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37th PARLIAMENT, 2nd SESSION

Standing Committee on Official Languages

EVIDENCE

CONTENTS

Tuesday, May 27, 2003

0905

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

Mr. Georges Arès (President, Fédération des communautés francophones et acadienne du Canada)

The Chair

Mr. Georges Arès

The Chair

0910

Mr. Georges Arès

0915

0920

The Chair

Mr. Hubert Gauthier (President, Société Santé en français)

0925

0930

0935

0940

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Benoît Sauvageau (Repentigny, BQ)

Mr. Hubert Gauthier

0945

0950

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Georges Arès

The Chair

Mr. Raymond Simard (Saint Boniface, Lib.)

Mr. Hubert Gauthier

Mr. Raymond Simard

0955

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Eugène Bellemare (Ottawa—Orléans, Lib.)

1000

Mr. Hubert Gauthier

Mr. Eugène Bellemare

The Chair

1005

Mr. Hubert Gauthier

The Chair

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

1010

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

Mr. Benoît Sauvageau

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

1015

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Hubert Gauthier

The Chair

Mr. Benoît Sauvageau

1020

Mr. Georges Arès

Mr. Benoît Sauvageau

Mr. Georges Arès

Mr. Benoît Sauvageau

Mr. Georges Arès

1025

The Chair

Mr. Georges Arès

The Chair

Mr. Raymond Simard

Mr. Georges Arès

1030

Mr. Raymond Simard

Mr. Georges Arès

Mr. Raymond Simard

Mr. Georges Arès

Mr. Raymond Simard

The Chair

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.)

1035

Mr. Georges Arès

Mr. Jeannot Castonguay

Mr. Georges Arès

Mr. Jeannot Castonguay

Mr. Georges Arès

Mr. Jeannot Castonguay

Mr. Georges Arès

The Chair

Ms. Yolande Thibeault (Saint-Lambert, Lib.)

The Chair

1040

Mr. Georges Arès

The Chair

Mr. Georges Arès

The Chair

Mr. Georges Arès

The Chair

Mr. Georges Arès

The Chair

Mr. Georges Arès

The Chair

Mr. Benoît Sauvageau

Mr. Marion Ménard (Committee Researcher)

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

Mr. Georges Arès

1045

Mr. Benoît Sauvageau

Mr. Georges Arès

Mr. Benoît Sauvageau

Mr. Georges Arès

Mr. Benoît Sauvageau

The Chair

Mr. Armand Boudreau (Director General, Société Santé en français)

The Chair

Mr. Georges Arès

1050

The Chair

Mr. Georges Arès

The Chair

The Clerk of the Committee

The Chair

Mr. Armand Boudreau

The Chair

Mr. Jeannot Castonguay

The Chair

1055

Mr. Benoît Sauvageau

The Chair

Mr. Benoît Sauvageau

The Chair

CANADA

Standing Committee on Official Languages

NUMBER 023

2nd SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, May 27, 2003

[Recorded by Electronic Apparatus]

¿ (0905)

[Translation]

The Chair (Mr. Mauril Bélanger (Ottawa—Vanier, Lib.)): Ladies and gentlemen, as the quorum for hearing witnesses is four, we may begin. I therefore invite people to take their places. With your permission, I'm going to start with some background.

Today we begin hearings that will lead us to issue a report which the House of Commons requires for the end of October. The hearings will be on the subject of a bill which has been withdrawn from the Order Paper. The purpose of that bill was to add a sixth principle to the Canada Health Act, that is respect for Canadian linguistic duality.

It is therefore a rather long-term exercise that we are undertaking today. In response to a request from the House, we will have to determine the will of the majority of the people's representatives and see how the Government of Canada can better ensure that the minority official language population in the country, that is Anglophones in Quebec and Francophones in the other provinces and territories, have access to quality health care in their language. We are thus commencing a long-term effort. We hope to contribute to the advancement of this cause through the report which, we hope, we will be presenting within a few months.

We will be hearing from a number of witnesses. We are starting today with the FCFA and Société Santé en français, and tomorrow we will hear from people from the Department of Health. Then we will be hearing from constitutional experts, representatives of the communities, senator colleagues, in short, a large number of people, and we will also try to hear from all those who want to be heard so that we can form a comprehensive and precise idea of the situation.

On that note, I'm going to invite Mr. Arès, the President of the Fédération des communautés francophones et acadienne, and Mr. Hubert Gauthier, President of Société Santé en français, to make their respective presentations. We will then proceed to the traditional and customary question and answer period.

Before we continue, I would like to ask my colleagues whether they have anything to add to the background I have just provided. All right?

Mr. Arès, the floor is yours.

Mr. Georges Arès (President, Fédération des communautés francophones et acadienne du Canada): Thank you, Mr. Chairman. I should like to thank you for giving us the opportunity today to share with you some of our thoughts on the constitutional and legal foundations providing a basis for access to health care in French and on the appropriateness of creating a program of intergovernmental co-operation in the health care field

I should like to begin by explaining that the FCFA has spoken out a number of times in recent years in an attempt to make not only our politicians and governments but also the community aware of the importance of providing access to health care in French for our communities. In approaches made to the Minister of Health to create a Joint Advisory Council, the Équipes francophonies in 2001 and 2002, our intervention in support of the Montfort Hospital case, or the submission of briefs to the Senate Committee on Health Care and the Romanow Commission, we have attempted to remind people that access to health care in our language is, after access to education, an essential right and a fundamental priority for the development and growth of our communities.

In these interventions, we have proposed that a sixth principle be added to the Canada Health Act and that a program of intergovernmental co-operation be established to help the provinces and territories to provide adequate health care to the official language minority population in the language of that minority. We believe that these possible solutions would make it possible both to clarify the responsibilities of the provinces with respect to access to health services and to help them deliver these services.

Moreover, it is interesting to note that the view that Canadians have of linguistic duality has changed on this particular issue to such an extent that the latest study conducted by Léger Marketing between March 19 and 23, 2003 following the publication of the Government of Canada Action Plan for the Official Languages indicates that 76 percent of Canadians agree that Canadians should be able to obtain service in their language.

The Chair: I know we're pressed for time, Mr. Arès, but I'm going to ask you to slow down.

Mr. Georges Arès: All right.

The Chair: Some people at the back may have trouble following at your rate.

¿ (0910)

Mr. Georges Arès: All right. So 76 percent of Canadians agree that Canadians should be able to obtain service in their language, whether English or French, in health care institutions. This rate increases to 92 percent for Canada as a whole among respondents between 18 and 24 years of age.

As to the constitutional and legal foundations, various writings and legal and constitutional documents and the government programs that support linguistic duality in this country have changed over time and have been written in a way that reflects the new realities. Thus, linguistic duality, which was already present in the British North America Act, was given greater definition in the Canadian Charter of Rights and Freedoms and the Official Languages Act. Moreover, in the second version of the Act, which was passed in 1988, Part VII gives all departments and agencies of the federal government (including Health Canada) responsibility for implementing concrete measures within their area of responsibility to ensure the enhancement and development of the official languages minority communities.

