais. That being said, despite the beauty and richness that the French language brings to us, when I discuss the health and well-being of my children, as a mom, in those most terrifying moments, I need to be able to communicate in my mother tongue. Thank you.
The Chair: Thank you very much, Ms. Callender.
[English]
Jessica Synnott, Executive Director, Vision Gaspé-Percé Now: Good evening, Mr. Chair and honourable senators. Thank you for giving me this opportunity to speak with you on the realities of the English-speaking community of the Gaspésie‑les‑Îles.
My name is Jessica Synnott, Executive Director of Vision Gaspé-Percé Now, a community organization working for the equitable services of our English-speaking minority community.
It is our collective duty to uphold the linguistic rights of all Canadians and ensure that the linguistic minorities, including the English-speaking community within Quebec, have equitable and fair access to services and opportunities.
The English-speaking community of our region is resilient and vibrant, making up close to 10% of the population, and it has contributed significantly to the cultural and economic richness of the region. However, our minority community has faced significant challenges in accessing health services in their language.
The English-speaking community in our region tends to be older — which generally comes with less bilingualism — have higher rates of living below the low-income cut-off, be more likely to have a low educational attainment and, inversely, less likely to have a high educational attainment, and they also have higher levels of unemployment.
These challenges are in addition to the geographic realities of our territory. The region of Gaspésie-les-Îles is five times the size of P.E.I. and only has five hospitals. The region has no designated bilingual hospital, and many specialized services are located outside of the region, which means travelling for health treatments.
To put this in perspective, I would like to ask you to put yourselves in the shoes of our community members just for a moment. Imagine that you have received a diagnosis of cancer from your doctor. The stress is unbearable, and you are told that you will need to drive over 800 kilometres, round trip, to receive the necessary life-saving treatments in another hospital with less English services, and you will need to make this trip every week for the next five weeks.
Imagine that you have spent months trying to explain to your social worker your service needs and things remain unclear to them due to a language barrier. But thanks to the support of a patient navigator, you are able to have your needs understood in less than an hour.
Imagine you are accompanying your mother to a follow-up appointment as she does not understand or speak a word of French, and the doctor doesn’t speak English. The doctor gives a diagnosis of terminal cancer, and as you sit there in tears, your mother is comforting you as she still has no idea what is happening, and you are the one who has to give your mother the news.
These are just a few real examples of the challenges that have been faced by our English-speaking community over the years.
The community organizations in our region, known as CISSS, play a huge role in supporting our regional health providers. We work closely with them to help ensure equitable services to the English-speaking community. Our organizations have worked to implement various projects such as name tags that help to identify bilingual health providers, English-language courses for health professionals and patient navigation services.
Community members often reach out to us when they are unable to access or find a service. Because our organizations are not limited by the Charte de la langue française, we are well placed to support our CISSS, who are restricted by language regulation policies. These partnerships are crucial in ensuring access to health services in English. However, there remain obstacles.
Living in a more geographically isolated area presents a problem in the recruitment of health professionals, in particular bilingual health professionals. We have worked with our CISSS to identify areas that require a high level of bilingualism. However, it remains difficult to fill those positions.
For instance, there are currently 10 bilingual social worker positions that remain unfilled in the region. Also, there are currently no English speech-language pathologists in the region.
One barrier to recruitment of bilingual health professionals is that professional orders require passing of very challenging French tests which discourage many who are considering moving to the region or those wanting to pursue a health career; it can lead professionals to leave the province altogether.
The areas of psychosocial services remain the areas lacking the most bilingual professionals. With the seemingly increasing mental health issues present, this is definitely a concern.
The Government of Canada, including the Senate, has a role to play in ensuring that its official minority language programs and policies consider the challenges faced by our communities in accessing health and social services and continue to foster and enhance the abilities of our communities to work collaboratively and in a complementary way with our provincial service providers. We are counting on your support in ensuring that the minority English-speaking communities’ rights to access health services in their preferred language are protected and upheld. Thank you.
The Chair: Thank you, Ms. Synnott. We will now start our Q&A period.
[Translation]
Senator Mégie: Thank you to all our witnesses online and to those who are here. I am a senator from Quebec. I’ll start with Ms. Callender. I didn’t quite understand your criticism of the person who was seeking care in English. Is that in the greater Montreal area or elsewhere?
Ms. Callender: Yes, actually, it’s in a hospital in Lachine.
Senator Mégie: She couldn’t find care in English in Lachine?
