LANG Committee Meeting

37th PARLIAMENT, 2nd SESSION

Standing Committee on Official Languages

EVIDENCE

CONTENTS

Wednesday, June 11, 2003

¹

1540

The Chair (Mr. Mauril Bélanger (Ottawa—Vanier, Lib.))

Mr. James Carter (Coordinator, Community Health and Social Services Network, Quebec Community Groups Network)

The Chair

Mr. James Carter

¹

1545

¹

1550

¹

1555

The Chair

Mrs. Sara Saber Freedman (Researcher, Missisquoi Institute, Quebec Community Groups Network)

The Chair

Mr. James Carter

The Chair

Mrs. Sara Saber Freedman

Mr. James Carter

The Chair

Mr. Benoît Sauvageau (Repentigny, BQ)

The Chair

º

1600

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

Mr. James Carter

º

1605

Mr. Benoît Sauvageau

Mr. James Carter

Mr. Benoît Sauvageau

Mrs. Sara Saber Freedman

Mr. Benoît Sauvageau

Mrs. Sara Saber Freedman

The Chair

Mr. James Carter

º

1610

The Chair

Mr. James Carter

The Chair

Mr. James Carter

The Chair

Mr. James Carter

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1615

The Chair

Mr. James Carter

The Chair

Mrs. Sara Saber Freedman

The Chair

Mr. Benoît Sauvageau

Mr. James Carter

Mr. Benoît Sauvageau

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1620

Mrs. Sara Saber Freedman

Mr. Benoît Sauvageau

Mrs. Sara Saber Freedman

Mr. James Carter

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1625

Mr. Benoît Sauvageau

Mr. James Carter

Mrs. Sara Saber Freedman

Mr. James Carter

The Chair

º

1630

Mrs. Sara Saber Freedman

Mr. James Carter

The Chair

Mr. James Carter

The Chair

Mrs. Sara Saber Freedman

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1635

The Chair

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CANADA

Standing Committee on Official Languages

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NUMBER 028

l

2nd SESSION

l

37th PARLIAMENT

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EVIDENCE

Wednesday, June 11, 2003

[Recorded by Electronic Apparatus]

¹  (1540)  

[Translation]

    The Chair (Mr. Mauril Bélanger (Ottawa—Vanier, Lib.)): Because quorum is four Committee members for the purposes of hearing witnesses,

[English]

we will start the meeting. This is one in an ongoing series of meetings that this committee has undertaken at the request of the House, in the reference made by the House to this committee, to look at the subject of a bill that has been withdrawn. That subject deals with health services, as they are available to communities of official languages in Canada.

    We've heard so far from the francophone community representatives. Today we will hear from the English-speaking minority in Quebec. We have with us representatives of QCGN, the Quebec Community Groups Network, Mr. Carter and Madam Freedman.

    We will proceed with your presentation, after which there will be an exchange of questions and answers in order to elucidate the points we may wish to have a bit more information on.

    If you're ready to proceed, I invite you to do so at this point.

    Mr. James Carter (Coordinator, Community Health and Social Services Network, Quebec Community Groups Network): Thank you very much, Mr. Bélanger.

[Translation]

    I would like to begin by thanking Mr. Bélanger for inviting us to appear. In recent months and years, and especially lately, we have had increasingly close contact with our Francophone colleagues, particularly in the health care sector. Over the last two years, we have done a lot of work. Before I begin my presentation, I just want to say that what is important to us is that both communities be represented on Health Canada advisory committees. That experience gives both communities an opportunity to get to know each other better and to learn more about each other's situation. So, our group, the Quebec Community Groups Network, was perfectly prepared when we received the invitation to appear before the Committee, not only to participate, but to support initiatives taken by our Francophone colleagues with respect to the health care system. We have a lot of common interests. So, thank you, Mr. Bélanger.

    I also want to say that Mr. Murphy was unable to attend the meeting today. Unfortunately, he has a health problem, but he would like me to pass on to you…

    The Chair: He wrote a report on his experience with the health care system, to see whether he had in fact received good service.

    Mr. James Carter: I think everybody that comes into the health care system now has to have a debriefing afterwards with their family, their colleagues, and their friends, in order to tell their stories, whether they are positive or negative.

[English]

    Thank you very much for the invitation to appear before you today.