The Supreme Court of Canada has asserted on a number of occasions in its decisions that linguistic duality is a fundamental Canadian value and that the protection of the official language minorities is in fact also a fundamental Canadian value, although this is not stated in writing in statutory instruments.

Linguistic duality and protection of official language minorities were reaffirmed in, among other judgments, the Reference re the Secession of Quebec (1998), Mahé (1990), Reference re Language Rights in Manitoba (1985), Mercure (1988), Beaulac (1999) and Arsenault-Cameron (2000). An attachment contains a document prepared by counsel for the FCFA that looks at these judgments in greater detail.

We merely need to quote a passage from the decision in Beaulac to gain an understanding that constitutional language rights, which are expressly recognized in the Charter, are the culmination of a process designed to confer positive and enforceable rights on the official language communities in Canada in order to reflect the history, federal structure and federalism of this country.

The principle of gradualism does not exhaust section 16 (of the Charter), which officially recognizes the principle of equality of both official languages of Canada. It does not limit the scope of section 2 of the Official Languages Act. Equality does not have a lesser meaning in matters of language. With regard to existing rights, equality must be given true meaning. The Court has recognized that substantive equality is the correct norm to apply in Canadian law.

The demand for health services in French in the Francophone communities in those provinces where the majority is English-speaking is accordingly based on the concept of equality entrenched in the constitutional legislation.

In fact, the Constitution and the Canadian Charter of Rights and Freedoms guarantee our right to be educated in French. The Supreme Court guarantees our right to obtain justice in French. We even have the right to purchase a postage stamp in French. Is it not time for us also to be given the right to receive health care in French? Is this not a question of the most fundamental dignity?

Section 7 of the Canadian Charter of Rights and Freedoms defines this right, which is regarded as fundamental in Canadian society, as follows:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

The right to life necessarily underlies the right to health and accordingly the right to health care. In order to be consistent with the Charter of Rights and Freedoms, I would add that we must talk about the right to health care in both official languages of our country.

Studies have shown that 50 percent of Francophones in the minority communities in Canada are able to obtain health care in their language only rarely or not at all. However, we are convinced that health services in French in a minority situation should be provided in the name of fairness, quality of service and efficiency. They must also be provided because they allow for a greater return on the money invested. No one can deny this equation: quality service produces better returns. Quality is defined, among other things, in terms of the ability of programs and workers in the health field to communicate, inform, instruct, care for, assist, advise and direct the users of health services, including the million or so Francophones who live in the predominantly English-speaking provinces. The ability to understand and to be understood is accordingly an integral part of the quality of service.

¿ (0915)

A number of studies of the language barrier in the health services have made it possible to conclude that the inability to communicate adequately in the language of the user has the following consequences: it reduces the use made of preventive services; it increases the time taken for consultations, the number of diagnostic tests and the probability of errors in diagnoses and treatment; it influences the quality of service in which effective communication is essential (for example, pediatrics, psychiatry, etc.); it reduces the reliability of treatments; it leads to overuse of emergency rooms; and it reduces satisfaction with the health care and services received.

In simple terms, a patient must be able to understand with complete clarity the advice and instructions given by the doctor. The patient's health and possibly his or her life, depend on this. Do you not agree with me that, in light of these observations, Francophones living in a minority situation have received services of lesser quality than those received by the majority?

The Preamble to the Canada Health Act asserts that the Parliament of Canada wishes to promote the development of health services across the country by helping the provinces to bear the cost of those services.

Section 3 of the Act also provides:

3. It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.

Section 7 states that:

7. In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, the health care insurance plan of the province must, throughout the fiscal year, satisfy the criteria described in sections 8 to 12 respecting the following matters:

(a) public administration;

(b) comprehensiveness;

(d) portability; and

(e) accessibility.

Even under the principles of universality and accessibility, the right of Francophones to receive health services in French should have been recognized in the Canada Health Act in 1984, given the fact that the Canadian Charter of Rights and Freedoms was adopted in 1982. Section 7, which was quoted above, and section 16, which concerns the equality of English and French, might have influenced the interpretation of the principles of universality and accessibility.

Furthermore, the Supreme Court of Canada has clearly told governments that the principle of equality of the English and French languages (section 16 of the Canadian Charter of Rights and Freedoms) means in particular that institutional language rights require action by the government to implement them, and therefore impose obligations on government. In fact, the country's highest court has stated that the exercise of language rights must not be considered to be exceptional in nature or to be some kind of response to a request for accommodation. In fact, these language rights can be exercised only if the resources are provided. What is more, the federal government is bound by the principle of gradualism in equality of status of the English and French languages in Canada. See Beaulac.

We also believe that when the federal government acts under the federal spending power, even if it does so within an area of jurisdiction that is not strictly federal, it is patently clear that it must comply with the Official Languages Act and the principles of Part VII. Furthermore, recent judicial decisions require all governments in Canada to comply with one of the four governing principles of Canada's Constitution, namely respect for minorities.

Here I would like to cite a paragraph from the Supreme Court's opinion in Reference re Secession of Quebec:

Underlying constitutional principles may in certain circumstances give rise to substantive legal obligations (have “full legal force”, as we described it in the Patriation Reference, supra, at p. 845), which constitutes substantive limitations upon government action. These principles may give rise to very abstract and general obligations, or they may be more specific and precise in nature. The principles are not merely descriptive, but are also invested with a powerful normative force, and are binding upon both courts and governments.

In other words, as this Court confirmed in the Manitoba Language Rights Reference:

In other words, in the process of Constitutional adjudication, the Court may have regard to unwritten postulates which form the very foundation of the Constitution of Canada.

¿ (0920)

In the Montfort decision, the Ontario Court of Appeal stated:

...fundamental constitutional values have normative legal force. Even if the text of the Constitution falls short of creating a specific constitutionally enforceable right, the values of the Constitution must be considered in assessing the validity or legality of actions taken by the government.

This having been said, it is our opinion that, when the federal government lays down objectives that apply across the country, it must comply with the principles underlying the Canadian Constitution as well as with the Official Languages Act. The federal government cannot force a province to comply with them but it may be reasonable to assume that if the provincial government wishes to obtain federal funding, it must comply with both the Constitution and the Act. In other words, the province is not obliged to accept federal funding. However, if the province accepts, it must comply with objectives that apply across the country.

In order to ensure that the federal government and the provincial governments are committed to the development of health services in French in the provinces and territories in which English-speakers form the majority and since the current provisions of the Canada Health Act do not recognize the right of Francophones living in minority communities to receive health services in their language, we believe that it is necessary to add a sixth principle recognizing the linguistic duality and the obligations set out in the Charter and the Official Languages Act in this regard. This sixth principle could clarify the Act and formally recognize the right of official language minorities to obtain health services in their language. Such a measure would also reflect the concept of gradualism in the rights of Francophones in this country and would be in keeping with the model that already applies in the fields of education and justice.

