THE STANDING SENATE COMMITTEE ON OFFICIAL LANGUAGES
EVIDENCE
OTTAWA, Monday, November 6, 2023
The Standing Senate Committee on Official Languages met with videoconference this day at 5:04 p.m. [ET] to study matters relating to minority-language health services.
Senator René Cormier (Chair) in the chair.
[English]
The Chair: I’m René Cormier, senator from New Brunswick and 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 with the deputy chair of the committee.
Senator Poirier: Good evening. Rose-May Poirier from New Brunswick.
[Translation]
Senator Mégie: Marie-Françoise Mégie, senatorial division of Rougemont, Quebec.
Senator Clement: Bernadette Clement from Ontario.
The Chair: Thank you. Welcome, colleagues, and welcome to our viewers across the country.
[English]
I would like to point out that I’m taking part in this meeting from within the unceded territory of the Algonquin Anishinaabe Nation.
[Translation]
Colleagues, we’re celebrating National Francophone Immigration Week, which is being celebrated across Canada this week in early November. Together, we celebrate the valuable contributions of French-speaking immigrants to our francophone and Acadian communities.
The Standing Senate Committee on Official Languages studied francophone immigration to Canada a few months ago, and we heard directly from these communities. The message was unequivocal: immigrants play a crucial role in maintaining the strength and vitality of Canada’s francophonie.
In March, our committee made a number of practical recommendations to strengthen Canada’s francophonie. I invite all of you who listen to this committee to read this important report, which you can find on the Senate of Canada website at sencanada.ca. Thank you.
[English]
Tonight, we continue our study on minority-language health services. For our first panel, we are pleased to welcome representatives from the Quebec Community Groups Network, Ms. Eva Ludvig, president, and Sylvia Martin-Laforge, director general, are joining us via video conference. Good evening, and thank you again for being with us. Thank you for your contribution to the work of our committee. We now are ready to hear your opening remarks, followed by a question-and-answer period.
Ms. Ludvig, the floor is yours.
Eva Ludvig, President, Quebec Community Groups Network: Good afternoon, Senator Cormier — or should I say good evening, as it is dark outside — and Senator Poirier and honourable members of the committee. I’m Eva Ludvig, President of the Quebec Community Groups Network, or QCGN. It is a pleasure to be back before you as you study minority-language health services.
With me today I’m pleased to have Sylvia Martin-Laforge, our director general.
Earlier this year, the Community Health and Social Services Network, also known as CHSSN, testified in this study and provided you with an excellent brief describing the demographics of English-speaking Quebec and the reality we face in health and social services.
We also draw your attention to this committee’s 2011 report, The Vitality of Quebec’s English-speaking Communities: From Myth to Reality, which remains an important and relevant piece of policy research related to your current study.
The QCGN would like to focus its testimony on the inclusion of language clauses in federal health transfers.
I would like to begin by commenting on the stubborn level of myth surrounding life as a member of English-speaking Quebec. One enduring and particularly troubling myth often repeated by Quebec francophone parliamentarians is English-speaking Quebecers have access to health and social services in their language across Quebec through a network of English institutions. There are currently 12 health and social service network organizations, largely concentrated in the Montreal region, recognized by the L’Office québécois de la langue française as having special status under the Charter of the French language, or Charte de la langue française, that may communicate in a language other than French. All must provide services in the official language of Quebec. These are, in fact, bilingual institutions.
Moreover, as our brief points out, the right to access health and social services in Quebec in English has important limits. English services are not available in all institutions. What services are available are contained in access plans that are not easily accessible to the public, nor are they understandable to the average citizen. There are no posters or signs in institutions that tell patients what their rights are. Accessing services in English in Quebec is a voyage of discovery — a voyage with no map and no compass.
Sylvia Martin-Laforge, Director General, Quebec Community Groups Network: Members of this committee who participated in their historic study on English-speaking Quebec heard first-hand that this is simply not the case.
[Translation]
We heard heartbreaking stories of couples who had been married for a very long time, who had to live apart and end their lives in long-term care facilities, CHSLDs.
[English]
This is because they could not be accommodated together in English. There are stories of English-speaking mothers from remote regions travelling to hospitals alone to give birth in institutions that were unable to provide services in English.
The recently modernized Official Languages Act contains new obligations on federal institutions when negotiating agreements with the provinces and territories. Institutions must:
. . . take the necessary measures to promote, when negotiating agreements with the provincial and territorial governments, including funding agreements, that may contribute to the implementation of the commitments . . . .
This is to, amongst other things, enhance the vitality of English and French linguistic minority communities. Moreover, there are additional and clearer duties to consult with official language minority communities in the development of these agreements.
Finally, there is a new evaluation and monitoring provision contained in the act that requires institutions to establish mechanisms to track positive measures taken with intergovernmental agreements. New obligations under Part VII are imposed on the federal partner when entering into intergovernmental agreements. This is seen as an opportunity.
First, the Government of Canada has a duty to consult with English-speaking Quebec during the process of negotiating intergovernmental agreements to identify positive measures. The agreements themselves must contain positive measures, which are now subject to evaluation and monitoring.
English-speaking Quebec has an established consultation mechanism with Health Canada and the Government of Quebec to communicate our health priorities. The Community Health & Social Services Network, or CHSSN, a trusted community partner, is a key part of this process. The opportunity now exists to ensure that these priorities are reflected in the text of the Canada Health Transfer agreement. Moreover, the positive measures that enhance our community’s vitality within this sector must be transparent and accountable.
The Government of Canada must avoid or at least mitigate the negative impacts of its actions on the vitality of English-speaking Quebec. However, the English-speaking community of Quebec sees no conflict between the Government of Canada’s obligation to enhance the vitality of our community and the commitment to protect and promote French.
There is no case to be made that ensuring health and social services are made available to people in need in English in Quebec in any way threatens the French language.
Ms. Ludvig: Thank you. We look forward to your questions.
The Chair: Thank you so much for this presentation.
[Translation]
Senator Mégie: Mr. Chair, may I add something?
The Chair: Yes, please. Ladies and gentlemen, I would like to point out that we have quorum at this time. However, in order to secure our ability to meet should one of us ever be absent, I should have asked at the start of the meeting that a motion be proposed to ensure that if we lost quorum today, we could continue to hear witnesses and report back.
This is a procedure that exists elsewhere. So, Senator Mégie, do you have a motion to move? I apologize to our witnesses.
[English]
Witnesses, we will be with you in a second. We just want to make sure that we can be with you for the whole hour.
[Translation]
Senator Mégie: I move that, notwithstanding usual practice and in accordance with Standing Order 12-17, the committee be authorized to hear testimony this afternoon in the absence of a quorum, if necessary, provided that two members of the committee are present.
The Chair: Very well. Is this motion clear to you, colleagues? Do you give your consent?
Some hon. senators: Yes.
The Chair: Thank you very much, Senator Mégie. We can continue and we’ll start the question period.
[English]
We will start with the deputy chair of the committee, Senator Poirier. The floor is yours.
Senator Poirier: Thank you both for being with us today. I have a couple of questions, and if time allows, I may come to a second turn.
I’m not going to start at the first question. I’m going to jump down, because you talked about the health transfers, and I had a question in and around that.
We’ve heard of multiple incidents where English-speaking Quebecers are denied health services in English. Why do you think this is happening more and more? Because we’re hearing that this is happening more and more. How could the federal government work with the Quebec government to ensure that these incidents don’t repeat themselves or get worse?
Ms. Ludvig: I can start. One of the ways that services are provided, as we mentioned in our document, is through access programs, which are not very well-known, as we also mentioned. It is complicated. It has taken many, many years to get these access programs approved. They were just approved very recently.
They are not necessarily well-known in institutions, so we have providers who don’t know their obligations, and we have patients who don’t know their rights. These are some of the obstacles.
Then we also have institutions that don’t have the capacity to provide services in English, especially outside Montreal. It’s a wide series of complex situations that requires attention and which we hope the federal government will help us with when working out transfer agreements with the Quebec government.
Senator Poirier: Explain to me what the first thing is, other than through the health transfers. What can we do immediately? If you’re saying that there is this pilot project or access program out there, and, obviously, there are some people who don’t know about it or know that the program exists, what can we do in the meantime until everything happens to make this more knowledgeable out there so that people would be aware of it?
Ms. Ludvig: Let me clarify. This is not a pilot project. It has been in place for a long time.
The problem is that it requires the approval of the provincial government, the access programs. It identifies each institution’s obligation and how it’s going to be providing access to the English-speaking population.
It has taken a very long time for these access programs to be approved. They have now been approved, and certainly the federal government can help in providing a means of promoting the information — I believe that is in their purview — and helping to promote the knowledge to make sure that the rights are known by patients.
We talked about how there’s no signage and there’s no information provided to patients. That certainly can be one way.
I will let Sylvia continue on that.
Ms. Martin-Laforge: Senators, a broader context in trying to understand what our rights are recently is certainly the introduction to the changes to Bill 101 and exemplary services. The English-speaking community has repeatedly said to the government that they are worried that their services in health institutions will in some way be curtailed. The access programs are there. There’s a section also guaranteeing services to English-speaking Quebecers.
But with the advent of Bill 96, there is a worry that one of the aspects of the bill — in terms of exemplary services, in terms of human resources specifics, even to bilingual institutions — will in some way compromise our access to high level of access to services. So awareness is incredibly important. What we can expect, what we should expect and what we must expect is at play here with the amendments to Bill 101. There’s misinformation about that as well.