    The Quebec Community Groups Network is a provincial association of organizations funded principally under the Department of Canadian Heritage's support for official language communities program. Our members are directly involved in the implementation and monitoring of legal guarantees protecting access to health and social services in English to member of Quebec's official language minority community.

    Our communities are present in every administrative region of Quebec, and are relatively less well-off than their francophone neighbours, despite the fact that education levels are comparable or even better in some areas. We have larger proportions of older members in English-speaking communities, and significantly higher poverty rates, particularly in several regions. These communities rely upon accessible health and social services, and consistently identify, through our surveys, access to English-language health and social services as their main priority.

    While the Quebec health and social services act includes a number of provisions that assure access to health and social services in English, the constraints of resource availability, the ongoing administrative reorganization of the health system, and periodic attempts by government to limit or constrain the extent of the guarantee in some way have served as a brake on the offer of services.

    Local communities have a clear picture of what's important to them. Often stated is the desire to have signage in English inside health and social service facilities, which is currently prohibited under Quebec law in institutions that are not designated as anglophone under the French language charter in Quebec. These communities want accessible community organizations that are able to provide the complementary health and social services important to them, which are also part of what sustains community vitality.

    They want to know that institutions have the capacity to offer English-language services when they are required. They do not want to experience lectures about lack of fluency in French in hospitals or long-term care centres, and certainly not when they attempt to assert their right to English-language services. They don't want to be subject to additional delays for service because they are members of a linguistic minority.

    Our English-speaking community consistently places the ongoing control of its institutions and its management among its highest priorities. We were very pleased to support the efforts of francophones in Ontario, fighting to keep the Montfort Hospital alive as a francophone institution. We felt great solidarity in supporting the fight for Montfort Hospital, in light of many campaigns we've had to wage within Quebec to protect some of our own institutions and their mandates.

    While the Quebec Community Groups Network fully supports the idea that the right to services in French outside Quebec, and English inside Quebec should be entrenched in the Canada Health Act, we have some reservations about Bill C-202 as it's currently formulated.

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    It is important to ensure that access programs do not include population thresholds. While the Official Languages Act includes language that establishes population thresholds for the guaranteed provision of mandated federal services, no such limitation should exist in the area of health and social service delivery. We therefore recommend that text with regard to amending legislation be modified so as to specifically preclude the application of a numerical threshold in the development of access programs.

    Another area is the importance of social service delivery in the minority language. We know, of course, that the Canada Health Act covers only insured health services and extended health care services, so the amendments proposed are obviously constrained by the legislation they're attempting to amend, and therefore the services in the minority language would experience the same constraint. This leaves social services entirely out of the range of protected services. We'd like to emphasize to the committee the importance of dealing with the issue of social services in some way, because they are critically important and very dependent on communication.

    We urge the committee to ensure that federal legislation in the broadest sense--especially federal funding--is a lever to ensure that social services continue to be available in English in Quebec and in French in the other provinces. We recommend that social service delivery in the minority language be afforded equal protection to that proposed for health service delivery.

    On the concept of progressive development of services, it has been our experience that the limitation of human, material, and financial resources in the health system has frequently been invoked in such a way as to effectively deny the right of access to English-language health and social services in Quebec. It's an argument that's been used from time to time.

    We are obviously aware that provincial governments cannot conjure up bilingual personnel out of thin air to meet all needs, but neither should there be so much slack in the system that administrators of the health system have easy recourse to a very broad principle of resources, to escape obligation to organize services for either anglophones in Quebec or francophones outside of Quebec.

    We're recommending that the text being proposed and studied include language that requires both ongoing development of minority language services and what we would introduce as a periodic review of the access programs being proposed.

    On the issue of control and management of minority institutions, the English-speaking community of Quebec has fought a number of initiatives that, had they been implemented, would have had disastrous consequences for our health and social service institutions. Indeed, our entire framework for legislative guarantees had its genesis in the battle to protect one such institution, Ville Marie Social Service Centre, which is the largest anglophone social service centre in Quebec, back in the early 1980s. This was to save our only social service institution from an administrative reform that would have decimated its access, even within the region of Montreal.