When we talk about the possibility of creating a program of intergovernmental cooperation in the health field, we are fully aware of the fact that legislative changes cannot be made overnight. We have accordingly asked the federal government to support those provinces and territories in the short term that are prepared to take action by creating a special fund or a program to support the implementation and continuation of health services in French for minority Francophone communities.

We have also suggested that a special program be created to offer incentives to the provincial governments to encourage them to provide health services to their minority official language communities.

We feel that Health Canada could develop a program in co-operation with the provinces and the territories. Such an initiative would reflect the principles of linguistic duality and interdepartmental responsibility set out in the Official Languages Act and would encourage the provincial and territorial governments to provide health services that meet the needs of their French-speaking minorities.

The ministers responsible for Francophone affairs in each province and territory could promote such action with their colleagues who are responsible for health and become parties in this matter of constructive cooperation. In short, we propose a program similar to the program already existing in education with the provinces.

In conclusion, I should like to reiterate the importance that we place on access for the Francophones in our communities to quality health care in their language. We are convinced that, even though at the present time the right to health services in French for Francophones in minority communities is not clearly enshrined in the Canadian Charter of Rights and Freedoms or in the Official Languages Act, the fact remains that this right is fundamental.

Our right to education was acknowledged after long and difficult struggles. Let us hope that the recognition of our right to health services in French will not take as long for us to achieve.

Mr. Chairman, we would also like to acknowledge your personal commitment to this issue, which is so important to our communities. We thank you for having placed this question on a front burner with your bill. We hope that you will continue to raise this issue with other parliamentarians and that the committee does the same.

Thank you.

The Chair: Thank you, Mr. Arès.

Mr. Gauthier.

Mr. Hubert Gauthier (President, Société Santé en français): Thank you, Mr. Chairman. Thank you for this opportunity to add to what Mr. Arès has just said.

Société Santé en français is more concerned with the practical side of things. I'm going to try to explain to you very briefly who we are, the purpose of our work, the results we expect and, in the wake of what Mr. Arès has said, what remains to be done.

I won't focus more on the question of the link between language and health outcomes because Mr. Arès has addressed that in a fairly detailed way. We could give you many examples which very clearly show the harm that is done to citizens who are unable to receive services in their language. Some go as far as to pretend to understand English in order to avoid second-class service in French in their institutions, where that service is not offered in a very proactive way. I won't start giving you a lot of examples, but we at Société Santé en français know of many stories that show that our elderly avoid requesting services in French because they believe they would risk losing all the services they could receive if they demanded too much in that respect. You all know of elderly persons who have that attitude and who avoid requesting the services due to them and that would be infinitely more useful to them from a health standpoint.

Société Santé en français is a relatively new organization, which was founded following work that was done in connection with the advisory committee that Minister Allan Rock established in 2000 and which made a certain number of recommendations to the government. The société was incorporated in February 2002. Its founding convention, which was held from November 29 to December 1, 2002, brought together 150 delegates from across the country. I would emphasize that those delegates represented five major partners in the health world: health facilities; people from community organizations devoted to health services, health professionals, that is to say doctors, nurses and therapists of all kinds; people from the training field; lastly--and I'll emphasize this throughout my presentation--government representatives from both the provinces and the federal government. I believe that's an important aspect. One might well wonder what the federal government is doing in a provincial jurisdiction and that would be a highly legitimate question. Mr. Arès indicated the reason why we are involved in this. For Société Santé en français, the provincial government's involvement is fundamentally important in this issue, and I'm going to come back to that point.

Société Santé en français is an organization that brings together networks from across the country. Those networks are associations of individuals who represent the five major partners I mentioned a moment ago and which prepare action plans to improve the accessibility of services in French in their areas: the national network is in place to provide professional and technical support to people in the field and to build bridges between the provinces, the territories, the federal government and the communities. It is extremely important to develop these links because people in the health field often work in isolation. One of our challenges is to try to break down the barriers between the various partners so that, together, they can develop better plans to improve the accessibility of health services for all citizens.

Société Santé en français is working to bring these forces together and to make them work together, which is no easy task, particularly when the provincial governments have to be involved. But we're beginning to achieve some success in that respect.

¿ (0925)

A financial framework was recently announced through the Dion plan. As you know, Mr. Chairman, under that plan, $119 million was announced for health. For Francophones living outside Quebec, of that amount, $20 million is allocated to services as such, $63 million to training and $10 million to establishing the networks I've just described.

I'm now going to take a few minutes to talk to you about what we're doing right now. I'll touch on three elements.

First there is networking. In a minority setting, we thought it obvious that all stakeholders having to improve the accessibility of services in French in their areas did not often have the opportunity to meet to make action plans specific to their community. Very often, a hospital or a community service centre is lost in majority Anglophone associations, and the subject of the accessibility of services in French is not often on the agenda, if it is at all. It was in that spirit that we wanted to ensure that there was a hub, that we called the networks. Those networks have various names depending on the province. In my province, Manitoba, we call it the Conseil de Communauté en santé du Manitoba. We think that working within these networks would be like building a house without building a foundation. The networks which regroup stakeholders have something to say and do to improve the accessibility of services. That's the priority. That's the foundation that enables us to build the rest. Those networks enable us to plan and to be a stakeholder for governments. We think it's very important to involve the provincial government in those networks from the outset. Although we're talking about the federal government today, I must tell you that, in the field, in each of the provinces, we're making considerable efforts to involve the provincial governments. We think that's an essential card to play. Currently, the federal government is participating in the various networks we're building. So we can't say the federal government is making an effort without the provinces' knowledge. On the contrary, it's an effort that involves and engages the provinces. That's it for networking.

The second priority is training. That's an extremely important element. What's the point of action plans if you don't have health professionals to deliver services to people? We were forced to admit that, apart from the lack of professionals, there is a lack in the general population. The problem is exacerbated by the lack of bilingual staff, Francophone or Acadian staff who are able to provide services to the public. So, as you've seen, much of the money that Mr. Dion announced is allocated to training, which will make it possible to train 2,500 to 3,000 new professionals over the next five years. That's long, and we're talking about a five-year program. In my opinion, this question should be considered in the perspective of the next 10 years. Regardless of the nice plans that can be made, if you don't have the doctors, nurses and therapists you need, you're going to have nice meetings but produce no results. So this issue is extremely important. Société Santé en français strongly supports the training consortium which is a joint venture with all the Francophone universities and colleges in the country: Moncton, Ottawa, Université Sainte-Anne, Université Laurentienne, the Collège universitaire de Saint-Boniface, Faculté Saint-Jean, Cité collégiale, Collège Boréal, collège communautaire de Campbellton and so on.

