LANG Committee Report

PART II: AREAS OF GOVERNMENT INTERVENTION

A. Health

1. Health: an area of exemplary cooperation

All of the OLMC witnesses, Anglophone and Francophone alike, agree that health is an area of exemplary government cooperation. This success can be attributed in large part to the model used for cooperation between Health Canada and organizations that work for OLMC. The truth of the matter is that this approach makes it easier for the department to fulfil its commitments as set out under Part VII of the Official Languages Act.[34]

For the English-speaking communities of Quebec, Health Canada has put in place a tripartite cooperation model that respects the Government of Quebec’s jurisdiction. It also fosters the accountability of government partners and Quebec’s English-speaking community. According to the Quebec Community Groups Network (QCGN), Anglophone communities are considered partners in the planning and delivery of services:

The other thing about the health agreement that's important is that it also answers questions of accountability. What we have here, then, is an agreement where federal money is coming into the province. The community has a say on where the money's going, and the community can track the money and work with the province. So this health agreement is really a model of how to support our community with federal money.[35]

Health Canada’s tripartite cooperation model in Quebec is vital to the province’s Anglophone communities, which are particularly affected by the division of powers between the federal and provincial governments. The strategies developed in the area of health show that the federal government can work with the Government of Quebec to oversee the interests of the English-speaking community:

The key to success has been an implementation agreement between the CHSSN [Community Health and Social Services Network] and the Quebec Ministry of Health and Social Services, through which the CHSSN and its community partners collaborate with Quebec authorities at the provincial, regional, and local levels. Health Canada's innovative and flexible approach to implementing the Roadmap measures has been another key factor in this success.[36]

The excellent collaborative work being done in the health sector in Quebec must be used as a model in order to give English-speaking communities in the province access to maximum funding and programs under the Government of Canada’s future official languages initiative. Further, the accountability of communities in the health sector is important for both OLMC. Consequently, the Committee recommends:

Recommendation 3

That the Government of Canada and the Department of Canadian Heritage take note of the tripartite cooperation model put in place by Health Canada to implement Part VII of the Official Languages Act in Quebec and urge other federal institutions to adopt, inasmuch as possible, a similar model that promotes cooperation among federal institutions, the provincial and territorial governments and official language minority communities and fosters the accountability of each of the parties involved.

2. Roadmap 2008-2013 Investments: Initiatives and success stories

Health care is a matter of concern for Canadians, especially those living in a minority community. In 2001, 45% to 55% of Francophone minority communities in Canada did not have access to health services in French.[37]

According to Health Canada, “Access to health care in the official language of one's choice should be available, no matter which province or region we live in.”[38] Further, “at the Association of Faculties of Medicine of Canada, requirements respecting cultural and linguistic competencies are increasingly high and will probably even become accreditation standards for our Canadian faculties of medicine.”[39] For those reasons, the federal government gave Health Canada a total of $174.3 million for the period covered by the Roadmap. The Department’s Official Language Community Development Bureau (OLCDB) is responsible for implementing official languages programs.

The Roadmap enhances existing Health Canada programs. One component with a budget of $22 million over 5 years was designed to create and maintain community and regional health networks. The component in question is being implemented by two partners: Société Santé en français and the Community Health and Social Services Network (CHSSN). Health Canada describes the health networks in OLMC as preferred partners:

These networks engage health care stakeholders to enable improvements to health care services access in the minority official language. These stakeholders include provincial and territorial government representatives, health care administrators and health care professionals. The work of the networks is meant to leverage the introduction of new services in the communities they serve.[40]

The ability to build, maintain and strengthen networks is crucial for OLMC. Société Santé en français stated that networks are useful in organizing services and linking government and community priorities:

The networking approach that we adopted was the key factor in the success of the Société Santé en français. …

The networks are known as the agencies that can facilitate or put in place projects to accurately meet the needs of the scattered and often remote minority Francophone communities.