The Chair: Can I ask a supplementary question? It might sound obvious, but what are the access programs, what are they comprised of? This is so we can understand what the challenge is here.
Ms. Ludvig: Yes. This is under provincial legislation, created at a provincial committee made up of community representatives that sit down and work with government representatives to develop programs for each institution as to how they can provide services in English to English-speaking clientele or patients. These access plans are then approved by the government. Once they become approved, then each institution is to implement it. The understanding is that the institutions are varied throughout the province. They each have different capacities, and they will each find different ways of providing services. The important thing behind this is that it’s adapted to each individual institution to make sure they are capable of doing that.
Whether they are implemented — and implemented in a proper fashion — is what’s in question here. As I mentioned, two things are at issue here: Do people know what their rights are? And then do the employees know what their obligations are, and do they have the capacity? Do they speak English well enough to be able to provide the services?
This is when the rubber hits the road, and this is where we find that there are problems.
Senator Poirier: To follow up on that, we’re hearing that more and more of the problem is the anglophone community are being denied health services, so I’m questioning if the access program, which is provincial, I understand, is not working to the extent that we would hope it would be working nowadays, is there anything the federal government can do that would enhance or help that? Would it be by changing the mandatory language clause in the health transfer? Would that help at all? What would help? What would you recommend at this point?
Ms. Ludvig: One of the important things in the transfer programs is the accountability of the provincial government to follow through with its responsibilities in implementing the agreements and consulting the community, which is also very important. These are things that we are hoping to see in the new transfer agreements with the province. Our experience with other transfer agreements has not been as positive as it should be.
Senator Poirier: We’re trying to see which way the federal government can help. If I’m understanding correctly, then the health transfer agreements have a key role to play and that the government can play; am I right?
Ms. Ludvig: Absolutely. And follow up to these agreements to make sure they’re implemented.
Senator Poirier: Thank you very much.
The Chair: I will ask a question. You spoke about Part VII of the modernized Official Languages Act. As you know, federal institutions must now promote inclusion of language clauses in federal-provincial-territorial agreements that could, for example, affect the health sector. We know that. We know that the details of this new obligation will be set out in the forthcoming regulation. When she appeared before this committee, the President of the Treasury Board suggested that the process of developing and implementing a Part VII regulation could take a few years.
What are your specific expectations for the forthcoming Part VII regulation implementation, especially with regard to language clauses, but other issues that you would have? What would you say around the regulation that will have to be taken, of course, and is so important for the implementation of Part VII?
Ms. Ludvig: Yes. As you know, Senator Cormier, we ourselves had a lot of concerns about the modernization of the Official Languages Act. We are very anxious to see and to make sure, because we are counting on these regulations; the reassurances that we have received regarding our rights are that they will be respected and that the regulations will confirm this. Now you get me worried when we’re talking about years and years, because we expect that it be done from day one.
The Chair: The government has to consult, right?
Ms. Ludvig: Absolutely.
The Chair: Have you been consulted, or have you been speaking with either Minister Boissonnault or Minister Anand on this regulation?
Ms. Martin-Laforge: Yes, we have been consulted. We have met with Minister Boissonnault, but not Minister Anand yet.
In the regulation, we will be specifically looking at the beginning of this understanding of an asymmetrical approach. There must not be an asymmetrical approach in the way that Part VII is envisaged in terms of accountability and transparency. If the Government of Canada does believe that asymmetry is the way to go from a legislative perspective, it must not have a negative impact on our community. I would say that in any other province, there is a danger in approaching Part VII and the regulations from an asymmetrical approach.
There needs to be a principled approach to Part VII in terms of impacts on any minority community, and of course we’re speaking in favour of you looking at how you will be dealing with linguistic clauses or any other measure in terms of Part VII with Quebec. We are concerned.
The Chair: I understand. What could you tell us about positive measures? What are your expectations specifically concerning positive measures for the English minority in Quebec? Do you have specific ideas or needs that you’re asking for so we can understand how concretely it could help your communities?
Ms. Ludvig: Positive measures mean that you know the community, that you consult the community and then you respond to the needs of the community. An institution doesn’t decide that it is a one-size-fits-all and the English-speaking community itself is not homogeneous.
Communities out in the far regions, such as the Lower North Shore or Eastern Townships, have different needs than those in Montreal. Each of those needs has to be taken into consideration and applied. And it is not to use one model — a model that may have been defined perhaps for Ontario, Manitoba or Newfoundland — and then to apply that to the English-speaking community in Quebec.
To me, that is a fundamental basis for a positive measure. And then afterwards, it is to respond to those needs appropriately and sufficiently — the appropriate funding and follow-up to it, and all the other parts of the administration to ensure the community’s vitality, each of the different parts of the English-speaking community. It’s a big community. We’re over 1 million in one province, dealing with one province, yet we have different needs in different areas. Some of those needs are more dire than others, depending on where they are and the kinds of services that are available to them.
Ms. Martin-Laforge: I think that special measures are patient outcomes and the workers in our community. A myriad of factors should be considered in ensuring that the health sector in Quebec is tooled to give services to the English-speaking community. Certainly, patient outcome is very important, but everything else in the sector, the whole infrastructure piece, has to be considered.
Senator Poirier: Often we hear that one of the issues we have sometimes is lack of manpower to offer the services everywhere in the province in both official languages. We hear the same comment in reverse when it’s the rest of Canada, where it’s the francophones who are in a minority situation where there’s a lack of manpower.
I’d like to know your thoughts on this: We’ve heard through the committee that the Community Health and Social Services Network and the Connexions Resource Centre explained how Health Canada’s investment at McGill University is helping.
Could you let us know if there’s anything else you think could be done to help integrate McGill’s graduates from the medical facility into the Quebec environment in order to retain them in the province instead of having them move away?
Ms. Ludvig: As mentioned, it has been a successful program. By and large, we are producing health care workers who are able to work in French and English. The problem is more about having health care workers who can provide services in English. When I say “health care workers,” I’m not just talking about doctors and nurses but about speech therapists, psychologists and psychiatrists, especially outside Montreal and in remote regions. That is an important area that needs to be studied further and supported, and the federal government can play a role in that.
Senator Poirier: When we talk about health services, we don’t just talk about clinics or hospitals. In my point of view, we always include the nursing homes and special care homes.
Is the problem for the anglophone community equal among all those health institutions, or is it worse when it comes to the special care homes, specifically in the smaller communities? If yes, what suggestions can you provide in terms of what the federal government could do to help?
Ms. Martin-Laforge: Let me tell you that I’m on the board of Chez Doris, a women’s shelter where 25%, if not more, of our clients’ first official language spoken is Indigenous or Inuit. The pressure to get staff is incredible. They have to speak English. We have to remunerate them properly. We are in competition with old age homes and other places — not hospitals — that offer health care services. The broadening of our understanding of what needs to be done for the homeless, the elderly and autistic children is terrifically important.
There is a link. Last year, the expansion at Dawson College was cancelled. There was going to be training for health care services.
The federal government has a responsibility, I believe, to look at what is happening in the province and see where programs exist and where programs are needed to ensure we have the infrastructure required to serve the vulnerable, the sick and the elderly. That is an important thing to do.
What is needed as well is an understanding of the traditions and culture, certainly for the Indigenous who speak English. Those people have to come from an English-speaking place to be able to understand and to give the right service at the right time.
McGill is terrifically important. The attraction from outside of the province and from other countries of people who have a tradition of speaking English to patients is — [Technical difficulties] — needs to be connected to the culture. It’s not just about the language; it’s about the tradition and the culture.
Senator Poirier: With technology nowadays, it’s important for specialists and different clinics to help out in a virtual environment. Is that something the federal government can help with? Is that efficient in Quebec at this point, to be able to reach out through technology?
Ms. Martin-Laforge: It’s situational. We need a hug sometimes. Technology won’t give us that hug.
My mother was francophone, but she raised me in English. She sang songs to me in English when I needed comforting. When I can’t speak French anymore, I’m going to need that hug by somebody who can sing “Mother Goose” to me or something. Technology, absolutely, but let’s not just rely on technology. I don’t think you meant to say that either, senator.
Senator Poirier: I’m from New Brunswick. There are certain situations where now your whole medical history is online. No matter where you go, any doctor can click to it and get it. When it’s a remote area, if there’s an emergency or something comes up, sometimes you cannot get a person in the language of your choice to respond right away. The next solution is to do it in another way in order to at least get the answers and the help in an immediate situation or important emergency. I was wondering if that technology was available. Technology never replaces a human being as far as I’m concerned.
[Translation]
Senator Mégie: Thank you, witnesses, for being with us.
Do you have any data showing that there is a truly observable difference between the accessibility of health care for the English-speaking community and the community in general? Do you have any data on that?
[English]
Ms. Ludvig: There are many studies. I don’t have anything right now in front of me, but I do know that the CHSSN, which appeared before you a bit earlier, does studies, and they are funded by the federal government specifically. They do studies and it’s certainly something that we can make sure you receive. If you don’t have access to that, we can make sure that you receive that afterwards.
[Translation]
Senator Mégie: It would be interesting to receive this data.