The third component is services. Here again, I would emphasize that networking enables us to do good planning. Training will give us professionals, but you still need receiving places, places where Francophones and Acadians meet and where services can be actively offered.

¿ (0930)

I come back to my example of the sick person who enters a health service. A sick person is vulnerable. Asking him to fight for services in French is asking him to do the impossible. None of our fathers or mothers will start fighting for services in French at the emergency ward. That battle may perhaps be fought at Air Canada or Revenue Canada, but it won't be fought in emergency because people are vulnerable and concerned about their health.

So, with regard to the organization of services, we need the means to enable us to provide services on a proactive basis. You have to say: “Hello madam, may we serve you in your language?” The idea, when someone requests services in French, is not to say: “Well, let's see if we have somebody here.”

In view of that information, we think it is extremely important to create a good primary health network. Some funding has been granted to start things up, which will make it possible to put in place the first models which, we hope, will be sustainable and will meet the needs of the Francophone community. You very often have to develop innovative models, in view of the small number of people and the way they are scattered across Canada. I think we'll even be able to provide the community at large with solutions that could be part of innovative projects and even the models for the majority community.

I'm thinking, for example, of community health centres, integrated services, single windows, particularly in the smallest communities, which could even be integrated into the school system, of health information telephone lines open 24 hours a day, seven days a week, teletriage, links with our school boards for health in schools, the training of multidisciplinary ambulatory care teams. If we don't have enough, perhaps we'll organize a mobile service which will move around.

Mr. Chairman, I would like to tell you two things before completing my presentation. I would like to tell you that we have already taken action to involve the provinces. If you ask me whether the provinces are currently at the table, I will answer yes. But there is one very important condition. We can say there is a federal-provincial program, as my colleague Mr. Arès said, but I believe there is one extremely important ingredient for ensuring that long-term health service plans are developed: there are three partners and all three must be involved if we want to come up with realistic plans that will produce good results. They are the three legs of the table: if one leg falls, the table will fall. We often talk about a federal-provincial program, but I would emphasize that there has to be a federal-provincial-community program. Without the community, we may come up with solutions that aren't adapted to the needs of Francophone communities. We currently have a promising model which Health Canada is putting forward. The tools and resources, through the community, through Société Santé en français, which gives us a major lever for attracting the province to the table and ensuring that it plays a role as a partner instead of a role determining solutions in isolation.

Mr. Chairman, Société Santé en français, through its networks, is playing and will play a role as a bridge between the communities and provincial government authorities. It is our impression that there can be a major agreement between the provinces and the communities, and together we'll probably be able to talk to the federal government in different circumstances from those of traditional federal-provincial quarrels in the area of health.

As for our concerns, we have a legal framework that gives us little or no support, except as regards certain policies and statutes in certain provinces. We don't have as sound a legal framework as in education, for example. Your bill referred to that, Mr. Chairman.

¿ (0935)

However, Société Santé en français believes it is essential in the context of the work it's doing with the provinces to avoid getting involved in federal-provincial jurisdictional disputes.

Second, our concern about services is to ensure that the money announced continues to be provided. If we really want to provide high-quality service, we must acknowledge that the money we have right now is only a start and that, once the foundation has been laid, it will be necessary to add more money and to create a program, as Georges Arès said, including the community. I think excluding the community would be a serious mistake, as people in the education field say.

I would like to tell you that, to help us, you must support the work we're doing, which will enable us to establish a link between the communities and the provincial governments, which must first make a commitment and get involved, and you must also give us money, which will enable us to adopt a long-term vision of services instead of the short-term vision we are forced to have at this time.

Mr. Chairman, I'll close by telling you that the order is a tall one. The fact that we lag behind in health, as a result of the fact that education has been on the agenda for decades in our communities, forces us to work extra hard. We hope that people like you will be able to support the efforts we're making to obtain better services for our fathers, our mothers and our children in the field. Thank you.

¿ (0940)

The Chair: Thank you, Mr. Gauthier. Are there any other witnesses who want to add anything?

Mr. Hubert Gauthier: Mr. Chairman, I will have to leave around 10 o'clock or 10:15. Armand Boudreau, General Manager of Société Santé en français, is with me here. He'll be able to take part in the question period, if you agree to that.

The Chair: All right. I invite those of my colleagues who have questions to ask Mr. Gauthier to put them to him first.

Mr. Sauvageau.

Mr. Benoît Sauvageau (Repentigny, BQ): Good morning, ladies and gentlemen. Welcome among us. You are the first stakeholders to talk about health and, more specifically, our Chairman's bill. I'm honoured by that.

I would like to ask Mr. Gauthier a few questions. I heard Mr. Arès' remarks when Mr. Dion's action plan was tabled. You no doubt spoke as well. However, as a lot of comments were made when the action plan was filed, I don't remember yours as well.

It looks good when $10 million, $25 million or $52 million is allocated to health, but that money will be spread over five years and 10 provinces and two territories. When you compare those amounts with those invested in each of the provinces in health, you realize that they may look very nice on paper, but that their impact in the communities, as you emphasized, may not be very significant.

I would like you to tell us about the lack of specific objectives in the Dion action plan, in health, among other things. We spoke about accountability, but I believe there should have been specific objectives and short-term checks of those objectives to determine whether the action plan was going in the right direction, so that we're not required to meet again in 10 years and say to each other it's too bad but that we blew it because we had no guidelines. I would like to hear you on that.

At first glance, there appear to be three possible solutions for health care. First, a sixth principle was put forward by the FCFA and various other stakeholders, including our Chairman, who introduced a bill. Second, federal-provincial agreements based on the education agreements may be entered into. Third, in my opinion, we can ask the provinces to look to Bill 142--if my memory serves me--in Quebec on health care provided to the Anglophone minority and implement a similar statute to ensure health care.

Given your lengthy experience in education, which you no doubt don't want to repeat, do you think that one of those three priorities should be put forward in our study and, if there are any others, what are they?

Mr. Hubert Gauthier: Thank you, Mr. Chairman.

With regard to your first question, the objectives are clear. In fact, my impression is that we had to work hard to clarify our objectives because health wasn't originally something included in the context of the Dion plan. The first question we were asked was this: What's the federal government doing in an issue such as this? So we worked and we were forced to clarify our objectives, so that now, if there's a component of the Dion plan... If ever we had the opportunity to come back, I could make a presentation to you on the quantitative and qualitative objectives of each of the issues I've presented to you. If we want to ensure continuing support, we'll have to be able to show that we achieved the objectives we committed ourselves to achieving. For example, as regards networking, we set ourselves four or five very specific objectives that can be measured.