We have always wanted to put the emphasis on the quality of health services in French and patient safety. Through that, the networks have managed to build bridges promoting communication and joint action among the partners, including the provincial and territorial departments.[41]

The CHSSN, meanwhile, had this to say:

The community networks have increased the adaptation and coordination of services resulting in improved access to a range of programs in English. Partnership activities between community networks and services providers have enhanced the knowledge, strategies and innovative service delivery models addressing the needs of English-speaking communities.[42]

The aim of the second component of the Health Canada program is to train and retain Francophone or bilingual health professionals and researchers. The component was given a budget of $114.5 million over 5 years. On the Francophone side, the project is being spearheaded by the Consortium national de formation en santé (CNFS). Concretely, the 11 colleges and universities that are members of the CNFS and the Consortium’s national secretariat are improving French-language health services in Francophone minority communities through postsecondary education for Francophone and bilingual health professionals and through research.

The Roadmap has produced solid results in terms of health training in French:

Since the Roadmap was implemented, it has made it possible to introduce 15 new French-language health programs, for a total of 48 new French-language health programs in Canada since 2003. In addition, since 2008, there have been 3,000 new registrations, 3,000 new students in programs supported by the CNFS and 1,000 new graduates. Since 2003, 6,000 students have registered for French-language health programs in our Francophone communities. Nearly 3,000 of that number have now graduated and are working as professionals providing services in our communities. According to a survey we conducted, 86% of our graduates are working in health institutions and agencies serving our communities, and 79% of them are working in their home province or territory.[43]

Among Quebec’s English-speaking communities, McGill University is Health Canada’s main partner. The approach is different from the one used by Francophone minority communities. The emphasis is on English language training for French-speaking staff who work directly with the public. This helps increase the availability of health care in English, particularly in areas where access is limited. “Staff” includes receptionists and all health and social services professionals. According to the CHSSN, the initiative is a success:

The McGill program has supported initiatives aimed at further developing or maintaining acquired skills outside of the classroom or once the formal training has ended. These include pairing professionals with volunteers from the English-speaking communities or involving professionals in cultural activities in English-speaking communities. Other materials such as self-study workbooks have been produced by the McGill Project …. In the first three years of the Roadmap investment, well over 3,000 French-speaking professionals have participated in language-training programs.[44]

McGill recently launched a bursary program for students who are willing to work in designated regions once they graduate. The bursaries will be managed by the seven community networks in the regions concerned.[45]

The third component put in place by Health Canada promotes the integration of services and the improvement of access to health care in the minority language. The component was given a budget of $33.5 million for the period covered by the Roadmap. In Francophone minority communities, projects target three groups: children, youth and seniors.[46] In Quebec, two areas were given priority: health promotion, and adaptation of health and social services. Excellent cooperation between Health Canada and the CHSSN led to the signing of a framework agreement with the Ministère de la Santé et de Services Sociaux. The aim of the agreement is to improve access to health and social services for English-speaking communities in Quebec within the public health system.

The Committee is of the opinion that in order to deliver health care in English and French in minority communities on a sustained basis, the government has to act under all three of the components described above. Consequently, the Committee recommends:

Recommendation 4

That Health Canada, in collaboration and consultation with its provincial and territorial partners, continue its strategy of investing in official language minority communities by:

a)    training more health professionals to be able to work in official language minority communities;

b)   creating and maintaining regional and community health networks;

c)    integrating, promoting and improving access to health care in the minority language.

3. Evidence and recommendations

According to the health related evidence the Committee heard, there are three other areas that require federal government intervention: support for research and access to new technologies; recruitment of immigrant health professionals; and access to health services for caregivers and seniors in the language of their choice.

3.1 Support for health research

The witnesses representing OLMC are looking for federal government support to facilitate research projects devoted to health in OLMC across the country. Professional research targeting health would yield strategic information that would guide stakeholders in their decisions on the organization and delivery of health services and other matters.

The Committee is pleased to see that the Community Health and Social Services Network (CHSSN) has identified Quebec’s Institut national de santé publique as a primary institutional partner for research on the health and well-being of English-speaking communities in the province. A tripartite committee — the CHSSN, the Ministère de la Santé et de Services Sociaux and the Quebec’s Institut national de santé publique — is overseeing this initiative.[47]

Since 2003, the Consortium national de formation en santé (CNFS) has supported 325 different research projects covering such subjects as the profile and health determinants of Francophone minority communities; governance, management and delivery of health services in French; and the postsecondary training needed to provide safe, quality health services in French.

