Ottawa’s Incurable Disease: Interference

The Bloc Québécois would like first of all to thank all those individuals and groups from Quebec and Canada who appeared before the Committee with regard to Health Human Resources (HHR). Naturally, the Bloc Québécois questions why such a topic should be considered by the House of Commons.  

In its report, the Standing Committee on Health “agreed that the jurisdictional complexities involved in HHR would be respected during the study, including recognition of the fact that the Province of Quebec considers HHR planning as its exclusive provincial responsibility and therefore does not participate in current pan-Canadian initiatives related to HHR.” The logical choice would have been to explicitly exclude Quebec from the report’s recommendations. Despite all the evidence presented, the federalist parties flatly refused the Bloc Québécois’s request to do so.

We must conclude that once again Ottawa is suffering from an incurable disease: interference. There is no denying that the divide between Quebec and the rest of Canada is growing steadily. These two irreconcilable visions are constantly clashing, with Canada seeking to interfere in matters over which it does not have jurisdiction and Quebec having to constantly defend itself against these attacks on its sovereignty. Let us be clear though that health services have always been and remain under Quebec’s exclusive jurisdiction, regardless of the specific issue in question.

1. Health human resources: a huge challenge

The members of the Bloc Québécois do of course recognize the challenge posed by the shortage of health human resources (HHR) in Quebec and in Canada. In 2009, in Quebec alone, there were some 5,000 vacancies to be filled[1] in health services, and the needs in this field are growing steadily, especially with the ageing population.

In its report, the Standing Committee on Health suggests measures that the federal government could take with regard to HHR. Apparently the Bloc Québécois has not repeated it often enough that HHR planning falls under Quebec’s exclusive jurisdiction. Appearing before the Committee, Joshua Tepper, Provincial Co-chair, Advisory Committee on Health Delivery and Human Resources, noted that Quebec is a “leader[s] in numerous ways in health human resources.”[2] Not only has Quebec always been excluded from HHR agreements, it has already taken various measures to address the shortage of qualified health workers within its borders.

2. A question of jurisdiction

Let us recall that, in the 2003 First Ministers’ Accord on Health Care Renewal, Quebec decided not to participate in developing the Framework for Collaborative Pan-Canadian Health Human Resources Planning, the purpose of which was to determine provincial HHR requirements and to establish the Pan-Canadian Health Human Resource Strategy. This accord led to the adoption of the 10 Year Plan to Strengthen Health Care by federal, provincial and territorial first ministers in September 2004.

For its part, Quebec signed a separate agreement with Canada under this accord to enable it to “exercise its own responsibilities with respect to planning, organizing and managing health services within its territory.”[3] Quebec is already meeting its commitments in this regard since a number of cooperation mechanisms are in place, including FPT issue tables, formal and specific agreements and regular and ongoing contact with the provincial governments and the federal government.

In short, it is up to Quebec to establish its own human resources strategies in order to address such issues as wait times and the shortage of qualified health care workers. Quebec is nonetheless open to sharing information and best practices in this regard with other governments, including the Canadian Institute for Health Information.

3. Acting within its jurisdiction

The report of the Standing Committee on Health recognizes the complexity of managing HHR issues in Canada given that Quebec “does not participate in current pan-Canadian initiatives related to HHR.” Yet despite the Bloc Québécois’s best efforts to reach a compromise, the Committee categorically refused to exclude Quebec from the report, whether with the intent of undermining it or for lack of understanding of the issues. The Bloc Québécois accordingly feels compelled to contest the vast majority of the recommendations that directly interfere in matters under Quebec’s jurisdiction.

The Bloc Québécois does of course acknowledge and appreciate the fact that the Committee has given serious considerations to matters under its jurisdiction. Yet it deplores that the Committee has once again deviated from its original mandate for health care, which involves services to such groups as Aboriginal communities, veterans, the military, federally sentenced offenders and the RCMP.

Instead of trying to extend its jurisdiction into matters in which it has no expertise, the federal government should have focused on its own clients such as the First Nations and Inuit, where the HHR shortage is much more acute than in the general population in Canada. The federal government faces major challenges in this regard, as it has a constitutional responsibility for providing health care to these groups.