    So naturally we endorse the intent of proposed paragraph 12.1(c) of Bill C-202, but we have some reservations to put forward about what “entirely in the hands of members of the province's anglophone or francophone minority” means. This is somewhat problematic for us in Quebec. Does this refer to the institutional board at the level of the board of directors, the senior management, or both? If the province decides to entirely abolish institutional boards of directors in some areas, as we have seen in other jurisdictions, how would this measure be implemented in some altered organization of service delivery? How can we ensure that minority institutions continue to benefit from highly qualified members of the provincial majority communities, who in many cases have contributed to the leadership of our institutions?

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    We have a mixed bag in Quebec, so institutions that were developed by the English-speaking community also have to serve francophones. Increasingly, their administrations and their boards of directors have taken on the character of not only the anglophone communities they serve, but the francophone clientele they serve as well. It would be difficult for us to conceive of a situation where there would be a kind of 100% anglophone board of directors. In fact, the legislation in Quebec wouldn't permit that anyway because some of the appointments to boards come from outside the community, according to provincial legislation.

    The “where numbers warrant” provision also requires some discussion. We look forward to it after the presentation. In Quebec, the charter of the French language currently allows us a threshold of 50% plus one, meaning now with modification to the legislation, those whose mother tongue is English. While we find this threshold unreasonably high, in light of the fairly limited exemptions we have for our institutions in Quebec, we wonder how this provision in the proposed amendment would be implemented.

    Our position is that we support protections for minority community control and management of its health and social service institutions, without precluding the participation of members of the majority community. We reject a “where numbers warrant” threshold that sets the standard of being a numeric majority, as is the case in Quebec.

    On the issue of the participation of the minority communities, we believe the legislation should include language that specifies that the access program being proposed be created in consultation with the affected minority language communities. This requirement would favour community development and community leadership, and actually enhance the vitality of the communities concerned. It would ensure that programs were responsive to local needs. This is also, in our experience in Quebec, the most effective way to ensure that plans are monitored.

    Subsequent regulations concerning the terms of Canada's cash contribution in respect to the program ensuring access should also include federal consultation with the affected minority communities.

    We therefore recommend that language be included in Bill C-202 that ensures the participation of local minority language communities in the development, implementation, and evaluation of health and social service access programs.

    On the concept of the creation of an intergovernmental cooperation program in the area of health, the work plan upon referral of the subject matter of Bill C-202 identifies the creation of an intergovernmental cooperation program as one of the two areas the committee should examine. Quebec's English-speaking minority communities have already benefited from two intergovernmental agreements in force between 1989 and 1999. These agreements were signed between the Department of Canadian Heritage and the Quebec government, and financed regional coordination of English language services and the development of limited community activities.

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    We heartily endorse the federal cooperation with the provinces in this area. The importance of having an infrastructure within regional planning authorities was the key to our success in gradually integrating our English-speaking communities into Quebec's health and social service system. Just about everyone, including the two governments involved, recognizes that the intergovernmental cooperation agreement really brought the legislative guarantees for services into reality for English-speaking communities in Quebec.

    We're also very pleased that the new government action plan on official language minority communities has identified health and social services as one of its major funding priorities. So we endorse the idea that intergovernmental programs should be established in the area of health and social service delivery to minority language communities. We insist that Quebec's English-speaking communities receive a proportional share of any resources that are allocated in that regard. We also think, given the fact that we have a very important consultative committee to Health Canada, as do the francophones, that these committees should continue to be involved in the discussions of these initiatives.

    We recommend that the Government of Canada commit itself to ensuring that the minority communities possess the capacity to carry out social planning and program evaluation with regard to their members.

    Thank you very much.

    The Chair: Thank you, Mr. Carter.

    Madam Freedman, do you wish to add anything?

    Mrs. Sara Saber Freedman (Researcher, Missisquoi Institute, Quebec Community Groups Network): No, thank you very much.

    The Chair: Just for clarity's sake, have all the members received the document distributed by QCGN?

    Does this contain a summary of the report on the advisory committee?

    Mr. James Carter: Yes. This is substantially the executive summary of the brief.

    The Chair: Do you mean the brief that was prepared by the advisory committee and then presented to the Minister of Health?

    Mrs. Sara Saber Freedman: No.

    Mr. James Carter: This brief was prepared by the Quebec Community Groups Network, and it's very distinct from a report that the consultative committee delivered to the health minister earlier this year.