However, the Committee notes that research on health in OLMC recently suffered a blow when, to the chagrin of witnesses, the Official Language Minority Community Health Research Program, which was managed by the Canadian Institutes of Health Research, came to an end:

Unfortunately, the recent decision by the Canadian Institutes of Health Research to terminate the health of official language minority communities research program will have a significant impact on our current and future projects.[48]

The CNFS explained the consequences of that decision for Francophone health networks:

… we understand from this situation that it will be increasingly difficult for Francophones to make funding requests. Furthermore, it won't be as easy to fund the entire research issue, which directly concerns the health of Francophone minority communities, if there is no more dedicated funding for research on French-language health services.[49]

The CNFS told the Committee that a meeting was scheduled with the Canadian Institutes of Health Research to find a way of continuing the excellent cooperation between the two groups that has existed since 2003.

Health research is key to sound decisions and the development of programs that are strategic and efficient. Consequently, the Committee recommends:

Recommendation 5

That Health Canada recognize that it is its responsibility, regardless of the Roadmap, to support research on health in official language minority communities (OLMC) in order to obtain conclusive data that can guide governments and OLMC in setting priorities for the training of health professionals and the delivery of better health services.

3.2 New technologies

New technologies play an important role in the training of health professionals. Because Canada’s Francophone and Acadian communities are small and widely dispersed, it is essential that the educational institutions that are members of the Consortium national de formation en santé (CNFS) have access to communication tools which enable them to provide distance training with Francophone specialists throughout the country. They also need specialized tools and instruments in order to deliver clinical training. Institutions must have these teaching tools before their programs can be approved.

New technologies are also used to promote health in OLMC. As part of the McGill initiative, the Community Health and Social Services Network (CHSSN) is carrying out a project aimed at delivering training on health promotion to English-speaking communities by videoconference.[50]

Société Santé en français told the Committee that because of a lack of funding, it had to drop a major component on the use of new technologies to deliver health services:

For budgetary reasons, we have had to downplay two areas of action. … Those two axes were the development of new technologies to support service organization and delivery and the development of strategic information, that is to say how to obtain convincing information on the Francophone communities that enables groups to make the appropriate decisions to establish better services.[51]

A future horizontal initiative on official languages that fosters interdepartmental and intergovernmental cooperation could help Health Canada, its provincial and territorial partners, and health organizations and networks in OLMC put in place programs that support the development and use of technology to train health professionals and improve health in OLMC. Consequently, the Committee recommends:

Recommendation 6

That Health Canada, in consultation and cooperation with the provinces and territories and in an effort to build on their own initiatives, meet the new technology needs of the health institutions of organizations that work in official language minority communities. It is also suggested that Health Canada seek support for these initiatives from such partners as Industry Canada and the National Research Council of Canada.

3.3 Recruitment of foreign-trained health professionals

The Consortium national de formation en santé (CNFS) believes that immigration is a key factor in improving access to health care in French in Francophone minority communities. Health networks must have access to Francophone or bilingual health professionals and researchers to meet the growing demand for health services in French. For example, communities, French school boards in particular, are actively looking for specialists (psychologists, therapists, speech therapists, etc.) to serve youth in the language of their choice. It bears noting that the same need is equally strong in Quebec’s Anglophone communities and school networks.

The recruitment, employment and retention of immigrant Francophone or bilingual health professionals and researchers require a great deal of cooperation among Health Canada, Citizenship and Immigration Canada (CIC), Human Resources and Skills Development Canada (HRSDC), the provincial and territorial governments, and health networks in Francophone minority communities. Most provinces and territories already have agreements with the federal government on immigration under which jurisdiction, especially jurisdiction over the selection of immigrants, is shared. Further, the recognition of qualifications between countries and between Canadian provinces and territories continues to be a problem.

The Committee was pleased to learn that the CNFS, in cooperation with its partners and with financial support from Health Canada, HRSDC and CIC, has taken a number of initiatives to improve and facilitate the socio-professional integration of foreign-trained health professionals and graduates into Francophone minority communities.The CNFS offers bridge training to prepare individuals for professional certification exams; cross-cultural training; local and regional integration and orientation programs; and a series of consultations on the recruitment and retention of foreign-trained health professionals. The CNFS has also conducted a feasibility study to implement a pre-departure program in French for French-speaking immigrants who want to work in Canada.