4. Spending power

The report also refers to the federal government’s supposed “spending power” in the section on the federal government’s role. The report notes that the federal government may take action with respect to health care by virtue of its constitutional spending power. Yet Quebec has always maintained that this “spending power” does simply not exist and that federal initiatives in areas under Quebec’s jurisdiction are unconstitutional. Quebec has always contested this view of federalism. In short, the Bloc Québécois could not leave this reference in the report unchallenged.

5. Process well underway in Quebec

Quebec is already taking its own initiatives and must receive its fair share of the funding earmarked for federal HHR initiatives, in accordance with its constitutional areas of jurisdiction and the 2004 ten-year plan. Here are three examples of measures taken in Quebec in this regard.

i) Recognition of foreign credentials

Appearing before the Committee, Corinne Prince St-Amand, Director General, Foreign Credential Referral Office, Department of Citizenship and Immigration, recalled that “In Canada, the provinces and territories are responsible for assessing and recognizing credentials.”[4]

In Quebec, the recognition of physicians’ credentials is the exclusive responsibility of the Collège des médecins du Québec (CMQ), which applies specific criteria, including competency in French. The federal government simply does not have the authority to overstep Quebec’s exclusive jurisdiction in order to change the process for the recognition of the foreign credentials of physicians wishing to practice in Quebec.

As to the shortage of physicians, Quebec is in negotiations with Ontario and other provinces and with France regarding workforce mobility. On 17 October 2008, Quebec signed the Quebec-France Understanding on the Mutual Recognition of Professional Qualifications, the first such agreement between Europe and America. Professional bodies in Quebec, in other provinces and in France will have to agree on the recognition of their qualifications, including the requisite postsecondary education and the additional training required for that recognition. These negotiations have so far led to the signing of mutual recognition arrangements (MRAs) for 54 occupations and trades in France and Quebec.[5] These arrangements fall under provincial jurisdiction and the federal government may not interfere in them.

ii) Recruitment for rural and remote areas

The underrepresentation of socioeconomically disadvantaged and rural groups at medical schools is a threat to accessible and quality health care for all Canadians, especially in the regions. The situation is somewhat different in Quebec however, which has frozen tuition fees and taken initiatives to increase the skilled workforce in the regions.

In 2003, for example, the Government of Quebec established a tax credit to recruit young graduates to work in the regions as a way of countering the exodus of young people and the shortage of skilled workers. This tax credit is equivalent to 40% of the salary an eligible young graduate would earn during the first year, up to a maximum of $8,000. This program has been very popular, with some 10,000 people taking advantage of it every year since its inception, the vast majority of whom might not have taken their first job after graduation in the regions had it not been for this Quebec tax incentive.

To continue to attract young workers to the regions, the Bloc Québécois has twice introduced a bill to establish a tax credit for young graduates who work in the regions, based on the model developed in Quebec. Bill C-288 is currently before the Senate. Moreover, to keep medical school accessible to all Quebeckers, the Bloc Québécois reiterates its demand that the federal government transfer to Quebec the $800 million shortfall under the Canada Social Transfer.

iii) Clinical research

Quebec and the provinces of course also have jurisdiction over basic and clinical health research. The Bloc Québécois considers research to be one of the most promising avenues and that it must be supported. It is therefore calling on the federal government to substantially increase research budgets and to transfer them to Quebec so it can in turn allocate the funding in accordance with its own policies and terms and conditions.

Appearing before the Committee, even the President of the Canadian Institute for Health Information, Alain Beaudet, maintained that the jurisdiction of Quebec and the provinces must be respected. “If we want to conduct effective clinical research in health services, epidemiology in particular, we have no choice but to work closely with the provinces. […] In Quebec, this would be the Fonds de la recherche en santé du Québec.”[6] The Bloc Québécois considers this to be the absolute minimum; the funding invested in research must be transferred to Quebec, with no conditions attached.

In short there are many ways of demonstrating the federal government’s constant interference in an area that is clearly under the jurisdiction of Quebec and the provinces. The Bloc Québécois concludes therefore that the federal government is truly suffering from the incurable disease of interference.

The Bloc Québécois therefore recommends:

• That if the federal government takes action to address the HHR shortage these actions shall not be binding on Quebec;
• That the federal government’s HHR initiatives must give Quebec the right to opt out with full compensation, and without conditions.