    The Chair: Fair enough.

    So just for colleagues' sake, that report is available. Perhaps our research assistant can make sure a summary of it is circulated so we can have access to it. Perhaps later on we will invite the representatives of that advisory committee to meet with us.

    Thank you.

    Mr. Kenney. No questions.

    Mr. Sauvageau, please proceed.

[Translation]

    Mr. Benoît Sauvageau (Repentigny, BQ): Good afternoon. Welcome to the Committee. I believe you are the witnesses initiating our work on this topic. I'm not dreaming here, am I? They are the first witnesses we have received on this particular topic, are they not?

    The Chair: No, they are not the first. We have already heard from the FCFA…

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    Mr. Benoît Sauvageau: That's right, we already heard from the FCFA. Pardon me.

    The Chair: Health Canada.

    Mr. Benoît Sauvageau: The light just went on.

    The Chair: This is our third group of witnesses.

    Mr. Benoît Sauvageau: Yes.

    I had a quick look at your Table 5 on page 22. It's interesting to see what it says about access to English-language services in Quebec by service providers. What it shows is that if you calculate the total for the regions, the average, in terms of access to doctors in private practice is 86 per cent; for hospitals overnight, it's 80 per cent; for community organizations, it's 78 per cent; nursing care is at 75 per cent; for clinics, it's 73 per cent; for private institutions or nursing homes, CHLSDs and CLSCs, it's about 66 to 70 per cent.

    Your presentation--and this is perfectly natural--pointed to certain visible shortcomings or problems the Anglophone community has had to live with in Quebec. But if you look at the numbers overall, the picture is not really that negative. An average of between 70 and 86 per cent is quite good. Of course, there is room for improvement, but that is still good.

    I don't think you are in favour of abolishing Bill 142. It can certainly be improved, but we don't want to abolish it. When you recommend doing away with the population threshold, of course you are aware that will entail certain costs as well, if services are provided everywhere. You also say that you are very supportive of Francophone communities. Yet if we do away with the threshold for Francophone communities, the costs will be even higher for Canada as a whole.

    Would you be prepared, out of a desire to show your solidarity, to accept a form of reciprocity? In other words, thresholds for Francophone communities would have to be 50 per cent of your own thresholds before new money would be allocated to you.

    Mr. James Carter: I think that there are two points to be made in answer to your question. Our experience relates mainly to distribution. The real issue is one of management. In terms of control and management of institutions, we see that concept in sub-section 12.1(c), in clause 2 of the Bill that was introduced. But we don't see that same restriction in the other two paragraphs that deal with the organization of health care services for either Francophones or Anglophones in Quebec.

    So, if the intention of the drafters of the amendment is to link the notion of a threshold to the establishment of control and management, then there will be a lot of debate on what those levels are. Those are the same debates we had on the Official Languages Act and federal government services with a view to establishing rules that would affect the vast majority of minority communities, but would also set limits in terms of the organization of government resources.

    Based on our experience, Mr. Sauvageau, if we set aside the question of the institutions and directly address the matter of service organization, it is clear that the “where numbers warrant” criterion was rejected when these legislative proposals were drafted. The reason for that is that in half of the regions, the Anglophone community represents less than 10 per cent of the total population. With the rule respecting constraints on financial and human resources, and all of that, even in the rural communities where there are fewer than 500 Anglophones, hospitals were able to define and identify professionals in a unit that could provide services in English. We were able to capture those resources. So, if we had a threshold of less than 10 per cent, the region would not be required to develop an access program. In that case, we would lose half of the population of our regions and the resources that are already in the health care system.

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    Mr. Benoît Sauvageau: Perhaps I could just interrupt, because our time is limited. I have a relatively good understanding of the issue with respect to the threshold. And I think I also have a pretty good grasp of what you have explained with respect to the regions.

    What I want to say is that if we remove that threshold for Quebec and Canada, we will have to ask the federal government to inject $10 million more, or $100 million more, or x million dollars more. So, out of solidarity with the Francophone communities, would you agree to that money going to the Francophone communities, so that they could attain 50 per cent of the access threshold that you have, and keep your money to maintain those thresholds? In terms of new money, that would make it possible to ensure that there would be some parity at some point.