Ms. Callender: Yes.
Senator Mégie: I’m surprised by that. My question is for Ms. Johnson. You mentioned a lot of numbers and percentages. I would like to check with you to see if, in these studies, over the last 10 years, you have seen an increase, a decrease or a stability in the percentage of the English-speaking community.
Ms. Johnson: Are you talking about the number of people? It’s an increase.
Senator Mégie: There’s an increase in the English-speaking population.
Ms. Johnson: Yes. Not in all regions, but overall, yes.
Senator Mégie: Is it more pronounced in the big cities, such as Montreal, Quebec City or any other area that is considered a big city?
Ms. Johnson: Yes, there’s Laval and the national capital; there are a few regions where they have the highest level of increase, but of course, in Montreal and the Montérégie region, we’re also seeing an increase in populations.
Senator Mégie: In the Action Plan for Official Languages 2023-28, it seems to me that 20% of the new federal budget is to be used by English-speaking minorities. In your opinion, among those who are aware of this, does this meet their expectations?
Ms. Johnson: In the past, it was more like 30% of the budget that was allocated to the English-speaking community. From what I’ve seen so far in the action plan, all the amounts allocated to the English-speaking communities are not yet established, but I’m very satisfied with what they have identified for the English‑speaking communities.
Senator Mégie: Thank you.
[English]
Senator Gagné: Thank you for your presentations but also for your commitment to make sure you have healthy communities. I really feel the passion. Coming from Manitoba, living in a French-language community, I understand the challenges your members have in accessing services in their official language.
Access to skilled professionals and health care personnel with the ability to communicate in either official language is a real challenge in all communities across Canada. What would you recommend to alleviate the shortage of bilingual health professionals in your communities or for English Quebec?
Ms. Johnson: The investment that Health Canada made in language training and retention through McGill University is a good step in the right direction. You have to be able to work with francophone professionals who need to respond to the English-speaking community and give them the skills they need to interact with English-speaking patients, absolutely. You have to be able to recruit those bilingual professionals in the community. The investments Health Canada has made through McGill University and the community sector to do that is a great start.
It is going to always be an uphill battle to ensure that you have enough bilingual professionals, but certainly investing in the programs themselves for English-speaking persons in the province of Quebec, ensuring that they have access to bursaries and that they go into the programs that encourage them to stay in and return to the community are things that can be done.
Ms. Lanyi: I think it is a challenge because it is also a systemic problem everywhere. We are talking about salaries and working conditions. Especially in Quebec, or maybe elsewhere, “le temps supplémentaire obligatoire” has been a huge problem. We’ve seen a lot of people, especially post-COVID, who have left the system, not just retired but chosen to do something different. There is that part which we don’t have any control over. I think the McGill initiatives have been really helpful. We have our bursary program for students who are studying. It’s not a lot but it is something.
Once they are hired, it is important to get them integrated into working within a French environment. Sometimes that will deter them if they don’t feel confident working in a predominantly francophone environment, so that can deter them as well. There are definitely the language skills and the whole integration pieces of it.
Senator Gagné: Is there anyone else who would like to respond?
Ms. Synnott: I would like to say that one of the things that might help — as I spoke about, there are very challenging French tests that a lot of health professionals have to pass if they are a member of an order — is determining a way they can integrate into the labour force and health system and delay the French test. From my own personal experience within the health system, when you are in the environment and you are hearing those terms that are applied to your job on a consistent basis, it is really there where you are going to pick that up and learn it. There could be a way to look at integrating the professionals before requiring them to pass that French test.
Senator Clement: Thank you to all of you for your testimony. I appreciate your comments around the fact there is so much diversity within the anglophone English community in Montreal in particular but elsewhere as well. Also, you are tackling the perception around English people being wealthy in Quebec. Very interesting to say that out loud and to talk about that. My questions are for Ms. Callender.
My pop is a Trinidadian Canadian Montrealer who is 101. He smartly raised francophone children. He is in a care home that is bilingual, but when he goes to the hospital, depending on where the ambulance takes him, it is another story. His francophone children and my francophone mom have been instrumental in making sure that he lives to be 101.
I want to ask you about your organization in particular and come back to Senator Gagné’s question. What is your funding model like? You talked about partnerships. What do you need to be more effective? That’s number one. Have things worsened since the founding of your organization in 2008, and in what way? And to Senator Gagné’s point about English-speaking health care professionals, I think you have an interesting partnership with McGill University that you could usefully talk about.