The English-speaking community has difficulty receiving certain types of care, but what I hear about in Quebec is always the labour shortage, among other things. Is the situation the same or more difficult for the English-speaking community compared to the general community when it comes to obtaining care? The community in general complains that it doesn’t get enough care.
If you have any data that proves or illustrates this, we’d like you to share it with the committee.
I have a question for Ms. Martin-Laforge.
I think you were the one who mentioned earlier that there was a couple or couples who had to be placed in different CHSLDs, because some of them can’t offer services in English.
With regard to the people who have lodged complaints, have any efforts been made to find a solution to this problem? Are there other challenges specific to Quebec, in addition to what you’ve just described?
Ms. Martin-Laforge: The challenges in the health care field are real for the majority francophone and English-speaking communities alike. There’s a shortage of spaces, waiting lists are long, the needs of a man and a woman who want to live together are sometimes different, and the same services aren’t offered in all establishments.
The health care sector is complicated throughout Quebec. We hear a lot about it. The added difficulty is language. Health care problems affect everyone, but language-related problems become even more complicated. Often, choices have to be made; families have to make choices.
I have some personal anecdotes to tell. The CLSC staff who come to care for a parent speak to us in English and French. It’s important for that person. But it’s not the same in every CLSC. Should we expect equal service across the province, whether for young people with disabilities or the elderly? The health care system has issues, but language is a particular problem.
Senator Mégie: Thank you. May I ask another question?
The Chair: Of course.
Senator Mégie: I’m going to change the subject. I’m going to talk about private facilities. I know that in Quebec, people often turn to private health care.
How can governments ensure that Quebec’s English-speaking communities don’t suffer from the privatization of health care? Have you thought of a solution or do you have any proposals to make?
[English]
Ms. Ludvig: I believe that’s a problem for all Quebecers. Privatization has had an impact, depending on your financial ability, on the ability to access rapid services, adequate services, to not have to wait for a long time. That’s a problem for all. Again, as Sylvia mentioned, even in this area, it becomes problematic when you introduce language as a part of the problem. I think that’s a concern for all Quebecers, francophones and anglophones in privatization, and whatever solution is to be found, I think it’s important for all Quebecers to have that solution.
[Translation]
Senator Mégie: All right. Thank you, senator.
Senator Clement: Good evening, ladies.
[English]
It’s good to see you again. Thank you for being with us. I think personal anecdotes are important. I’m listening to you, and I have to tell you, I live with a lot of intersectionality — a very busy intersection, actually. My father is a Black anglophone Montrealer and speaks with a Trinidadian accent. That has been an issue in terms of his being able to get services not only in English, but there’s cultural competency as well.
I’m wondering if you’re aware of groups that work particularly on that intersectionality, whether you work with them, who they are and how connected they are to the provincial or federal government. I just want to know who is out there and who is concerned about that kind of intersectionality. That’s my first question.
Second, I was in Montreal on the weekend with the anglophone side of my family, and the anglophone community in Quebec feels embattled. The announcement of the tuition fees for non-Quebecers in universities has everybody reeling. I wonder about the effect of that on anglophone Quebecers, and the ability to fight and request respect for rights.
Ms. Ludvig: First of all, let me just tell you that I don’t think you’re alone in intersectionality.
Senator Clement: I don’t say I am.
Ms. Ludvig: I’m saying that is becoming more and more common, which is why we, as a society, have to respect the diversity of our community and the needs, and that diversity includes language. There are many community organizations that understand this. Some of them are part of the Quebec Community Groups Network. We have different organizations that are part of it, coming from different groups, and the commonality in our organizations is the English language.
Certainly, the more diverse you are, the more complex your needs are, diverse in terms of whether it be an accent or language, culture and so on. I don’t think as a society here, at least not in Quebec, and I can’t speak for the rest of the country — but certainly we have not yet come to terms with that and taken on that responsibility. We see that with the English-speaking community.
You speak about your experience with your family members in Montreal, and I have to tell you, my experience, and what I’ve seen more and more, is that the English-speaking community is worn down and tired. It’s becoming more difficult to have some sort of optimism about our needs being taken into consideration. Will we receive the respect we want?
There is new legislation regarding health, Bill 15, which is now before the National Assembly. We are organizing a webinar to inform the public about this specifically, and again, we’re going towards more centralized health services, which removes it from the community, removes it from reflecting or understanding the needs of the community into the hands of a centralized bureaucracy that doesn’t necessarily understand. So we’re removing local control and local input, and this is concerning.
When you have a diverse community — including language, but other parts of diversity — a government has to be able to respond to that in an appropriate manner and to respect that. We in the English-speaking community do not feel that has been the case in the past few years; and yet, we must continue to voice our disagreement to ensure that our rights are respected, and we at QCGN intend to continue that.
Senator Clement: The situation in Quebec is quite unique, obviously. Do you look to other provinces or jurisdictions for inspiration anywhere in terms of what to propose in response to Bill 15 or what to propose in response to some of the issues?
Ms. Ludvig: We have always looked to our friends and colleagues outside Quebec, the francophone minority communities. We feel we have a lot in common with them, even though our languages are not the same. The protection of English is perhaps a different issue than protecting the English-speaking community, whereas French across Canada needs greater protection, not just the communities themselves.
We look at models out there to inspire as to what can help us, but the realities in Quebec are quite different. We are dealing with a different type of government approach, and of course, there’s the complexity of the fears which are sometimes stoked regarding the future of the French language or the health of the French language. We as an English-speaking community certainly support and understand the need to protect French, but we want our rights to be protected, and we want to be respected as an integral part of Quebec society.
That’s where our challenge comes; it is in health, in education and the protection of our institutions, such as our universities, our CEGEPs and our hospitals. We face these existential challenges daily in Quebec.
Senator Clement: That’s the right word.
The Chair: I have some questions too. I want to hear you about the 2023 to 2028 action plan. Do you think that the funding provided in the current action plan is sufficient to meet the needs of Quebec’s English-speaking communities? Do you have something to say around that action plan, which is important for communities to be able to receive and deliver services?
Ms. Martin-Laforge: We know quite a bit about the action plan in terms of how it will be used across Canada, and we do know what is being funded through Health Canada. Of course, CHSSN always wants more, but it was well represented in the action plan.
Over and above what is being given for Health Canada, there are other areas in terms of transfer funding that we might worry about. There is more money in transfer payments, other than in health. We can’t quite yet figure out how much the English-speaking community of Quebec will get. There’s a target of 20%. Is 20% enough? How long is a piece of string? Sometimes it’s not just about the amount, senators; it’s about how it’s used and if there is that accountability and transparency.
[Translation]
That’s the killer question.
The Chair: Yes.
[English]
I understand. Thank you.
We’re almost at the end, but I will try to be clear in my question. We know that Montreal is a specific region, that it has its own reality and challenges. Personally, I feel I know more about the situation in Montreal than elsewhere, and I’m lacking information and witnesses that could show us the reality concerning health services in Gaspé, in the different regions. You know what I mean by that. The perception is that, of course, you have all the hospitals and institutions.
Do you have any suggestions — maybe you can think about it — of whom we could hear from, people living in rural communities who could speak to us about the issues that you’re raising tonight? The questions that Senator Mégie asks about data are also important. We need facts and to be able to understand through testimony.
For me, that’s my personal concern. I would like to make sure that in this study, we understand and hear people who go through issues in rural regions, because that is different from Montreal. We know a bit of Montreal. Of course, we can always know better.
What can you tell us? If you don’t have any suggestions tonight, do you think you could help us to ensure that we meet people from rural communities?
Ms. Ludvig: Absolutely, and I think it’s critical for you to do that. I have travelled throughout Quebec. I’ve been in the Gaspé, the Lower North Shore, west Quebec, east Quebec. I have met English-speaking people and understand that those challenges are very different from my challenges in Montreal, especially when it comes to health services.
It’s an aging population out there, much more so than here. It’s a more homogeneous population. As part of a community, for instance, in the Gaspé, local people providing services are full of goodwill. It is not because people don’t want to provide the services. They don’t have the means to be able to provide the services that these English speakers require, especially older people who tend to still be unilingual or not comfortable in French. And then, because of the way the health system is organized, somebody from the Gaspé finds themselves in a hospital in Rimouski where nobody speaks English to them. As an older person, it becomes difficult.
There is a large population of English speakers on the Lower North Shore, an historical population that is on the border with Labrador, who have to leave their homes and fly out when they need services in English. Mothers have to leave when they are pregnant. A month, two months before their delivery date, they have to fly out and stay in Rimouski, or wherever they may be sent, where it’s not possible to have services in English. It’s an excellent idea for you to be able to hear from these people. Certainly, we at QCGN will see what we can do together with CHSSN to see what we can to find people who can better explain these to you than I can.
The Chair: We’re taking the lens of the federal government here to see what the federal government can do in its agreements with the provinces and territories, but that’s the purpose.
I want to thank you again for your contribution to this committee. We always more than enjoy it when you come. We get good information and it’s important for our report, for Canadians and Quebecers to make sure that we have a good report on this. Thank you so much.
[Translation]
Colleagues, we’re continuing our study on minority-language health services. Before we introduce the second panel, I’d like to remind you to refrain from leaning too close to the microphone or removing your earpiece. This will avoid any feedback that could have a negative impact on the staff. Thank you.
For our second panel this evening, we are pleased to welcome representatives from the Fédération des communautés francophones et acadienne du Canada, Liane Roy, President, by videoconference, and Alain Dupuis, Executive Director, who is here in person.