    I believe there is a problem with the symmetry of distribution of federal transfers and an issue of asymmetry in terms of Francophone communities' access to health care. What solution are you proposing to address that dichotomy?

    Mr. James Carter: The problem I have with your question has to do with determining the threshold. It is possible that Francophones will put a great deal of the emphasis on developing institutions that will serve 100 per cent of Francophones. I know that it is an important strategy to ensure that there are institutions controlled by Francophones that will be providing mainly primary care. We know that that is the objective. The population threshold may be very important in the context of developing provincial legislation. So, it is impossible for us to say what the threshold is.

    Mr. Benoît Sauvageau: That was not my question.

    Mrs. Sara Saber Freedman: Perhaps I could try to answer your question.

    Mr. Benoît Sauvageau: I would appreciate that.

    Mrs. Sara Saber Freedman: As far as we are concerned, there is one fundamental issue. The Anglophone community in Quebec is a minority language community, period. That is part of the many concerns associated with the Official Languages Act in everything that goes along with that.

    What you are saying is true about there being a certain lack of symmetry overall, in terms of access to services in English. You have calculated the totals. I would simply say that the fact that services are accessible in Montreal, where 60 per cent of our population lives, is not particularly helpful to an Anglophone in the Gaspé who needs hospital services, particularly in light of the whole matter of regionalized services. So, our needs in terms of service development and financial resources that could eventually be made available by the federal government have to be seen in that context.

    Here we are not talking about equality; we are talking about equity. I could say to you that when there were negotiations regarding the distribution of budgets as part of the government's Action Plan on Official Languages, I believe we accepted a ratio of three to one or four to one in terms of budget distribution. So, we are not expecting it to be dollar for dollar, but at the same time, it's not a question of…

    The Chair: Ms. Freedman, for the purposes of our discussion, the figures are as follows: of the $119 million, $30 million goes to front-line programs; $20 million, to the Francophone communities; and $10 million, to the Anglophone communities. Then there is another $89 million divided between two programs: training gets $75 million, of which $63 million is earmarked for the Francophone community--in other words, the consortium--and $12 million is earmarked for the Anglophone community in Quebec; finally, of the remaining $14 million, $10 million goes to the Francophone community, and $4 million goes to the Anglophone community. Those are the figures.

    Mr. James Carter: But I have to add something here, because the question you asked earlier had to do with thresholds, which are very important, and our figures on access. In fact, as part of the amendments to the legislation, it was always intended that the federal government would be the one ensuring that the provinces develop access programs, in the sense that that is the obligation set out here. We know that there is a lot of variation between the different regions and that if no provision were made, in a case where there would be a direct injection of funds from the federal government, for this to go through the provinces, for them to distribute federal resources across the health care system based on their own structure, it is difficult to see how that federal money could be targeted.

    My understanding, Mr. Bélanger, is that the amendment provides that the provinces will be required to develop an access program, and the determination of that program would fall within the jurisdiction of the provinces.

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    The Chair: Just to be clear, Mr. Carter, the bill you are referring to no longer exists.

    Mr. James Carter: I realize that; we're talking about the concept here.

    The Chair: Yes, we're talking about the concept, and we're talking about a reference to this Committee through which the House of Commons asked the Committee to examine such concepts as access to health care services by official languages communities across Canada, legal protection, and some sort of infrastructure program, as well as a possible transfer program.

    So, your comments regarding the bill itself will not be helpful, unless they relate to very fundamental points. I've taken note of your remarks, because that way our colleagues who have not yet read what you had to say will have an opportunity to do so.

    If there are no further questions, I would like to ask one. I know that this may leave me open to accusations from my colleague, Mr. Sauvageau, but I want to know exactly what we're talking about here. You referred to something in your presentation that concerns me somewhat, and I want to quote from what you say in the third paragraph of your brief on page 1:

[English]

While the Quebec Health and Social Services Act includes a number of dispositions that assure access to health and social service in English, the constraints of resource availability, the ongoing administrative reorganization of services, and periodic overt attempts by government to limit the extent of the guarantee....

I'm not familiar with these “periodic overt attempts”. If you could elaborate on that anecdotally or tell us if they're documented, that would perhaps be of use to this committee to understand the situation you face.

    Mr. James Carter: This reference has to do with recent experience that English-speaking communities had with regard to the development of access programs in Quebec.