Ms. Callender: Thank you for your question, and congratulations on your dad; it’s amazing.
Senator Clement: It is.
Ms. Callender: To the first question, with regard to what we need, obviously, we need funding support. I think we also need an understanding of the role that community plays in the health care sector. We have a lot of partnerships with institutions, youth protection and otherwise. Getting a seat at the table and having them understand the role, the expertise and added value that community members and community organizations can bring is key. So to highlight the benefits of these types of partnerships I think is something that would be useful.
As far as whether it has worsened since we started, in regard to most of the people we work with in our community and on a day-to-day basis, it feels like things have stayed the same. As I mentioned, there are areas in Montreal where — I live in the West Island, for example. Most likely I will be able to access health care, but it is not guaranteed. Montreal is such an expansive island. I think people underestimate — the fact that we have the Jewish General that offers English services and we have West Island that is bilingual does not create access for everyone, particularly those who are socioeconomically disadvantaged. Travelling and accessing care is not what it should be.
So I don’t know that I would say that it worsened. It feels like it has stayed the same. I think some of the challenges may be different, but the overall experience feels like a hit-or-miss sometimes, depending on where you are. Similar to what you said about the ambulance, depending on where you end up, you may get the services you need or you may not.
And your third question was about McGill.
Senator Clement: Yes, McGill and English-speaking health care professionals or bilingual professionals, really.
Ms. Callender: McGill has been a really great project for us. We have within the retention project reached out particularly to English-speaking Black students who oftentimes need more support, similar to what we said in regard to the integration part. I think just presenting professions in health care as something that is viable, because of all the barriers that were already mentioned, again, the community organization plays a role in supporting the students from the bursary process and all throughout their education.
I have several students who received bursaries who then interned with us whom we have since hired. It is to give them a safe space, a place they feel they can call home throughout their education and guidance throughout their education on their professional journeys. I think programs like that are really helpful for that.
[Translation]
Senator Clement: Thank you.
Senator Poirier: Thank you all for being here today.
[English]
I kind of translated my notes from French to English so I’ll go that route. What I’m hearing from you is a lot like what we are hearing from situations across the country where it is francophones in a minority situation; here you are the anglophones in a minority situation. In reality there is a shortage of health care professionals. There are problems with recruitment and retention of health care professionals. The challenges you are facing, from what I’m hearing, are pretty well the same across the country, depending on where you live and what the language issue is. We know that a lot of the roles in health care are under the provincial level, not necessarily under the federal level.
I’m curious to know in your opinion — and I’m opening up the question to all of you or whoever wants to answer. We always know and we always hear, absolutely, that more money and financial aid are factors that could actually help, and that’s where the federal government can sometimes help in bringing in more funds. But at the same time, if we have more and more funds but we don’t have the manpower, we don’t have the people who can come in and do the work, that is a big challenge.
So I guess my question to you is: How can the federal government help in getting more people to come, whether it is getting people from other countries to come in who are bilingual or who can work in a bilingual environment, either as a francophone or anglophone, depending on the situation? Or is there a role that the federal government can play in maybe encouraging more of our own Canadian youth as they grow older to look into the health care system as a career? Because we are getting into an aging population across the country, and that is a concern. It’s a concern everywhere.
My mother is still with me, too. If I were to bring her, she would refuse to go to the English hospital because she wouldn’t understand a word of what they were saying and wouldn’t be able to communicate. How do we address that? I want to know what other role you think the federal government can play here that can help to address this situation, because money can’t fix everything if we don’t have the people to put behind the money.
Ms. Johnson: I’ll take the first stab, but I’m sure that my colleagues have something to say on this. This standing committee are our champions. You are our champions. Having you support our community I think is extraordinarily valuable, to ensure that we don’t forget about the English-speaking community in Quebec. It is counterintuitive sometimes to talk about the English-speaking minority, but we really do have the same type of reality that francophones outside Quebec are experiencing.
Absolutely, making sure that the funding that is available through the official languages programming doesn’t get lost by transferring it to Quebec, because if you give that money directly to the Province of Quebec, I guarantee you we won’t see much of it or with regard to how it is spent. Being able to provide those resources directly to the community organizations or through McGill University ensures that that funding is having an impact, particularly on community organizations like my colleagues’ here. It is important that you advocate that that continues, that money is invested through the community, and it doesn’t become something where the Province of Quebec controls the funds.