Good evening, and welcome to you both. Your participation is always much appreciated. We always receive very pertinent information. I’ll turn the floor over to you, Ms. Roy, and then we’ll have a question period. The floor is yours.
Liane Roy, President, Fédération des communautés francophones et acadienne du Canada: Mr. Chair, honourable senators, good evening. Before I begin my statement, I’d like to point out that I’m joining you this evening by videoconference from a hotel where the network is a little unstable. Should we lose the connection, my colleague in the room will be able to continue.
Thank you for inviting us to testify before you today on a subject of great importance to the francophone and Acadian communities. As you know, Canada’s FCFA is the national voice of 2.8 million French-speaking Canadians living in minority situations in nine provinces and three territories.
Nearly 25 years have passed since francophone and Acadian communities first became involved in the health care field. Yet some of the challenges remain just as acute as they were 25 years ago. Indeed, according to a recent consultation conducted by Health Canada in 2022, two-thirds of francophone respondents said they had no or only partial access to French-language health services. This statistic should alarm us, as it not only affects the quality of life of minority francophones, but has a direct impact on their overall health and even their safety.
In the few minutes allotted to me today, I’d like to focus on the challenges of taking into account the specific realities of our communities in federal transfers to the provinces and territories.
Less than six months have passed since the adoption of Bill C-13, modernizing the Official Languages Act. As you know, taking into account the realities of official language minority communities in federal-provincial-territorial transfers was one of the FCFA’s priority issues in this modernization.
As you know, 80% of federal funding for health is allocated through federal-provincial-territorial agreements. These agreements are in no way binding, and the funds transferred are spent at the discretion of the provincial and territorial governments. The remaining 20% is distributed under bilateral agreements with the provinces and territories. It is in these agreements that equity-seeking groups are named, including minority francophones.
The first of these bilateral agreements, with British Columbia, was made public in October. There is no mention of French-language health care in this agreement, and no reference to the province’s francophone health organizations.
One has to wonder whether Health Canada even considered this in its negotiations with the provincial government. What’s more, if it turns out that our communities remained in the blind spot in these negotiations, it bodes ill for the other agreements to be signed with the other provinces and territories.
This is all the more serious as it concerns the services and care offered to citizens in situations where they are most vulnerable. Such omissions in both federal transfers and bilateral health agreements are no longer acceptable, especially in the context of the post-modernization of the Official Languages Act.
With your permission, we would like to propose nine recommendations to this committee, drawn up in collaboration with one of our members, Société Santé en français, with a view to strengthening French-language health care in minority communities.
First, that Health Canada respect its obligations under the new Part VII of the Official Languages Act, by ensuring that francophone minority communities are consulted on the inclusion of language clauses in future health transfers.
Secondly, that Health Canada take all necessary measures to ensure that the principle of equal access for our communities is respected in the bilateral agreements currently being finalized with the provinces and territories, including the resulting action plans.
Third, that Health Canada ensure greater accountability for federal funds allocated to French-language health.
Fourth, that Health Canada create a permanent advisory committee, reporting to the Minister of Health, to guide the department’s strategies for equitable access to health care in linguistic minority communities.
Fifth, that Health Canada create the necessary research and data collection infrastructure to document gaps, by province and territory, in: access to French-language health care; use of French-language services by the minority; and the health status of French-speaking people compared to the general population.
Sixth, that Health Canada increase funding for the Official Languages Health Program to reflect the growing needs of the French-speaking population, which is growing outside Quebec in absolute numbers, and that it support francophone and Acadian communities in developing innovative models of French-language service delivery in smaller settings.
Seventh, that Health Canada strengthen its support for post-secondary institutions in French-speaking minority communities, with a view to increasing access to French-language post-secondary programs in the health field; that the department set up a diploma and prior learning recognition initiative for French-speaking immigrants, in order to better address the significant shortage of French-speaking and bilingual workers in the health field in minority settings.
Eighth, that Health Canada work with the Department of Immigration, Refugees and Citizenship to accelerate permanent residency for French-speaking health care workers.
Ninth, that Health Canada use all the levers at its disposal to encourage the provinces and territories to take action to strengthen access to French-language health care in all provinces and territories outside Quebec.
We thank you for your attention and would be pleased to answer any questions you may have regarding these recommendations. Thank you very much.
The Chair: Thank you very much for your presentation, Ms. Roy. We’ll now open the floor to questions. I’m going to give the floor to the deputy chair, Senator Poirier.
Senator Poirier: Thank you both for being here; it’s greatly appreciated. It’s an honour and a pleasure to see you again. We hear a lot about the shortage of health care workers. We’re very concerned about it. All the witnesses spoke about it. This shortage is felt most acutely by the francophone and bilingual workforce in our francophone and Acadian minority communities across Canada.
As you probably know, last Wednesday the government announced an increase in the francophone immigration threshold from 4.4% to 8%.
Are you concerned that this target is lower than yours, which is 12%? You mentioned that you had conducted a study on the attainment of this 12% target. Do you have any results regarding the labour shortage that could be reduced with your 12% target?
Ms. Roy: Thank you for your question, senator. We don’t have any results in terms of exact figures to counter the labour shortage. However, we do know that the 6% target for 2024 will continue to contribute to the decline in demographic weight. That’s why we reacted so strongly last week to this announcement.
In 2026, the target will be 8%, which is the minimum required to avoid further decline. So, yes, there are labour shortages in health care. That’s why in my presentation I talked about the recognition of qualifications and diplomas. We need to pay particular attention to the importance of the recognition of prior learning, qualifications and diplomas, and find much faster ways of recognizing what is being done among French speakers arriving in Canada.
What’s more, the labour shortage is so acute that it will affect all Canadians. We wonder why francophones should suffer more than others in this case. We are weakened, and with the immigration targets announced last week, we will continue to be weakened, much more than the majority. So it’s really a matter of life and death in this case, because we’re talking about health. When they appeared before your committee, our colleagues from Société Santé en français mentioned that a recent study carried out in Ontario in 2022 revealed that the risk of death for a French-speaking long-term care resident decreased by around 25% when language barriers were eliminated. That’s a considerable difference.
We’re very interested in anything to do with labour shortages. We did a study on bilingual labour shortages, but I don’t think we were able to get the data you’re asking for. However, we can provide you with that study.
Senator Poirier: Yes, if you have it, it would be interesting; kindly send it to us.
In your opinion, how can the federal government attract bilingual health care professionals from abroad, and what can it do to ensure their retention?
Ms. Roy: We’re talking about recruitment strategies for French-speaking immigrants. More concerted efforts could be made to recruit in French-speaking source countries. When raising awareness and recruiting, we need to mention to people that they’ll have to speak English in certain regions, which isn’t always done, and this is detrimental to retention.
This subject is very important and is linked to targets. We need to increase targets and ways of recruiting, and position the Canadian francophonie when recruiting abroad. I’m going to hand over to Mr. Dupuis, as he’s done a lot of work in this area. He may have something to add.
Alain Dupuis, Executive Director, Fédération des communautés francophones et acadienne du Canada: Obviously, we’re asking for higher targets, but the Government of Canada must also be able to link the arrival of people with the jobs available.
We’re proposing that the department create a separate francophone immigration program that would designate and accredit certain employers who could easily link the existence of positions to the right candidates. At present, francophone immigration is handled in the same way as general immigration, and the results have been the same for 20 years.
In certain pilot programs, such as the Atlantic, Rural and Northern programs, we see this ability to directly mobilize employers who want to offer positions to immigrants. They are identified and people are brought in quickly with work permits, while IRCC processes their application for permanent residency.
A francophone immigration program that would accredit employers who want to match candidates with specific francophone or bilingual positions also seems like a promising solution.
The department is going to develop an accelerated bridging program for teachers, for example. We know that the country is short 12,000 first- and second-language teachers. We can’t wait to develop this fast-track gateway. We don’t yet know what it will look like, but we can also imagine accelerated programs for francophone and bilingual health care workers. We’re very open to further discussions with the department.
Senator Poirier: In the health care and teaching sectors, we hear that when we recruit candidates, when they arrive in Canada, the accreditation or training they have received is not equivalent to training in Canada. This discourages many of them, because they know that when they arrive in the country, they’ll have to go back to school.
Have things changed, or is it still the same? Is there anything the federal government can do to improve the situation?
Mr. Dupuis: The federal government could fund initiatives where it would be possible to work with provincial professional associations, colleges and universities to develop fast-track bridging programs where it’s possible to work in the field as soon as you arrive in Canada, knowing that there will be certain courses to complete and that there will be potential requalification to have the right terminology and standards in place.
The federal government does have a role to play. At the moment, unfortunately, we see governments passing the buck by saying that the shortage is a federal or provincial responsibility, or that it’s all a matter for the professional orders. The federal government has the ability to bring stakeholders together and fund pilot projects. That’s one of the things we’re asking Health Canada to do.
In a context where there is a shortage of French-speaking and bilingual workers in the health care field, we could launch a pilot project to speed up the process and work in collaboration with colleges and universities. In short, the situation is gradually improving.
Senator Poirier: So, the situation is improving.
Mr. Dupuis: Yes, but we can still do better.
Senator Poirier: Thank you very much.
Senator Mégie: Thank you to our witnesses for appearing before the committee again. My question concerns French-speaking health professionals.