    The Chair: Could you just explain to us what “development of access programs” means? Give us the context, please.

    Mr. James Carter: In Quebec, we have legislation that states that the regional health authorities will develop programs of access to English-language services, which are then approved by the Quebec government in the form of a decree. These access programs identify the services, region by region, that must be made accessible in English to the English-speaking population. These access programs are subject to revisions every three years.

    In bringing the legislative guarantees in, there was a very important debate between the two principal political parties about this legislation. The party that proposed the legislation, when it was the government, proceeded to implement the legislative guarantees. When the opposition party became the government it was very difficult for the Parti Québécois government to proceed and implement legislative guarantees it had fought so hard to keep out of the Quebec health and social services act.

    That was also at a time when there was politicization of the issue of health services to anglophones. This created a climate in which it was extremely difficult for English-speaking communities to become involved with regional health planners in identifying and revising the access programs, because the government in power found many different ways to avoid having to take responsibility for revising the program.

    Two things happened. The minority language community finally went to Quebec Superior Court because the government was over two years late in revising the programs, and court action was required on the part of the minority community to force the government to respect its own legislation. The government then proceeded to undertake a program to reduce the list of services in every region. So there was quite a serious attempt to reduce the services that had already been identified by the regional planning authority.

    Due to that experience, the mobilization that was required by English-speaking communities was considerable. The whole thing ended with the government approving a set of revisions, under force of court order. Now, of course, we've had a change of government, and it views this legislation as important.

    So from the point of view of the minority language community, even with the legislative framework in place, two separate governments can take two entirely separate attitudes to implementing it. We had to engage in very significant mobilization to hold onto the legislative guarantees we fought for originally.

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    The Chair: Are these access plans prepared in consultation with the community?

    Mr. James Carter: Yes.

    The Chair: Where do they go once they're prepared at the institutional level?

    Mrs. Sara Saber Freedman: They go to the Quebec ministry of health and social services, and then to the cabinet for approval in the form of a decree. I think it's important to explain that the Quebec legislation situates access to health and social services as an individual right rather than a systemic obligation. It creates a very different dynamic from the one that would have been foreseen in the legislation that is no longer under consideration.

    The access programs are done in consultation with all the public institutions and local communities through a regional consultative process. That community consultation dynamic, which Mr. Carter referred to earlier, is critically important in helping communities and regional planning structures find ways to work together creatively.

    Once the list of services is developed, it goes through the normal bureaucratic process up to cabinet, and ends up as a decree. What's important is that because of the three-year revision process and other legislative dispositions elsewhere in the act that require the overall regional planning process to take language into account, there's a developmental process by which an access plan is essentially a set of services that are currently available. You then have a basis on which to develop new services that are identified as priority by local communities. So you have a dynamic process through which services can be developed over time.

[Translation]

    The Chair: Thank you.

    Mr. Sauvageau.

    Mr. Benoît Sauvageau: On page 24, you have a table showing that on average, services are accessible in 75 per cent of the regions. That table dates back to the year 2000, and the Parti québécois was in power at that time.

    Mr. James Carter: What table are you referring to, Mr. Sauvageau?

    Mr. Benoît Sauvageau: I am referring to Table 5 on page 22. This is not a question, but rather, a statement. My political knowledge may be minimal, but I do know that the Parti québécois was in power at that time. You said that when the Liberal Party was in power, Bill 142 was applied in a more open and generous manner in terms of its impact on the Anglophone community.

    Going through the clerk, would it be possible for you to send us a similar table for the years when the Liberal Party was in power, as well as a table presenting averages during the mandate of the Parti québécois, so that we can ascertain whether or not what you are asserting here really applies? I have no reason to doubt what you're saying, but if access to hospitals overnight was at 75 per cent prior to the former government, and it is now at 80 per cent, one can hardly criticize the Parti québécois for the 2 per cent increase. Since you made a political assertion, I have no doubt that you will be pleased to have a chance to prove the accuracy of your statement.

    You also say that Bill 142 has some shortcomings. I am not contradicting you. It is possible that it does have shortcomings, but the rate of access is nevertheless 75 per cent. Other than New Brunswick, can you name one other Canadian province that has legislation guaranteeing access to health care services to the Francophone community?