I think, lastly, your concern about having money but no one to do the work is a real one in the sense that we are all experiencing challenges hiring individuals at the moment, but we can’t let that be a reason to not take action and move forward. I think we really have to make sure that we can pay adequate salaries so that we can keep people. Community organizations are notorious for underpaying staff. So if we are able to have the resources that allow us to pay competitive salaries, then we can keep the personnel and we can keep them in our communities.
People want to work for the English-speaking community. They want to support the people who are in their community, but if they are offered $10 more in a different setting, it is hard for them to justify staying.
Senator Poirier: Does anybody else want to answer before I go to my second question?
Ms. Callender: I’ll add something. Just to press a little bit on what Jennifer Johnson said about the role that community organizations play and being able to pay to retain our staff, I think it is that piece about us being closest to the community. We know what the community needs. We are day in and day out with them. I think the understanding or the promotion of community organizations as key players is something that could be done a little bit more. With that would come I think the respect of the work they do. Particularly in our community, in the English-speaking Black community, a lot of our community organizations do not have adequate funding. So to work in a community organization, to support your community in this way, is essentially a sacrifice. I think, to Ms. Johnson’s point, more funding would change that and would encourage more people to be of support and of help. We are the people who can arguably help the most.
Senator Poirier: On the retention side, how are you guys doing? What percentage of the people who you are able to recruit are you able to retain?
Ms. Johnson: I think it depends on the region. I would imagine that the urban centres probably have a better retention than — maybe Jessica could comment on this.
Ms. Synnott: At our community organization, I have to say that we have been lucky in terms of having a stable staff. We have the opportunity to provide more flexible hours and work‑life balance. I think that would be the biggest draw for us.
We do have newcomers to the province who have come to work for us and who don’t speak French. We provide the environment for them to be able to work and not have to come in right away with a high level of French. As an employer, we offer the opportunity for them to learn French during work hours and to improve on their French. We try to set it up to make it a good working environment, and it has worked so far.
The Chair: Thank you very much.
[Translation]
Senator Moncion: According to section 29.1 of the Charter of the French Language, the Office québécois de la langue française has the authority to recognize a health and social services institution where it “provides services to persons who, in the majority, speak a language other than French.”
[English]
According to the website, 12 of these institutions that offer health and social services are on the Island of Montreal. They have to offer complete services to the population in a language different than French, so we presume it is English. That’s on the website, but they said that is in Montreal.
I would like to know if in Pontiac and Outaouais you have similar information, and I would like to know if it is the same for Gaspésie.
Ms. Lanyi: The municipalité régionale de comté, or MRC, of Pontiac is designated bilingual. That means that all of the institutions need to provide services in both languages. As well, in the MRC des Collines, only the Wakefield Hospital is designated bilingual. The rest of the institutions are indicated as per the access programs.
I can tell you that the challenge in providing services in both languages is still great. In the Pontiac they are still struggling. It is hard for them to recruit any kind of professional because there is a lack of housing as well, so it is hard to bring in new employees. The Wakefield Hospital is a small hospital. I know that for a while the only doctor on call could not speak one word of English, and that’s in a designated institution.
As Ms. Callender said before, it is hit-and-miss. It’s important to remember that, even though it is designated, it depends on the available resources and on the person who is doing the staffing and whether or not they know what an access program means. There are still many who don’t even know what a designated or indicated institution is.
Ms. Synnott: As I mentioned, in the Gaspésie–Îles-de-la-Madeleine, there is no designated institution. The closest would be Jeffery Hale Community Partners or Saint Brigid’s Home in Quebec City, which is over 800 kilometres away. It’s not an option to say, “I can’t go to this hospital because I’m not going to get served in English. I’m going to go down the street.” Unfortunately, it is not like that.
However, we do have a close partnership with our health establishment, and they do strive, to the best of their ability, to offer services in English as much as they can. When they can’t, we try to help the community members.
One of the services is a project known as Patient Navigator, where there is someone who accompanies and translates. However, right now we have one person to serve the entire Gaspé coast, which, as I mentioned, is fairly large.
In terms of publicity of different services within our health system, as they cannot publicize in English, we also take that on.
We also have the Regional Access Committee, as Danielle Lanyi mentioned. We have an access plan for the region. We have worked with our health establishment to identify a number of positions within the establishment that require a high level of English. Thankfully, this did not have much fallout from the union.
I would say that, luckily, the health establishment in our region is a very open system. However, they have constraints because they are not a designated bilingual institution.