Do you have any data on the number of French-speaking health professionals providing medical care to the minority language community in your area?
Ms. Roy: I don’t have those figures with me right now, but we can certainly try to send you some figures that we could get from our colleagues in our member associations.
Senator Mégie: In those numbers, there would be regional variability between urban and rural areas. Would we receive that kind of data?
Mr. Dupuis: I’d say that’s one of the things we’re trying to address, because Health Canada isn’t collecting the data needed to have an overview of either access to services, labour shortages, the use of services by francophones, or the health status of francophones as opposed to the majority.
This remains a major structural challenge, because the provinces don’t collect this data, the federal government doesn’t have it, and community groups are doing the best they can to gather it.
We need to systematize the approach, and Health Canada, in its strengthened responsibility under the new Part VII of the act, has an obligation to collect data. However, this is a whole field, and Health Canada doesn’t have the required infrastructure in place, nor the provincial partners, nor the answers to all the questions that arise. To bridge these gaps, we need to document them.
For example, the Réseau de la santé francophone de l’Ontario claims that 3,500 bilingual positions are currently unfilled in the province’s health care system. If this figure represents a single province, one can imagine the magnitude of the problem on a pan-Canadian scale.
Senator Mégie: Thank you. I’d like to come back to our study on francophone immigration. When we were talking about retaining professionals in various fields, especially health care, we were told that, in general, when people arrive from a French-speaking source country, they are quite surprised to have to fill out documents that are only in English; this discourages them.
Today, Ms. Roy has just told us that even with recruitment in source countries, candidates must be advised that, in certain regions, they will have to speak English. What would be the best way to bring them into the country and retain them, knowing that they’ll have to respect linguistic duality? We recruit them from French-speaking source communities because we already have a deficit, but we tell them they’ll have to respect linguistic duality. I’m sure you’ve thought about this. Do you have any comments on this?
Ms. Roy: Obviously, language training is needed, and that can be done before they leave home. We can do it in a pre-departure model, to be able to give them the foundation they need to function well when they arrive in their respective environments.
Mr. Dupuis: The other problematic element is that when they arrive in Canada, they have to choose one of the two official languages in which they can take courses free of charge. In a minority setting, since this choice has to be made, some people will sometimes choose French to get an update in Canadian French, but they won’t have free access to language courses in English. It’s absolutely essential that these courses, paid for by the federal government, be offered in both languages for people who settle outside Quebec.
Senator Mégie: If I understand correctly, this is not currently the case, and you’re hoping that the federal government will fund such a program?
Mr. Dupuis: Indeed.
Senator Clement: Welcome to both witnesses. We’re always happy to see you; you’re always well prepared and that’s much appreciated. I’d like to come back to the nine recommendations that Ms. Roy read out to us. In response to Senator Mégie, you talked about data, and one of the recommendations is to create a research institute for data and access to care.
Could you tell us more about this? What was the conversation between you and Health Canada about these nine recommendations? What’s the current state of play? These nine recommendations seem very clear. I imagine you’ve had conversations, but what is the current status of these recommendations?
Mr. Dupuis: There was talk of a research infrastructure. I don’t think it’s an institute per se, but Part VII of the new Official Languages Act talks a lot about positive measures. Departments must take positive measures to close certain gaps and contribute to the vitality of communities. However, if they don’t have the data, how will departments be able to develop positive measures in line with needs?
We’ve had discussions with our health network, which has satellite facilities in every province and territory. The data issue is a major one, and I believe it’s the first structural problem that needs to be addressed. If the Government of Canada isn’t aware of the gaps to be filled, it won’t be able to better fund French-language services through the various transfers and agreements.
We therefore need to develop a departmental capacity, but also reach out to our colleges and universities, which have institutes and research chairs in francophone health. It’s also a question of pooling this knowledge to establish indicators and clearly indicate the gaps we need to close in terms of services or health for francophones, for example.
Senator Clement: This is the fifth of your nine recommendations...
Mr. Dupuis: There’s no hierarchy, but it could be one of the fundamental points. All departments will have to step up their data collection and become more aware of the situation. Health Canada is one thing. As for relations with the department, our member, Société Santé en français, is the first point of contact, but we’ve had discussions with the Minister of Health’s office about the agreements and our expectations when the federal government negotiates with each province. It’s obviously the beginning of the conversation, but it’s not the end.
Senator Clement: I have a question about the 80% and 20% figures; you say that 80% of health funds are alloted in provincial and territorial agreements and 20% are from bilateral agreements. I’d like to understand the distinction between the two.
Mr. Dupuis: The 80% figure represents federal transfer agreements. It’s an unconditional amount that the federal government pays to the provinces and territories...
Senator Clement: Without language clauses?
Mr. Dupuis: Apart from the standards set out in the Canada Health Act. There are four principles I don’t understand — ensuring equitable access to an equivalent health care system across the country. So, 80% of the money goes there, but 20% falls under bilateral agreements where the federal government negotiates certain priorities, conditions and data collection.
Obviously, the vehicle of bilateral agreements is interesting for us, and in the renegotiation of these agreements, the federal government has established this principle of equitable access for equity-seeking groups, including communities. The principle is there, but when we see the action plans, like the one in British Columbia, we see that the federal government has not followed its own funding and has established a broad principle, without demanding results or defining key indicators for official language minorities. This is problematic in terms of implementation, despite the principles that have been added to recent rounds of agreements.
Senator Clement: Which are the best provinces, then?
Mr. Dupuis: We don’t know yet. British Columbia is the only one... We’re hearing good things from Alberta, for example, where the community has worked hard with its ministry, but that remains to be seen, because the agreements and accords aren’t public yet.
Senator Clement: It depends on the communities’ work with their ministries?
Mr. Dupuis: We work there on the ground, on both sides, with the federal government and in each of the jurisdictions, to ensure that our concerns are taken into account, but the success rate also sometimes depends on the will of the provincial governments.
Senator Clement: Thank you.
The Chair: You talked about the Canada Health Act. I’d like to hear what you have to say about the famous advisory committees, because we’re confused about the number and relevance of committees, and we don’t know who does what. It would be interesting to clarify with you the needs of these communities in this area, to know the composition of the committees, and so on.
First, you’ll recall that in the early 2000s, MP Mauril Bélanger — whose memory and actions I salute this evening — introduced a bill to add a sixth principle to the Canada Health Act, which was in fact that of linguistic duality. This legislation would have added the principle of linguistic duality to the conditions that provincial health insurance plans had to meet in order to receive a full financial contribution from the federal government. You supported this amendment at the time. In 2019, in your document entitled Time for Action: The FCFA Proposes a new Wording of the Official Languages Act , you reiterated your support for this proposal. Where do you stand on this proposal in the current context? What can you tell us?
Mr. Dupuis: We always defend and support that principle. There’s no intention to reopen the Canada Health Act, but if we go by the principles of this law, it’s a principle of equity where there’s a certain equalization in Canada that ensures that public services are funded so that they’re accessible everywhere. The fact that both national linguistic communities must have equitable access to health care does not mean that the same health care is offered everywhere. We can explore new delivery models, but this would be a principle we would continue to defend absolutely if the government wanted to reopen the Canada Health Act. I think we support that idea, and we could add it to a recommendation that this committee would make. I think it’s still very relevant.
The Chair: I’m going to draw on a vision outlined by Senator Clement on the question of diversity and the realities... We’re talking about two linguistic communities, but we know that within all that, there’s a diversity of realities, cultural diversities and diversities of all kinds. In your opinion, is there anything to be said for this, because the notion of linguistic duality contains all this? Is there a need to clarify what linguistic duality means today in the context of 2023, for example?
Mr. Dupuis: It’s good to have a principle that would mention equity-seeking groups, name them, make a list and name official language communities, but we know that realities are intersectional and that, within the Canadian francophonie, there are other obstacles if you’re a racialized person, a woman, an LGBTQ2+ person, et cetera.
We can’t include these equity principles and name groups if we don’t collect data and track these intersectionalities. We’re starting to name principles, but operationalizing equitable access for equity-seeking groups requires a lot of work on the part of the department. Funds must also be made available to support these groups. There are new and innovative service offerings that can be developed if we are serious about this commitment, not just for official languages, but for all groups in Canadian society.
The Chair: Thank you. I’d like to hear what you have to say about the advisory committee. In your fourth recommendation, you call for the creation of a permanent advisory committee. In 2017, an advisory committee was set up for the health portfolio. Did you contribute to this committee, and did it lead to any progress? What can you tell us about it? Can you tell us more about the permanent advisory committee you want to create?
I put the question to you with the following vision or perception: we have the impression that, in Canada’s health care system, there are a multitude of players and a lack of concertation, collaboration and consultation. What exactly are the benefits you hope to achieve through this permanent advisory committee, and what can you tell us about its operation, composition and objectives at this stage?
Mr. Dupuis: The committee we are proposing is a departmental committee that would report directly to the Minister of Health. The challenge with the current advisory committees at the department in their various iterations has been: do they report to the other levels of the department or to the branch, or elsewhere? I think it would be more appropriate to create a permanent minister’s advisory committee, which would be responsible for providing guidance to the minister when he negotiates with the provinces and territories.