Recommendation 7

That Citizenship and Immigration Canada take into consideration the urgent need to recruit specialized health professionals in the Francophone and Anglophone minority health systems, including foreign-trained professionals.

3.4 Access to health care for caregivers and seniors

Under the access to health care component, two target groups have been identified as needing special attention: caregivers and seniors.

Generally, a caregiver is a person who looks after a friend or relative who is permanently or temporarily disabled because of a handicap, an accident, illness or advanced age. The Alliance des femmes de la francophonie canadienne told the Committee that between 70% and 80% of caregivers are women.

There have always been caregivers, of course, but the dynamics of Canadian society are leading caregivers to join forces and take part in the public debate on health. Aging of the Canadian population is a key factor in this awakening. In 2006, 32% of Canadians were 50 or older. In response to these changes, Canada’s health care systems have promoted home care. Some of what used to be the government’s responsibilities have now been transferred to caregivers:

Provincial health care systems are increasingly seeking to keep seniors and people who are ill at home. But there is only minimal planning to set up support and training programs to expand home care and respite care.[52]

By all indications, this is a Canada-wide problem not restricted to OLMC. However, limited access to services in the minority language adds a dimension to the problem that is a source of concern for caregivers, the sick and seniors in OLMC.

According to the Fédération des aînées et des aînés francophones du Canada (FAAFC), Health Canada and Société Santé en français have set up 12 projects aimed at seniors. Funding has been provided to develop in cooperation with the Victorian Order or Nurses (VON) Canada a program to support Francophone caregivers in Alberta. The FAAFC said that the project is yielding considerable benefits:

Every time I meet with Franco-Albertan seniors, they all speak highly of this project. They tell me how much it helps Francophone seniors. People are so appreciative that an organization the size of VON Canada has developed services in French. It is interesting to see the benefits of this project because it is making progress.

In parallel with that project, VON Canada reported that it is worthwhile and feasible to provide services in French to Francophones in a minority situation. So VON Canada is quite interested in continuing this development.

We recently held a four-way meeting. In attendance were VON Canada, the Alliance des femmes de la Francophonie and the Société santé en français, among others. We spoke about developing a true pan-Canadian strategy to help seniors with care and services at home, but also care with family caregivers to establish a pan-Canadian strategy. As you ee, by working on a small project that began in Alberta, we are in the process of implementing a project that will grow across Canada and serve all Francophone seniors in a minority situation.[53]

This is a tangible example of the importance of cooperation. Consequently, the Committee recommends:

Recommendation 8

That Health Canada develop with its partners a long-term strategy to provide caregivers and the individuals they take care of with services and support in the official language of their choice given that language of communication is essential to the delivery of quality services.

In the context of the renewal of the Roadmap and given the 2013-2018 outlook for Health Canada programs for OLMC, it is essential that the Department of Health and the federal government be reminded of the importance of ensuring that Canada’s linguistic duality is recognized in planning and funding the services provided to communities.[54] Cooperation that encourages OLMC and the provincial and territorial governments to get involved and take matters into their own hands must always be at the heart of federal initiatives.

The Committee was pleased to learn that Health Canada consulted Francophone minority communities in 2011 regarding the implementation of a new health strategy for the period from 2013 to 2018. A report on those consultations titled Consultation of French Speaking Minority Communities: 2013-2018 was made public. Three priorities were identified: increase the availability of health programs in French in order to increase the number of professionals capable of delivering quality health services in French throughout the country; improve access to postsecondary health training in French in all regions of the country; and develop new French-language health training programs for which there is a demand but which are not available outside Quebec.

The Quebec Community Groups Network (QCGN) was given a mandate to tour the regions and gather comments from communities. A report on those consultations was recently submitted to Health Canada. The Community Health and Social Services Network (CHSSN) presented before the Committee the four priorities that came out of this consultations report: adaptation of human resources; adaptation of local services to local needs; availability of information about services in English; and involvement of community.[55] It bears noting that the Ministère de la Santé et des Services sociaux du Québec has recognized the relevance of these four priorities.

The Committee takes note of these success stories and urges Health Canada to carefully study the results of these consultations as well as the evidence and recommendations in this report as it develops its 2013-2018 strategy for health in OLMC.