Senator Moncion: Thank you for your answer. How would you become designated?
Ms. Synnott: I believe that over 50 per cent of your region must be anglophone, and we are at 10%. Ms. Johnson can correct me if I’m wrong on that percentage.
Senator Moncion: I will say that you are “lucky” — I put that in quotation marks — because you have access to an individual, and it seems that in New Brunswick they have access to computers. I guess there is a little more humanity associated with having someone who translates.
Senator Dalphond: To follow up on the questions from Senator Moncion, the Gaspé Peninsula community has difficulty in terms of access to specialists. I understand that the government has put in place some programs in the northern islands where specialists are flying in for a week or two to provide basic coverage instead of bringing the patients to Montreal or Quebec City.
Is there a similar program for anglophones where if you need services that are not provided in the region because they don’t have specialists, you would have to fly to another city and be directed to a hospital that provides English, such as CUSM, Centre universitaire de santé McGill, Montreal General Hospital or Montreal Children’s Hospital for children suffering from cancer or leukemia or things like that?
Ms. Synnott: Yes. At the CISSS de la Gaspésie we have a corridor of service, as they say. Typically, the farthest that patients are sent would be Quebec City. However, if services are not available in Rimouski or Quebec City, they will cover the charges to travel to Montreal. It does happen with some children’s services. There have been a handful of times when they have had an entente with New Brunswick. They do strive to ensure that there are services.
For I don’t know how many years, children with behavioural issues who needed to be placed in an anglophone establishment had to be sent to Batshaw in Montreal. However, the CISSS de la Gaspésie worked hard to ensure that whoever they hired at the centre here in Gaspé was bilingual, so that has since been remedied. It’s a long answer to your question but, yes, we are sent to the English services if there are none closer.
Senator Dalphond: Thank you.
[Translation]
Senator Mockler: I’m interested in hearing what you have to say about the health reform that’s going to take place in Quebec. You said that you would follow it very closely.
What are your thoughts on the reform? What are the determining factors that you’re going to follow in order to protect our community?
Ms. Johnson: Would you mind if I answered your question in English?
[English]
The main challenge that is proposed by Bill 15 is the erosion of the influence of the English-speaking community and its institutions. They are eliminating the boards of directors of all the local institutions; they will no longer exist. We used to have a representation on those boards but that is not being replaced.
Regarding Santé Québec, there is no representation of the English-speaking community or of any community identified yet in Santé Québec. As the law is written right now, the access programs will be developed by Santé Québec and not by the regional institutions. We’re not sure if the influence of the community, the local reality, is going to be part of the development of those access programs in the future. That is very concerning.
Regional access committees are no longer going to exist. They are not mentioned at all in the legislation. In the law, each institutional council can develop a committee at a local level, but it is in competition with all of the other interest groups: employees, other populations, et cetera. There is no guarantee that the English-speaking community can have representation at the institutional council level.
Senator Mockler: What are your expectations of the Quebec government’s action plan? What do you think about the investments in health transfers announced in Budget 2023? Should they have a linguistic lens?
Ms. Johnson: It is unrealistic, I think, to think that Quebec would put a linguistic lens on those transfers.
There is only one official language in Quebec: French. Ms. Lanyi, do you have anything to say?
Ms. Lanyi: Exactly. The language of work in Quebec is French. I agree with Ms. Johnson. It would be unrealistic to expect that there would be something there.
What hasn’t been mentioned here today is that what we need to see are more inclusive policies that include the English-speaking community, but there are the cultural communities also. We have come up with some ideas for having pictograms in the hospitals, regardless of whatever language you speak.
Yes, in terms of the budget, we accept what is going to be there. That is why our federal funds are so important.
The Chair: Thank you. Thank you, colleagues, for your questions.
Thank you for your comments. We heard from you that it is true that we think your communities have great post-secondary institutions and great hospitals; there is a perception about that. At the same time, however, we heard from you that there are systemic problems within the system.
You are the key players on the ground, and funding for your organizations is important. Also, the relationship between the federal government and your organizations is important for the future of the services that you will deliver and that you are delivering.
I want to thank you for that. As Senator Gagné said, I want to thank you for your engagement, for your passion around official languages and, in particular, for your official language. Thank you. It will help our report for sure.
[Translation]
Thank you very much, colleagues. We’re going to finish with the witnesses, but I would remind you that we have an in camera session.
(The committee continued in camera.)