Second, we're talking about training 2,500 to 3,000 persons. Each of the universities has a very specific plan, year by year, and it will be able to demonstrate that it has achieved results in that respect. We're probably most concerned about services. The amount of $30 million that was announced is part of the primary health care envelope, which is a transitional, non-recurring envelope. It's going to be used, of course, but we would like that envelope to be recurring. That's the aspect that concerns us most. To try to ensure that it continues, we're preparing dossiers with the provinces' collaboration. So it's a non-recurring envelope. There too, the objectives are clear in quantitative and qualitative terms. We've developed models and various projects are being mapped out.

We're obviously working on three fronts at the same time. Over the next year, the problem of the organization of services in the field will have to be solved. This is among the objectives of the Dion plan, of course, but I think it's up to the Department of Health and the provincial governments to define the objectives more specifically. So, for us, the Dion plan is one answer, but not the only answer. Others must get involved. We can't say that the Dion plan has all the answers. You must not think it's the only avenue. We have to explore all other avenues. In technology, for example, other departments should contribute. The Dion plan is not the only path to follow. That's my answer to your first question.

I'll let Georges answer your second question. Société Santé en français represents the practical side of matters. Please excuse us for being practical, but, as I said earlier, Mr. Chairman, elderly persons don't have the time to wait till the end of a legal debate that could drag on for 10 years. I believe that debate must be held. In my view, it must be held, but we're interested in the practical side of matters. My mother needs home care services. She is currently in touch with 21 persons, two of whom speak French. This is 2003 and my mother is 80 years old. She needs services right now, not in 10 years. We are the practical side of things, and we have to find ways to provide services today.

We devote all our energy to improving access to health care in French. I constantly repeat at all levels that it is important, apart from the major legal debates, that we make gains every day. We're striving to do that. While thanking the federation for conducting the legal debate, which helps us a great deal and enables us to be here today. Perhaps we wouldn't be here otherwise.

¿ (0945)

I'm obliged to say that these questions don't go one without the other. Ultimately, for me, all the levels of government should get involved at the legal level and at the practical level. As I said earlier, I hope the committee does not focus solely on federal-provincial dealings because if that were the case, the community might be excluded from these debates and pay the price of major federal-provincial disputes.

¿ (0950)

The Chair: I'll have to interrupt you.

Mr. Hubert Gauthier: As my mother tells me, what does that change about the services she's receiving?

The Chair: I'm going to interrupt you, Mr. Gauthier, to allow Mr. Arès to add to that. Then we'll move on to Mr. Simard.

Mr. Arès.

Mr. Georges Arès: I'm not going to do so right away because Mr. Gauthier has to leave in a few minutes. There may be other members who have questions to ask him.

The Chair: Mr. Simard.

Mr. Raymond Simard (Saint Boniface, Lib.): Thank you, Mr. Chairman.

Welcome madam, gentlemen. Since I'm from Saint-Boniface, this is something I'm particularly concerned with. In addition, at home, 25 percent of Francophones are 65 or over, compared to 15 percent in Winnipeg. Health is obviously a great concern for my electors, among others.

I don't want to speak on behalf of all those here, but I think that everyone will agree that we're entitled to services in French. However, our resources are limited. You have five guidelines, Mr. Gauthier. Where do you want to include a sixth principle?

You're no doubt familiar with the Chartier report, advocating the provision of services in French where numbers warrant, for example. At home, that was a resounding success. Recently, I went to Notre-Dame-de-Lourdes, where a bilingual service centre was opened a few months ago; they're already considering doubling the present space. Would you agree that services should be provided in French where the Francophone population lives, instead of entering a sixth principle in the act, which could result in services in French being introduced in places where they would not be used?

Mr. Hubert Gauthier: You question is similar to the one Mr. Sauvageau asked. Société Santé en français, as I told you, is concerned with identifying places where there is a Francophone population and thinking up practical solutions so that people actually have access to services. We do that work in cooperation with the regional boards and departments of health. It's not theoretical. Société Santé en français supports the FCFA in its legal demand work, and it's a constant debate, but, even if we won a legal victory, that victory would have to result in an organization of services that would be specific to the community and would provide actual services to people.

I won't go into the legal debate this morning--I'll leave that to my friend Georges--because our daily concern is to improve accessibility, but I acknowledge that one of your committee's objectives is precisely that. I believe that the two debates are necessary and that one should not be ruled out in favour of the other. Our role is really to act in the field every day. Georges' role is to make it known that, without a legal foundation, what we're doing can only be of short duration. Like money, that's necessary for services to continue, because as soon as the spending stops, if we have no legal foundation, we may find ourselves in difficulty.

I won't say that I'm married to Georges, but each of us has a separate but related role to play. I talk about concrete things concerning the citizens we serve. I was a health manager, and that's why I got involved in this area. But that doesn't mean that I don't acknowledge the necessity of a sound legal foundation. There is a certain foundation in the country, whether it's Bill 142, what there is in New Brunswick or even policies that we have at home, but they're very uneven from one region of the country to the next.

Mr. Raymond Simard: Mr. Gauthier, you said that the provinces were at the table, but they're at various levels. In your view, what's the secret to the success of certain provinces? Can you tell us where the provinces stand and what's been done to encourage them to participate?

¿ (0955)

Mr. Hubert Gauthier: You want a report card, don't you? When we started, we were a somewhat surprising specimen. One of the secrets to our success was that Health Canada said to itself it was going to use Société Santé en français to channel the money, which is a quite unusual arrangement. Although the $20 million we'll have for clientele services across the country isn't an enormous amount, the mere fact that the provincial governments realize that the money is circulating through people in the community is beneficial. Moreover, Ottawa says that the provinces have to be involved. That forces the provinces to come to the table and the communities to contact the provinces. That simple fact has attracted people to the table, but it took a lot of effort to get there.

The provinces often have no common ground to discuss with the communities. There may be a community group here, a group of professionals there. There may be a particular association here and another association elsewhere. Provincial governments, somewhat like you, see that coming from all sides. There's no joint action or unity of thought. For the provinces, networking is a solution to the question: What the hell do Francophones want? We tell the provincial governments that they won't have 15 or 20 doors to knock on: there'll be a single group, and it will establish the priorities. Do governments love priorities? Yes. They detest being forced to choose among 25 priorities. With our networks, the community can tell the government what its priorities are, and thus avoid any Enrons or other groups requesting other things. That gives the provincial government a place and an interlocutor which it did not previously have. Various groups could tell it that they needed this and that. So the network is a very important second tool, and we have had trouble advancing that argument.

Ms. McLellan always told us to make sure we secured the participation of the provinces. I told her that the provinces would come on board to the extent they had a clear contact. That's what's happening now. We don't need to work hard to convince them. As soon as they see that there's a good solid and credible contact and that the partners at the table, the provinces come to the table. Armand toured across the country and insisted on meeting representatives not only of the community, but also of the provincial government. I would say that there are now participants from the provincial governments at all the tables. The intensity isn't the same everywhere, but we now have provincial representatives everywhere. Recently, in April, we were able to bring all the provincial representatives together. We had them all come to Ottawa, with people from our communities, to start a dialogue. I won't tell you that the participation of a particular province rated three on a scale of 10 or that that of another province rated 10. It's a long-term effort, but, right now, they're all at the table.