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    Mrs. Sara Saber Freedman: I can answer the first part of your question. The information regarding the level of access is taken from a major survey that was funded by the federal government. That survey allowed us to interview more than 3,000 Anglophones across the province. We asked a series of questions, including some on access to English-language services. This survey was conducted in 2000. I would be very pleased to repeat that exercise if the government is prepared to provide the funding. It would provide an opportunity to compare access to services under another government.

    Unfortunately, we do not have comparable prior information. We do not, unfortunately, have any information dating from the period the former government was in power. That is the only survey of this type to have been conducted.

    Mr. Benoît Sauvageau: But what are you basing yourself on to make these assertions?

    Mrs. Sara Saber Freedman: What we are talking about are legislative guarantees and access programs. The figures you have quoted relate to access in the field. It is quite possible that in Montreal, for example, particularly when it comes to hospital and medical services, even prior to the adoption of Bill 142, services were at the same level, because the English population is highly concentrated in Montreal; there is McGill University and the hospital system there, and so on. The guarantees we are referring to helped to develop English-language services, particularly in areas where the population is smaller, and that is why they are so important.

    Unfortunately, as I said earlier, we have no comparable data going back 10 years.

    Mr. James Carter: I don't think it's really possible to make a connection between governments in power and those figures, in the sense that…

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    Mr. Benoît Sauvageau: But you are the ones who prepared that table.

    Mr. James Carter: I answered the question to try and explain what we are saying in our brief. We noted that sometimes there can be political constraints. We have had two different regimes, but I did not draw any parallel between the answer I gave and the figures presented in our brief.

    The fact is, Mr. Sauvageau, to answer your second question, that we believe the guarantees in Quebec are a model that could be used by other provinces and Francophone communities. Our intention today is to ensure that all the concepts we are discussing here support the legislative framework that exists in Quebec. That is why we rejected the concept of “where numbers warrant”, because that does not exist in the Quebec Act and we prefer that it be separate, for our sake and for the sake of our institutions.

    Also, we had to be completely honest; there is still the legislative framework for the Anglophone population that can be used as a model, but as with all legislation, there are always constraints. We want to be perfectly honest. Even where the constraints relate to resources, there can still be gaps, because we're talking about existing resources, such as nursing staff, doctors and other professionals.

    In a hospital or CLSC, according to our legislation, a multidisciplinary team can be identified where there are enough professionals available to provide service to Anglophones. But it is also possible that in another care unit, there won't be enough nursing personnel for administrators to be able to guarantee access to services. So, in preparing the lists of services, unit A will be in the access program, but unit B will not.

    Another important point to mention in explaining these figures is that the Quebec Act states, and I quote:

15. English-speaking persons are entitled to receive health services and social services in the English language, in keeping with the organizational structure and human, material and financial resources [...]

    So, this is a right.

    Many services are provided on a voluntary basis. A lot of people are able to receive a service at their CLSC that isn't guaranteed in the legislation, and resources that are there on Monday may not be there on Tuesday. So, the director of the CLSC will decide that where services can be provided in English, they will be provided, but it is not an obligation. As a result, a lot of Anglophones are able to obtain services from Francophone professionals--services that are not listed in a government order or decree.

    Mrs. Sara Saber Freedman: I think it's important to emphasize the existence of legislation dealing with language of work in Quebec and access to services in the English language. The Charter of the French Language includes a requirement that an employer prove that there is an actual need for employees to know a language other than French, and to demonstrate the level of proficiency that is required--and that applies to all employees, particularly in the health care sector. That means that if political direction is given which is aimed at decreasing the number of positions that require bilingualism--such as in a hospital, for example--hospital administrators will have a tendency to reduce the number of positions requiring the use of English. So, when positions do become available, seniority is the deciding factor, of course, and the next person in line, who may not have any knowledge of English, is entitled to apply for the position.

    So, if there are no formal requirements attached to the position, the ability of the health care sector to provide services in the minority language could well be lost. In a political climate which is more favourable to minority access, the tendency is to increase the number of positions and work with the unions to find a way to provide these services in English. When the atmosphere is more tense, it becomes more difficult for hospital administrators. That is the kind of issue we very often face.