We know that one of the first responsibilities of Canada’s Minister of Health is to negotiate transfer agreements with the provinces. This remains an exclusive responsibility of the provinces and territories. We are seeking to have direct access to the minister’s ear and to mobilize experts on health issues affecting the linguistic minority, to equip the minister and other levels of the department on what needs to be done in the next round of renegotiations in the North.
The Chair: On composition and representativeness... That’s often the challenge with advisory committees: representing different realities. Ms. Roy, do you have anything to add to that?
Ms. Roy: Community organizations need to be part of these advisory committees if we’re to get a good indication of what’s going on in the community. Our organizations need to be able to participate in these consultations.
We could refer to the Official Languages Act to see the importance of consultation.
I think we need to bring together people who know what they’re talking about. We’re going to bring back consultations, because we need people who can talk about data collection, accountability and transparency. In addition to people from the community, we also need to have leaders who can talk about these aspects.
The Chair: Okay. Thank you very much.
I have a few more questions, but first I’m going to give the floor to Senator Poirier.
Senator Poirier: We were talking about the recommendations, and I’d like to have a follow-up on that. With regard to the nine recommendations you mentioned, have you had a chance to meet with the new Minister of Health to share your recommendations?
Ms. Roy: We haven’t had a chance to meet him yet.
As Mr. Dupuis mentioned earlier, many of these discussions are being led by one of our members, the Société Santé en français. The Fédération des communautés francophones et acadienne, or FCFA, has not yet met with the new Minister of Health.
Senator Poirier: Do you intend to request a meeting with the minister to share your recommendations?
Ms. Roy: Yes, absolutely. We want to meet with him along with our colleagues from the Société Santé en français.
Senator Poirier: With regard to your recommendation on the advisory committee, do you intend to have people from every province in Canada sit on this committee? Is that one of your recommendations?
Ms. Roy: I think we’re in a position to have people who can speak knowledgeably with representatives from the various provinces. For example, the Société Santé en français is a federation of several organizations working in each of the provinces. They know what’s going on there. We have spokesperson organizations at the national level. So we have a good idea of what’s going on across Canada.
Rather than having nine representatives from the provinces and three from the territories, we can sometimes go and find other groups who can speak on behalf of the entire Canadian francophonie.
Senator Poirier: I promise this is my last question.
Since New Brunswick is Canada’s only officially bilingual province, do you find that health services offered to citizens in the language of their choice are better in New Brunswick than in official language minority communities in other provinces? Even though francophones are a minority in New Brunswick, which is an officially bilingual province, are francophones better off?
Ms. Roy: The tools exist to improve the situation for New Brunswick francophones. It’s not perfect yet. As an officially bilingual province, there are rights that recognize the importance of communities. These rights exist in both communities.
I think it’s perhaps easier to obtain services in French, but we also hear certain comments to the effect that in certain regions of the province, although there have been many improvements in recent years, it’s more difficult to access certain services in French.
Senator Poirier: Thank you.
The Chair: Go ahead, Mr. Dupuis.
Mr. Dupuis: What there is in New Brunswick that may inspire us elsewhere in the country is the idea of separate institutions. With the new Official Languages Act, the federal government recognizes the importance of distinct minority institutions.
In the health field, does that mean we’ll have a bilingual health authority, like in New Brunswick or other provinces? No. In some cases, they will be designated institutions. In other cases, they will be francophone or bilingual family health centres.
It’s important for the federal Department of Health to think about different models with the communities and how we can structure the health system to ensure a certain autonomy and influence in decision-making, and to create more effective service delivery models.
Today, as francophones in a minority setting, we all too often don’t know where to turn to find a family doctor, let alone a specialist, especially when we’re referred to specialists elsewhere in the country.
In New Brunswick, a certain institutional stability and vision have emerged for bilingualism in the province. We also need to think about how we want and can structure strong institutions in minority communities across the country. We need to increase access, and above all see to it that francophones who want to be cared for and served in French are no longer forced to constantly seek out these services. Unfortunately, we’re not there yet, but there is hope. The new tools in the Official Languages Act point us in that direction.
The Chair: Thank you.
I’d like to hear your comments on the upcoming regulations and implementation of the Official Languages Act. You’ve probably heard Treasury Board President Anand tell the committee that it’s going to take some time.
I’d also like to hear your comments on the issue of health care in the private sector and the ability to obtain services in the language of one’s choice in the provinces and regions.
My question is simple: are you concerned about the issue of health services being increasingly privatized? What concerns does this raise? In your opinion, how can the federal government, in the context of the agreements, help counter the possible negative effects of private establishments?
Who can answer my question? Ms. Roy?
Ms. Roy: I can start, and Mr. Dupuis can continue.
It’s difficult for us, because it’s not a question of evaluating the profitability of offering a service to a francophone community in its own language. That’s what we’re talking about here, services in the private sector. There are profitability objectives, and the development of our communities must not be seen through the prism of ability to pay. In the long run, this would jeopardize our communities. It is more important, in our view, to be able to get services in the public system than to start seeing what it would mean if our communities had to start paying for services.
The Chair: Okay.
Mr. Dupuis: We already have a problem with third parties doing business with the federal and provincial governments. Often, when a third party is involved, the linguistic obligations don’t follow or they’re in the contract, but the implementation isn’t carried out, because it’s a private or separate entity that manages a service on behalf of the government. This worries us enormously. I don’t see in any...
The Chair: What you’re saying is that accountability doesn’t exist. What is the...
Mr. Dupuis: We already have a problem when it comes to monitoring government services that are supposed to be offered to francophones. I don’t think we have the capacity or the desire to see what third parties in the private sector would do if they were obliged to offer certain services. I think we’d be very far from their top priorities.
The Chair: All right.
Ms. Roy: If I may, I was going to say that we could compare this to language clauses. It’s very difficult to have language clauses included in federal-provincial-territorial agreements. If we have third parties from the private sector, it will be the same scenario again.
The Chair: I have a question about regulation-making.
You’ve done a lot of work following the passage of Bill C-13. What are your main concerns in this regard? The President of the Treasury Board and the new Minister of Official Languages are talking about their ability to implement the legislation within a reasonable time frame. What are your hopes in this regard?
Ms. Roy: In our opinion, a reasonable time frame would be around 18 months, rather than the three years we heard about when we appeared before your committee. Our hope is that they will start with Part VII, the positive measures, because they affect our communities. This needs to happen relatively quickly, within 18 months. I’ll let Mr. Dupuis continue, if he wants to add any comments.
Mr. Dupuis: It took six years to pass a bill. If we have to wait another three years for the first regulations, we’ll have been working on this for a decade. Communities are resilient and organized. Everything has been said in the many consultations we’ve already held with the various departments in preparing to modernize the law. We told the Treasury Board of Canada Secretariat that the entire Canadian francophonie network was ready, that it already knew what its demands were, that we would be submitting a brief and that we wanted the formal process that would lead to the adoption of the regulations to get underway as quickly as possible. The communities are ready. Our hope is that it will happen sooner. The 18-month period was seen as a promise. The government has said that we intend to adopt the first regulations in 18 months. We hope the government will keep its word and work with us to move quickly. The needs are known.
The Chair: In your opinion, in the comments made by the two ministers who appeared before us, do the areas of responsibility of each seem clear enough? If not, do you have any comments to make on this, to help the committee understand how this division of responsibilities should or will work?
Mr. Dupuis: At the moment, we don’t have any clear indications as to who will play what role. We’re relying on the legislation that’s been passed. It would be very important for Canadian Heritage and the Treasury Board of Canada Secretariat to make this division of tasks public as soon as possible, so that we can clearly understand who is responsible for establishing regulations, overseeing and monitoring the implementation of the law, as well as for the elements of public policy and overall vision.
We had proposed a central agency. The outcome of the parliamentary process gave us two institutions that play important roles. This tandem must be absolutely clear. If we can’t see on paper what the roles and responsibilities of each are, we’ll have trouble implementing the law.
The Chair: Ms. Roy, is there anything else you’d like to add?
Ms. Roy: No, that’s fine. It’s very good, yes.
The Chair: I don’t think my colleagues have any further questions for you. I’d like to thank you both for your commitment to official language minority communities, for the work you do and for the thoroughness of your committee appearances. It’s always a pleasure to welcome you and to hear what you have to say. Thank you very much. Your contribution will certainly enrich our report. Thank you very much.
For our final panel of witnesses, we are honoured to welcome, by videoconference, Mr. Paul G. Brunet, President of the Conseil pour la protection des malades du Québec. Good evening, Mr. Brunet, and welcome to our panel. I’ve read your biographical notes. I’m impressed by your background. Thank you for all the work you’ve done. We’re ready to hear your opening statement, which will be followed by a question and answer session. The floor is yours, sir.
Paul G. Brunet, President, Conseil pour la protection des malades du Québec: Thank you, Mr. Chair. Honourable Senators, good evening. I would like to remind you that the Conseil pour la protection des malades is an organization founded 50 years ago by my older brother, Claude, who lived in a nursing home before dying. This year marks my 25th anniversary as spokesperson for the council.
[English]
Let’s remind everyone that the Quebec Counsel for the Protection of Patients is not a language-rights advocate. We advocate for access to health care for all patients, whatever their language is, so that the patient gets the adequate health care that they need.
[Translation]
We’ve been fighting this battle for almost 50 years. Our organization does not advocate for languages, but for access to care for patients. In fact, we fight for patients on the West Island of Montreal who can’t be cared for in French; for patients in the east end of Montreal, because some English-speaking patients are misunderstood by French-speaking staff; at Santa Cabrini Hospital, for elderly people who speak only Italian; at the Chinese Hospital, for people who speak only Chinese.