The Chair: Thank you, Mr. Simard.

Mr. Bellemare.

Mr. Hubert Gauthier: I must tell you that the Assistant Deputy Minister of Public Health and Medical Services in New Brunswick, Ms. Rachel Bard, is the deputy chair of the board of directors of Société Santé en français. Rachel works very hard to increase the awareness of her colleagues across the country.

The Chair: Mr. Bellemare, please.

Mr. Eugène Bellemare (Ottawa—Orléans, Lib.): Thank you, Mr. Chairman.

The committee is obviously very much aware of the Francophonie question, particularly in health. You referred to principles, the act and the Charter of Rights and Freedoms. We're aware of all that. It's in the practical matters that the problem arises. Naturally, no one here is opposed to this idea or is going to find problems.

You talked about today and tomorrow. Mr. Gauthier talked about today. He said that everything was urgent, that things had to be done right away. I agree, but do we have the necessary human resources where there's demand? And where's the demand? Have the places been targeted? You listed a range of people responsible for various services.

For the future, you'll have to do training. Have you estimated the costs in your communities? Opponents will immediately ask us how much that's going to cost. Are we simply going to pick up a basket full of money and throw it at the communities that shout the loudest, hoping that they'll have accomplished something in five years?

How can the federal government help the communities directly? How can it contribute to training? I could suggest two ideas for training to you, but first I'd like to hear your answers.

À (1000)

Mr. Hubert Gauthier: Training is the area that received the most support: $63 million. That was one of our priorities. If we don't train people, we can dream about whatever we want, but it won't happen. So under the Dion action plan, $63 million was allocated to training; as I said earlier, we want to train from 2,500 to 3,000 new professionals. That's essential. Without that, we can't think of establishing health centres and service points everywhere. These are things that must go together. To train a nurse, it takes three and a half or four years, depending on the place. To train a doctor, it takes five to eight years, depending whether he or she is a family practitioner or a specialist. Training is already under way, but a considerable additional effort has just been made, and the capacity of our universities will virtually be used to its limit with that.

We had thought that our institutions would be able to train professionals to a maximum of $100 million because their ability has to be taken into account. We won't ask Anglophone universities to train Francophones. Our universities and colleges prepared a very realistic plan, and we think that those 2,500 to 3,000 persons will meet 40 percent of needs, but you have to start with that. We're going to reassess the situation in three years to see where we stand, whether we have achieved our objectives and whether we need to go further.

I think training is fundamentally important. We need a good consortium of nine or 10 institutions in the country, and that's the basis. You ask who should be helped. That group was helped and should continue to be helped, in my opinion; otherwise, nothing else will be viable in training.

As for services, I told you I was troubled about that. To improve accessibility, reception areas specific to Francophones must be established. We have $20 million, which isn't much. In the first recommendations we made to Health Canada, we said that four times that amount was necessary to provide something sound over the long term. That hasn't yet been established. We still have work to do in that area with the provinces' cooperation. The provinces are already giving a certain amount of money, and there's probably a way to add to what has already been put on the table. That's how we see the future.

Mr. Eugène Bellemare: At the outset, you congratulated our Chairman on his bill, and rightly so. Now do you think his bill would be practical nationally? We need those answers because we're going to have a debate with people who are opposed to this bill or who are for it but are wondering if it will work.

The Chair: Excuse me, Mr. Gauthier. Before you answer, I would like to clarify one point. The bill my colleague Mr. Bellemare refers to and to which Mr. Sauvageau referred no longer exists because it was removed from the Order Paper. You have to understand that. Our committee received a mandate to conduct a study on the subject of the bill, which essentially concerns the notion of a legal framework and some type of legal protection. So you have to understand. If it was my bill, as you say, I wouldn't be chairing this committee.

Second, we have also received, and I'm going to make sure it is distributed to committee members, a letter signed by Minister Dion and Minister McLellan asking us to go beyond the reference from the House of Commons, if we are willing to do so, to examine the notion of a system for health such as exists in education and to consult the provinces. When you talk about a bill, care should be taken not to mislead anyone. Thank you.

Mr. Gauthier.

À (1005)

Mr. Hubert Gauthier: I was simply going to say that any legal framework would be a very useful tool. We're often at a loss in our discussions because we don't have a legal basis such as the one we have in education. Here again we were at a loss and we often find ourselves in court. So the legal tool is always helpful, but it isn't the only tool. We can't think that that tool alone will work miracles, but it's a useful and important tool when you're working on these kinds of issues.

The Chair: Thank you.

Mr. Sauvageau.

Mr. Benoît Sauvageau: Mr. Gauthier, you talked about practical things, and I appreciate that very much. You talked about today, tomorrow and the next day, and about actual services provided directly to the public. As regards training, you also spoke about the constraints on the French-speaking universities outside Quebec. However, agreements have been signed, in particular between New Brunswick and the University of Sherbrooke and other universities in Quebec. For tomorrow and the day after that, do you think there should be more of this kind of agreement? You referred to the limits of the Francophone institutions outside Quebec. Should there be more of these agreements with Quebec? That's very practical.

Second, would it be desirable to encourage the creation of language training and exchange programs among health professionals, nurses, therapists and so on? Those professionals, who mainly come from Quebec, would go to Anglophone minority communities to enable those people to work in French. They are already trained and they already have experience. Second, health professionals who have studied in French or who want to work in French could be permitted to go to Quebec to learn the language. Could that facilitate training?

Mr. Hubert Gauthier: Yes, on both fronts. First, there is an agreement between New Brunswick and the University of Sherbrooke, as you said. Moreover, part of the $63 million may only be spent in the context of this agreement on physician training. So this is obviously a lifeline for us. It's essential for us.

I'm going to give you a second example. My hospital, in Saint-Boniface, is twinned with the Sherbrooke campus. We've signed a memorandum of understanding, which was supported by the Province of Manitoba and the Government of Quebec, to carry out a number of projects together, training projects, but also to share knowledge, services and so on. I've always said and I will always say that Francophones outside Quebec need a lifeline with Quebec and Quebec institutions. We can benefit from them. At home, for example, young people are studying in English at the Faculty of Medicine in Manitoba, but we can get them back along the way. We've agreed with the Dean of the Faculty of Medicine in Manitoba that, during their training, we would reach agreements with Sherbrooke, in particular, but also with Ottawa and others so that they could do internships and have those internships accredited. So the answer is clearly yes and yes.

New Brunswick has already done a lot of work in this area and has opened doors for us. The University of Sherbrooke is often at the table when we discuss these issues and has taken a very active part in all our debates on training.