[English]

    Mr. James Carter: The interesting thing we're presenting to you here is that in Quebec we have a legislative framework that has a history, as we have described. A couple of opinions of a provincial advisory committee actually give a history of that, and I'd be glad to forward them for those who want to read some of the background on this. They would find them very instructive.

[Translation]

Also, I think I can provide them, because they are available in both languages.

[English]

    On what interests us very much in the concepts you are considering here to ensure the introduction of linguistic duality into the Canada Health Act for the minority language communities, we highly recommend that you continue to pursue the concept of an access program. We think that's an excellent concept.

[Translation]

    We have had very good results, despite some ups and downs and the political rhetoric, which can be…

[English]

    The Chair: The bill that was initially put forward was indeed copied mostly on the legislation of Quebec. I've never seen one--and maybe some of my colleagues have, and we have a doctor among us who might have seen something similar to it--but what does an access plan look like?

    I'm sure they're different, whether it's in a large conglomeration such as Montreal, or somewhere in Gaspé. Do you have something you can share with us, in terms of a small community's access plan, so we can get a better understanding of it?

º  (1630)  

    Mrs. Sara Saber Freedman: There are two documents that need to be considered, and I'll see if we can easily arrange to send them to the committee. The first is the local administrative planning document, which reads more like a report and talks in a general way about where services need to be developed, etc.

    The second document is a formal government decree that exists as part of the public record. We can offer both of those to the committee. I think they would be very instructive. Indeed, they are different for Montreal and for the regions; however, in the end, the decree in both cases is a list of institutions and services.

    Mr. James Carter: I'll even add a third document, which is also excellent for you as a resource document. We prepared a framework for the development of an access program, which the government then instructed every regional planning authority to use as the guide to develop the plan.

    You could see how it works. You have une carte de référence that indicates all the criteria for development of the plan, so there's some uniformity in all the regions. Then each planning authority spends a year to two years working with its institutions and communities to develop the plan, so you get a document with all the demographics. The ministry takes that and then the decree is: “institution one”, “institution two”, “services a, b, c, ”. That's all that exists in terms of the decree.

    The Chair: We're going to have to wrap this up, but in all of the discussions in presenting the law, approving it, and then having these access plans developed, was the hurdle of costs a big one, and how was it overcome?

    Mr. James Carter: Sara and I are both going to answer this, but I'd like to lead off. It goes back a little to Mr. Sauvageau's initial asymmetry and the money aspect.

    On the question of resources, even when I was in government on the government side doing access programs in the early 1990s, the services were always identified within the existing resources. You would rarely see the government provide new moneys for services. That was a little bit why I was struggling with Mr. Sauvageau's link of money.

[Translation]

We're talking about the framework of existing resources.

[English]

The resources that are actually in place are financed generally from the Quebec treasury--those are the services. So there was never any special envelope, except on one occasion during a political campaign. Other than that one occasion, there were never any special moneys set aside. It wasn't like education. We didn't take any transfer payments from the federal government through the Canada Health and Social Transfer and say it was to develop services for anglophones.

[Translation]

    Everything is done on the basis of equity principle. I think the important principle here is the right to access services in English. That means Anglophones have the same opportunity as Francophones to access services.

[English]

The same chance to have access to services as the rest of the population.

[Translation]

That is why there is no special budget or earmarked funding.

    The Chair: Ms. Freedman, you will have the last word.

[English]

    Mrs. Sara Saber Freedman: My own experience, in Montreal particularly, is that if institutions are willing and committed, the lack of money is less of a problem. However, if there is real resistance then the availability of money is a very substantial encouragement. Keep in mind--and I really want to underline this--the Quebec model for delivering health and social services in English did not envisage the creation of a parallel system. On the contrary, from the very beginning the position was that we already had a strong network of institutions in Montreal, but the model was that we wanted services within the existing structures.

º  (1635)  

    The Chair: Thank you.

    I believe that will bring this portion of the meeting to a close. I want to thank you both, Mr. Carter, and Madam Freedman. We're embarking on a bit of a journey, and we're not too sure where we're going to end up. We're exploring here. I think you've given us a lot of material, and especially the material to come. I suspect it will end up being rather useful in our exercise. I want to thank you both, on behalf of my colleagues, for taking the time to be here today.

[Translation]

    Thank you very much.

    We will continue our meeting now in camera.

    [The meeting continues in camera]