[English]
We fight for everyone. That is the story of our lives.
[Translation]
Language is an essential tool for understanding and being understood when a health issue arises for us, a family member or a friend. Quebec’s Act respecting health and social services provides certain guarantees regarding the right to understand and be understood. For example, there are some extraordinary doctors at the McGill University Health Centre, highly specialized physicians, who are unable to speak French. We are able to provide translation for the care that an experienced doctor gives, because we need him or her, notwithstanding the fact that the person may have difficulty speaking French.
These rights include confidentiality of the file, the right to be sufficiently informed of one’s situation, the right to understand staff and to be understood, the right to participate in decisions that concern us, the right to consent or refuse treatment and to be treated with respect and dignity. The right to receive care in Quebec is part of the more general right recognized by the Canadian Charter of Rights and Freedoms, which is the right to life. For us, the right to receive care clearly falls under the right to life, and is notably protected by the Canadian and Quebec charters of rights and freedoms.
Since 1991, the Quebec government has limited the rights provided for under its Act respecting health and social services, stating that they are subject to the availability of human, financial and material resources. Section 15 of the current law will be replaced by section 14 or 16 of Bill 15, which is currently before a parliamentary committee. However, these limitations, be they linguistic or health-related, cannot be overridden by people’s right to receive care, because under the Canadian Charter of Rights and Freedoms, the right to life, and therefore the right to care, and the right to security are constitutional rights.
In our opinion, the Quebec legislator cannot legally and constitutionally limit access to care on the basis of section 15, because of the guaranteed rights to life and security enshrined in the Canadian Charter of Rights and Freedoms.
Section 15, which limits these rights, should be interpreted. We do so in many respects, because of the work we do to ensure that people receive care and that the right to life and security is always respected, despite the fact that resources are lacking.
The question of health-related rights arises in relation to the question of services that are on the periphery of clinical care, such as bedside care, the right to a bath, a shower, the lack of hygiene in long-term care centres, proper meals, and Alzheimer’s patients who are not housed in places that are safe for them and for other residents.
We continue to argue that these all-important care activities in long-term care facilities are not protected by provincial health jurisdiction. They are not health care. So section 92(7) of the Constitution Act cannot apply, because it talks about health and hospitals. For us, where the Canadian government could intervene — and we will certainly support it — is in all peripheral care that is not medical care, that is not hospital care. We’re talking about basic care. We’re talking about bedding, meals. Is a meal a bit like medical care? Some would say yes, but these are not protected clinical acts reserved for doctors and nurses.
In that sense, the federal government certainly has room to manoeuver to avoid the endless battles with provincial governments over jurisdiction in health care. I’m sorry. I’ve heard Premier Legault say, “Health care is our jurisdiction.” Yes, but you do a very poor job of delivering care related to baths, showers, meals and answering the bell in nursing homes. So don’t tell us that it’s your exclusive jurisdiction, let alone that you do it well, because it’s not true. There is currently a class action lawsuit before the Superior Court against all Quebec nursing homes for the mistreatment of residents.
When someone is ill, the language barrier must not become an obstacle to understanding them and their caregivers, especially in emergency situations. I’ve heard the testimony of previous witnesses, and I have to say that, generally, when we fight for patients to receive care and to be understood in French or English in Quebec, there are certain regions where it’s more difficult; but in general, we succeed, with good accommodations, in making nurses and doctors listen to reason and respect their oaths of office when it comes to offering urgent care, particularly to Quebec patients.
According to the Institut de la statistique du Québec, 20% of patients don’t speak French and have difficulty understanding and being understood when they need care or social services. Accommodation and translation services are now available in many places, but special attention must be paid to ensuring that caregivers and patients have access to learning Canada’s two official languages.
I was recently at the Toronto airport. I went up to the Air Canada counter, which has to be bilingual, and asked the lady if she was bilingual.
[English]
She said, “Yes, sir. I speak English and Hindi.” With all due respect, of course, this is not the kind of bilingualism we’re talking about here in Canada.
[Translation]
During the pandemic, for example, few information documents were made available in English, so that unilingual English-speaking patients, who were often elderly, had very little access to government instructions, which put them in a risky situation, especially during a pandemic, since we all experienced it together. Verbal and non-verbal language are also indicators of a patient’s state and condition. Those indicators shouldn’t get lost in the translation process set up by the health care institution. I know that there are translation services at several major hospitals, such as McGill and the CHUM. I know that Indigenous communities in places like Joliette in western Quebec sometimes have access to translation services for First Nations people who cannot understand French or English.
In some situations, a very ill patient loses certain language skills and may require special attention to the language he or she understands at the time of care, and not necessarily to the language identified in his or her file. Someone who suffers a stroke, for example, will lose the knowledge of one of the languages they speak and suddenly be more at ease in another, for reasons I can’t explain. Speaking another language in which one can be understood, even if the designation of the language differs in the file, can be an asset for this patient or for the nursing staff.
The idea is to work so that Canadians and newcomers, whatever their origin, have the right to learn and can access English or French instruction, depending on the province in Canada and where they decide to make their life. Quebec’s health care system is cumbersome and complicated, and every measure must be taken to ensure that a patient can understand and be understood during his or her stay in hospital, when receiving care at home or in a long-term care facility. Failure to do so inevitably puts the patient’s treatment and recovery at risk.
Bill C-15, which is currently under consideration, is intended to ensure that the health care system will be less cumbersome and bureaucratic in the future. I hope it will. Patients themselves and their families are increasingly called upon to be partners in the care in which they participate with caregivers. In this sense, it has never been more important for everyone to understand the issues surrounding care and consent. We must therefore work to improve access to care, especially primary care, and above all ensure that language is never an issue for any patient, in Canada or Quebec.
Finally, let’s not forget that the Conseil pour la protection des malades is a private, non-profit organization, poorly funded by the Quebec government. We look forward to the federal government’s help in funding our services, and we wish to act independently of government, people’s age, illness or disability, language, ethnic group, sexual orientation or socio-cultural background, because patients have the right to receive adequate care and services, worthy of their condition and needs. Thank you.
The Chair: Thank you very much, Mr. Brunet. Thank you for having specified that you do not advocate for English-French language rights. Your experience with the challenges faced by health services and patients in the area of language, whatever the language, can inform our debate on health services in the minority language. Your words are enlightening in that sense.
You’ve touched on certain issues that generally have a broader impact on issues other than language, i.e., issues related to health services more broadly. Our aim is to focus on issues that concern linguistic minorities, whether they be the English-speaking community in Quebec or the French-speaking community outside Quebec. That said, I’d like to open the question period with this context in mind. Thank you again for being here. I’d now like to turn the floor over to the deputy chair of the committee, Senator Poirier.
Senator Poirier: Thank you for joining us this evening. I have a few questions. In Quebec, anglophones are in the minority, compared to the rest of Canada, where francophones are in the minority. Do you receive complaints about the lack of access to health services in English, such as those received by the Quebec Community Groups Network? If so, what kind of complaints do you receive?
Mr. Brunet: : I receive complaints from English-speaking patients and even from nursing home residents or their families in certain areas of Montreal. In Quebec City, I receive complaints from English-speaking patients who are not understood by the nursing staff. In Montreal, I receive complaints from francophones on the West Island about staff who don’t speak French. As I said earlier, at the Santa Cabrini Hospital, there are many people who speak only Italian — especially the elderly — and who need help to be understood and to understand. It’s the same thing in the east end of Montreal, where English-speaking patients make complaints. What we do is intervene. We remind the administration of its duties and obligations under the law. They tell us that there’s section 15, which sets limits based on resources; I tell them that the right to care is a right to life, that the right to life is protected by the Canadian Constitution and that it’s not a defence or a limit that they can raise under the law. I’m a lawyer myself.
In general — I’ve been a spokesperson for 25 years — we succeed in making them see reason. Sometimes, however, we have to fight and resort to higher authorities, such as filing a complaint with the complaints commissioner or turning to the Protecteur du citoyen du Québec. Just recently, I had to deal with the case of a lady of Russian origin who only understands English, and for whom we had to do battle, because the person wasn’t being taken seriously, given that she didn’t speak French. We had to turn to the Protecteur du citoyen; in the end, the CLSC in question ended up offering the person services.
All it takes is a little goodwill, and that can ensure that citizens of a bilingual country like ours can live together.
Senator Poirier: Does your organization receive funding from the federal government to protect the rights of English-speaking patients in Quebec? If so, how do you use this funding to protect the rights of English-speaking minority patients in Quebec?
Mr. Brunet: We don’t receive any funding. We don’t understand why we don’t get more help and why the federal government doesn’t help us; we’re underfunded by the provincial government, because we only get $150,000 a year to cover the whole of Quebec. There are very few of us in the office; there are only three of us, in fact. It would be really appreciated if links could be created so that we could apply to the federal government for funding. We don’t have anything right now.
Senator Poirier: Have you already met with the federal government to make requests?
Mr. Brunet: I spoke to my MP, Mr. Guilbeault, and they told me about different possibilities; during the pandemic, we could take out a $20,000 or $40,000 loan. I replied that this was not what we needed, but ongoing funding, so that we could continue to work and defend the rights of people who need care, despite the fact that they don’t speak French. We receive no funding from the federal government, and that’s sad.