À (1010)

Mr. Benoît Sauvageau: In the short term, while supporting the $63 million allocated to training, you said yes and yes again. However, how can we--not the committee, but all of us together--induce the provinces to reach more of these kinds of agreements with Francophone hospitals and health centres?

You referred to your hospital in Saint-Boniface, which has reached an agreement with Sherbrooke; so it's possible that tomorrow--we don't need to wait until five years of training are over--in other hospitals that receive minority Francophones, those services will be offered. That's undoubtedly an option that should be studied on a priority basis, at the same time as you.

Mr. Hubert Gauthier: I would say that it's positive for all those who encourage the people they know in the provincial governments to reach agreements with Quebec. No I don't want to address that question because it's an area...

Mr. Benoît Sauvageau: Honestly, I'm not talking about politics, but about purely practical matters.

Mr. Hubert Gauthier: Yes, but politics at times isolates the country's Francophones.

Mr. Benoît Sauvageau: I know, and that's unfortunate.

Mr. Hubert Gauthier: And I'm going to stick to that.

Mr. Benoît Sauvageau: If the Chairman allows me a final comment, if it's a desirable initiative and if time permits, I would like to know, depending on our travel arrangements, whether you could give us names of places to visit so that we can see actual examples.

The Chair: Allow me to tell you that the committee has proposed a trip in September--the second week of September, if I'm not mistaken--to the Yukon, to Whitehorse, Vancouver, Saint-Boniface, Sudbury, Quebec and Moncton. I believe that's correct, Mr. Clerk. That's been submitted to the House, and we expect to have the green light to do that tour.

Mr. Benoît Sauvageau: The clerk could give you our travel dates, since it's not going to happen tomorrow morning.

Mr. Hubert Gauthier: I believe we're in contact with the clerk.

Mr. Benoît Sauvageau: You could tell us places we could visit.

Mr. Hubert Gauthier: I'd be pleased to do so.

The Chair: Members, I would like to clarify a few details, with your permission. Have the amounts of $63 million and $75 million that will be allocated to training been confirmed with you?

Mr. Hubert Gauthier: That was confirmed on the weekend in an announcement that Mr. Dion made in Halifax. If you don't already have it, we can give you the text of his speech.

So Mr. Dion confirmed that $75 million would be allocated to training, that $63 million would be allocated to the consortium of Francophones outside Quebec and that the balance would go to Quebec Anglophones. As for networking, we're talking about $14 million, $10 million of which will go to Francophones and $4 million to Anglophones in Quebec. As for services to the public, the amount is $30 million, $20 million of which will go to Francophones outside Quebec. That's exactly what he said.

The Chair: Perfect.

Mr. Hubert Gauthier: That's roughly what we expected.

The Chair: I hadn't received it.

Mr. Hubert Gauthier: That took place in Halifax on Friday evening.

The Chair: Thank you, we're going to circulate that. I know that your relations with the provinces are evolving, but would it be possible for you to send us a kind of table giving us an idea of the prevailing relations in each case and things that are being done with regard to provincial programs and support? That kind of document could fuel our discussions.

I would like to ask you a question. You spoke earlier about your two concerns, the first being bringing about a federal-provincial-community partnership. I don't believe there's much opposition to that from most of the members of this committee. You also referred to continuing funds; did you mean by that only federal funds or provincial funds as well?

Mr. Hubert Gauthier: I was talking about everything, but when I come to Ottawa, I talk about federal funds. In the provinces, health funding is generally recurring.

À (1015)

The Chair: Is it recurring in the case of programs for linguistic minorities?

Mr. Hubert Gauthier: Programs for linguistic minorities don't exist in the provinces; there's no specific envelope for that. Envelopes are given to the regions. Part of the work we have to do with the regions, in our areas, is to determine who is responsible for services in French and to clearly identify the resources allocated to that. That's part of the work that's being done.

In New Brunswick, when things are reorganized, battles have to be waged to ensure that the boards provide services to Francophones. This is a raging debate in New Brunswick which we are monitoring with a great deal of attention. In our smaller, less populated communities, Francophones are served by a large board. That's the case in Winnipeg, for example, where Francophones must ensure that part of the approximately $1 billion budget is allocated to services to Francophones.

I referred to continuing budgets. The $30 million amount that Mr. Dion announced for services is a one-time shot. In such cases, both the provinces and the communities are concerned to know what will happen afterwards. That question was put on the table from the outset. Moreover that's the problem of the provinces. I'm going to put on my provincial hat for 30 seconds because my organization is funded by the provincial government. The $800 million agreement which was reached between the federal government and the provinces for primary health care is a fund that will not be renewed. The ball will then be in the provinces' camp. I'm begging you to believe me: the provinces will be coming back to the table to discuss that some time in the future.

The Chair: I'm having trouble understanding. You refer to the need to integrate services that are created, but from what you tell me, they're already integrated at the provincial level.

Mr. Hubert Gauthier: Even though we're trying to integrate services in the hospitals, long-term care and first line care in a single region, Francophones are buried in each of those categories.

When we talk about integrating services and the single window, which Mr. Simard referred to, we're thinking about community health centres which will bring together all health services and even social services.

The Chair: You referred to the integration of all services in French, not the integration of services in French in the rest of the system.

Mr. Hubert Gauthier: That's correct. Now those systems aren't foreign to the rest of the system, but we need a place where Francophones can meet and feel at home, where they aren't embarrassed to speak French. It's like the difference between going to the home of a neighbour where everybody speaks English and going to the home of another neighbour where everyone speaks French.

The Chair: I'm glad I've grasped the difference; I hadn't understood the notion of integration in the same way. I'm comfortable with the notion of integration of services in French as I understand it now, but, for that, provincial funding will be necessary as well. So we'd be talking about a desintegration of funding.

Mr. Hubert Gauthier: We sometimes view it that way.

The Chair: I'm a case of once bitten, twice shy. In my electoral district, I recently lived through the Montfort situation, with which we're all familiar. All that was part of the provincial budget, and the government wanted to reduce the services provided by the hospital. That caused a reaction, as we know, and brought us here today.

Mr. Hubert Gauthier: Mr. Chairman, having networks will force the province to identify clearly who is responsible for doing what and how much.

The Chair: Thank you.

Mr. Hubert Gauthier: It will help us a lot, I believe.

The Chair: We understand each other. I have no further questions. If there are no other questions for Mr. Gauthier, I'm going to thank him for coming here today.

Mr. Hubert Gauthier: Thank you very much.

The Chair: If you wish to come back and see us...

Mr. Hubert Gauthier: Well, we'll see you in Saint-Boniface.

The Chair: That's right.

Members will now ask the other witnesses questions, Mr. Arès in particular.

Mr. Sauvageau.

Mr. Benoît Sauvageau: Good morning, Mr. Arès and Ms. Côté. Once again I'm going to ask you the question I put to you at the start.