Senator Poirier: Thank you.
Senator Mégie: Good morning, Mr. Brunet. Thank you for being with us. I really appreciate your dedication to defending patients’ rights in Quebec. I often hear you on the air.
I’d like to follow up on Senator Poirier’s question. I know that you receive many complaints, and that the complaints cover a wide range of subjects. Do you have any data on the proportion of anglophones versus francophones who complain to your organization?
Mr. Brunet: In terms of the number of complaints we receive, we don’t do statistical studies, because we don’t have the staff to do so. We’ve been receiving complaints for 25 years, and we represent everyone in Quebec. We have 300 duly subscribed individual members within our organization, and we also have 250 user and resident committees in as many care facilities throughout Quebec.
Of these affiliated committees, 20% are English-speaking. Tomorrow evening, I’m giving an information session on Bill 15 to the user committee at McGill University Hospital; it will be in English. That’s about 20% of the committees, to give you an idea, that are English-speaking.
I can tell you — and I’m very proud of this — that all our meetings are simultaneously interpreted every time we hold one. We recently held a symposium in Brossard on the patient experience, and there were professionals doing the simultaneous interpretation.
Senator Mégie: Does this mean that the language issue is a small part of the complaints you receive?
Mr. Brunet: Absolutely.
Senator Mégie: Thank you.
Senator Clement: Thank you for being here. I’m very interested in your work; it’s remarkable. You keep data on the complaints you receive; are you receiving more complaints from people who live in intersectionality, not only in terms of language, but also in terms of racialized populations, for example? Are you noticing a trend in terms of vulnerability?
Mr. Brunet: People subscribe individually and committees come from all regions of Quebec and all areas of the city of Montreal. People who can’t express themselves in French or English are relatively rare — well, for the cases we defend. We also do this at Montreal’s Chinese Hospital, for example, but I don’t have any precise data to give you, other than to say that I often take part in radio programs for Montreal’s Haitian community, and do so with pleasure.
In fact, complaints are often made by telephone. On the margins, we have racialized people who file a complaint and we accompany them through the system; these people generally need a lot more help, because we’re starting from a long way away. If by some misfortune we have to deal with a group of caregivers who are racist or who don’t want to understand that all people have certain rights, no matter where they come from, and especially no matter what their condition, we sometimes have to speak up a little louder.
What I often say when communicating with people... In general, situations can be resolved. Remember, there are usually people in the health care network who want to help. However, as I learned in my MBA course, there’s always 10% who are part of a hard core. I was once expelled from a care facility because they didn’t like us standing up for the sick. We had them on our radar for a very long time.
Usually, though, it goes well. Sometimes it doesn’t; once, in Verdun, I had to intervene because we weren’t able to offer care to an elderly person and her spouse didn’t speak French either. That’s when you have to hit harder. Generally, in my communications, if that doesn’t work, I say we can take legal, administrative or even media action. Often, the media will change the situation with the establishment concerned. That can happen. For us, it’s the result that matters; it’s not always done in compliance with the law and the authorities, of course. I’m a lawyer and I push. I remember someone close to former Minister Barrette telling me that they thought I was pushing a bit hard. I replied that when Minister Barrette stopped pushing on his side, we’d stop pushing on ours.
It’s a game politicians sometimes play, and one we’ve learned to play over time.
Senator Clement: I understand that your resources are very limited, but the data you’re managing through the kind of complaints you’re receiving could be relevant, precisely to fuel investments or results we should be aiming for. It would be interesting to know if there’s a trend or if there’s an increase in complaints from people with more vulnerabilities. That’s my point, but I understand that your budgets are limited.
Mr. Brunet: Yes, we should be helped by the federal government, but I understand the English-speaking population. In fact, half my family is English-speaking. They’re very concerned about Bill 96. I was recently at the Quebec Enterprise Register.
[English]
The woman said to an anglophone, “Sir, we cannot serve you in English anymore. But if you fill out the exclusions, we will have a meeting with you and an officer who is perfectly fluent in English. So please sit down and we’ll make the appropriate arrangements.”
[Translation]
I found it difficult. It wasn’t a care issue, it was a business service issue. The person was explaining how to receive services in English. I found that a bit difficult. I think it had to do with Bill 96, which I didn’t look at. The media called me often.
[English]
They said, “Paul, you have to intervene.” I said, “Whoa, whoa, whoa. Give me a case where a patient is not receiving adequate health care. We’ll fight for him. But I’m not an advocate for language rights; I’m sorry.”
[Translation]
Senator Clement: I have a quick follow-up question. You said you fight for everyone. Have you had any complaints related to other languages, Indigenous languages, for example?
Mr. Brunet: Yes, but not to the extent of what happened in Joliette, for example. As one of our members pointed out, we should have more people. We’re missing people. If you know people on the North Shore... In Gaspésie, we have some. In the Outaouais, we need representatives. We don’t want to be just a Montreal organization. We have representatives in Saguenay and Gaspésie, but we’re lacking representatives. If these people, by chance, were also representatives of First Nations communities or English-speaking people...
We have English-speaking members on our board. They’re the ones who make sure that all our activities are simultaneously translated into English. That’s what makes our organization so rich.
The Chair: I’d like to learn more. You mentioned peripheral care and translation services. When I hear you, it’s as if there are issues, and at the same time, you often say that you end up finding a way to deliver the services.
In the context of our study, I’d like you to tell us more about the issue of accommodation. The question is: how can the federal government, through its health and bilateral agreements, do more to encourage the provinces to deliver peripheral services?
You mentioned health care infrastructure. Obviously, this is an issue for all health services, but are there any specific infrastructure issues for Quebec’s English-speaking community?
I’d like to hear a little more about this to get a clear idea of what you mean by the word “accommodations.” What does it include? What do you mean by “peripheral care?” That would help us better understand how the federal government could intervene.
Mr. Brunet: Section 92(7) of the Constitution Act states that health care is exclusively a provincial jurisdiction. I don’t think it’s exclusive. There’s something else in there. The whole area of basic care, hygiene care... Washing someone is not health care, do you understand? Washing people’s clothes, cleaning their rooms, having a decent meal, that’s not health care under section 92(7).
I think the government certainly has some leeway here. I don’t want to be argumentative — that’s not the point — but I think the federal government has some leeway to act on these issues. We can certainly help them. I’d like to see the federal government, as one witness said earlier, be accountable. If Mr. Legault or other members of the Quebec government say they’re doing a good job and really delivering... I’m sorry, that’s not quite true.
The Chair: In your opinion, for the type of care you just described — which is not health care — are there more or less issues in Quebec’s English-speaking minority communities? Are there particular issues in this community in the areas of peripheral care, accommodation and infrastructure? Are there any particular problems? That’s the community we’re interested in here. Can you identify any particular issues?
Mr. Brunet: Apart from the right to be understood by the care professional and to understand him or her, all peripheral care, as I call it, is neglected everywhere. I want to make it clear that this is not just because of the CAQ. For several years now, we’ve been calling for people to be entitled to proper meals.
It’s a complaint made by both anglophones and francophones. There was a witness earlier who said that there are problems in the provision of care and services, for both anglophones and francophones. In terms of care, yes, there are some problems, and some of the complaints have to do with people not being understood or not understanding the professionals who care for them. That’s a big barrier that can be very dangerous.
The Chair: Let’s talk about culturally appropriate service delivery. Quebec’s English-speaking community is diverse. It comes from different countries. It has cultural baggage. Are there any concerns about how to deliver services? I’m still talking about Quebec’s English-speaking community, which is very diverse. Are there any issues around the cultural dimensions of service delivery, cultural sensitivity, for example?
Mr. Brunet: What I’ve been confronted with in this regard are people arriving in Quebec from Toronto and Vancouver — often people of Indian origin — who don’t know that French is spoken in Quebec. They speak a little English, probably mostly Hindi, but there’s a problem with service delivery, because there are English speakers who don’t understand Hindi. This can cause some problems in the delivery of care.
There are also people from Eastern Europe who don’t know that they have to speak French or a little English. They’ll sometimes get by a little in English, but there’s often a lack of knowledge of official languages among these people. This creates challenges or limitations in the care to be provided where the patient needs to be understood and needs to understand the medical staff. We often have to intervene in such cases.
The Chair: I don’t want to put words in your mouth, but do I interpret your comment — I’m talking about immigrants, people who come from elsewhere — to mean that there’s a lack of promotion of the linguistic realities of the communities where they’re going to settle? That’s more the responsibility of Immigration, Refugees and Citizenship Canada. Is this one of the possible factors? I don’t want to put words in your mouth.
Mr. Brunet: Yes, people should have a better understanding of what the official languages are in Canada.
They should also know what they should have access to in order for better care to be provided to English-speaking and French-speaking patients in Quebec. People need to have at least a minimum knowledge of these languages; I think that would be appreciated. This would reduce the risks faced by English-speaking patients, whom we often have to help.
The Chair: I see no further questions from my colleagues. Mr. Brunet, thank you for appearing before our committee. May I say that you are a credit to your brother by working in the way you do to continue his work. I thank you most sincerely. We will take your comments into account in drafting our report.
Honourable Senators, we will suspend the meeting temporarily and go in camera for a short period. Have a pleasant evening.
(The committee adjourned.)