You referred to the sixth principle. Between the time you started talking about it and today, things have no doubt changed. Do you still consider it a priority, even though our Chairman's bill no longer exists?

In my opinion, there are two other possible solutions at this time. We are starting discussions. There is the sixth principle, as you have stated it. There are agreements between the federal government, the provincial governments and the community based on the education agreements, as Mr. Dion and Ms. McLellan asked us in their letter to the committee. There are also existing statutes such as Bill 142 in Quebec and that of New Brunswick, in which the provinces are encouraged to offer services in English in Quebec and in French in New Brunswick. So everyone agrees with you that they want to correct the situation. We're in the health field. Everyone's making the same diagnosis, but I don't think everyone's proposing the same remedy. Do you still want to give the patient the same pill, that is to say the sixth principle, or are you thinking you should draw on other examples in other provinces?

À (1020)

Mr. Georges Arès: I think the three solutions should go together. The sixth principle should be there, if only to recognize that Canada is a country that values linguistic duality. That principle should be reflected in the laws and initiatives of the Government of Canada.

There may then be federal-provincial-community agreements. I very much appreciate what Mr. Gauthier said: the communities should not be forgotten.

Mr. Benoît Sauvageau: With all due respect, Mr. Arès, allow me to interrupt you.

And if the sixth principle prevented the other two from being implemented? Do you understand what I mean by that?

Mr. Georges Arès: I'm not a constitutional expert, so I can't determine whether the addition of a sixth principle might constitute an obstacle. From my way of seeing matters, the sixth principle would encourage federal-provincial agreements, and I agree that the communities should be included in them because they're very important. Then there could be laws similar to Bill 142 and New Brunswick's legislation in each province.

Adding a sixth principle does not mean excluding the others. First, it would emphasize the importance of linguistic duality in the context of health services. Then what do we do about it? We reach agreements at the provincial level, and then the provincial governments can pass legislation to comply with them. I don't see how that can cause a conflict.

Mr. Benoît Sauvageau: I'm going to explain my perception, even though it might be completely mistaken. First, the principle of linguistic duality already exists in the sixth principle in accordance with the Charter and the Official Languages Act. So we would be asserting a principle that already exists.

Second, if we reaffirmed that principle, Quebec or other provinces would be opposed in health as they were for too long in education. That would then trigger constitutional and legal disputes to determine whether the sixth principle in health is valid in areas of provincial jurisdiction, be it in Quebec or Manitoba. I won't start a political dispute in Quebec; that's a jurisdictional dispute.

The provinces would be so opposed that, if they were told that they could also rely on other statutes, they would respond that they no longer want to have anything to do with our idea and that we wanted to impose something on them that they still resent. Please pardon the expression, but they would tell us to stop troubling them with the subject, that they no longer want to have anything to do with it.

For those reasons, I want to make sure that, as you mentioned, the sixth principle would complement the other things. In a perspective in which everybody would be in good faith, I would agree with you, but I can't presuppose that that would be the case. So I wonder whether, in order to help Mr. Gauthier, our parents, our children and ourselves to receive health services every day, the sixth principle is the way for us to go--if so, we start the discussion this morning and we study the question--or whether there aren't other priority avenues such as, for example, what's being done and what has been done elsewhere.

I would like you to make your comments and also take into account the education question. I'm sure that, if life were like a VCR, we would stop and rewind; there are actions we wouldn't take in the same way to defend the education file in the various provinces.

Now that that's part of our experience, do we take the same political approach to the health issue or are there areas that we must not and don't want to repeat? It's on that subject that I want to hear your comments and to start discussions in the committee.

Mr. Georges Arès: In education, if you'll remember, the Laurendeau-Dunton Commission gave rise to the Official Languages Act, which then generated the official languages in education program. So first there was a study and then an act. I see the sixth principle as the act that could lead the way to reaching federal-provincial agreements. If the provinces got involved, we could start with that, but what's going to encourage them to get involved? Recognizing that linguistic duality is a fundamental principle of this country and that it must be recognized in health services.

In my opinion, if they don't get readily involved, we'll need the sixth principle to make them acknowledge that it exists, that it must exist and that it must be complied with. Then we could reach agreements. If they want to get involved before that, all right, but I think the sixth principle must be there to make all of Canadian society, all provincial and municipal governments and the health boards realize that linguistic duality is a fundamental principle that must be complied with in the context of the health services they offer to the public.

À (1025)

The Chair: Thank you, sir.

Mr. Georges Arès: Allow me to add this. Mr. Bellemare spoke of “where numbers warrant”. If the federal government wants to implement an initiative to have health services needs recognized and to meet those needs, it must disregard considerations of “where numbers warrant”. We have a serious problem in the education field because the Charter says: “where numbers warrant”.

The Supreme Court responded to that argument of the Government of Alberta in the Mercure case. When the Government of Alberta said that there weren't sufficient numbers in Alberta to offer provincial government services, the Supreme Court responded that the province could not reasonably advance such an argument after doing everything in its power to reduce the numbers.

The situation is similar in the health field. Not much has been done to develop demand, and, for a long time, provincial governments were even allowed not to offer health services. Through its act and the amounts of money it gave to the provinces, the federal government did not attempt to encourage the provinces to increase demand in French, and it says to itself that it might consider offering services where numbers warrant. That's not a reasonable way to think.

If you propose something after your consultations, I would like the expression “where numbers warrant” not to appear in your proposal. I think it's nonsense because demand hasn't been supported and encouraged since Canada has been in existence. So it's not reasonable to say now that, if there aren't sufficient numbers in St. Albert, Alberta, or in Wainwright, services won't be offered. That creates second-class citizens. People who aren't part of a sufficiently large group don't receive services. Since they aren't entitled to services, they are second-class citizens. In Canada, we shouldn't have second-class citizens, particularly when we have linguistic duality. For our communities, it would be a monumental error to add “where there is significant demand” or “where numbers warrant”. I wanted to make that point.

The Chair: We're quite flexible here.

Mr. Simard.

Mr. Raymond Simard: I would like to continue on this subject. Where I'm from, there are problems with universal programs. For example, there are designated bilingual positions and funds that are supposed to be allocated to Francophones aren't used for Francophones. In villages not far from home, there are bilingual positions, but no Francophones receive services in French. That's a problem. I understand what you're saying, but how do you omit “where numbers warrant” while targeting Francophones and ensuring that services will go directly to Francophones? That's what troubles me. When you legislate for the entire country and 20 percent of the money is used to serve Francophones, that doesn't suit me. I want to know how we can avoid that.

Mr. Georges Arès: I believe we have to educate people, and there's also the entire question of active offer. We're told, for example, that few Francophones complete Revenue Canada forms in French. What has Revenue Canada done to help people complete their forms in French? Have Revenue Canada people gone to high schools to show high school students how to complete a tax return in French so that they are able to complete the French form when they get their first job? None of that has been done. There's no active offer or training, and then they say the demand isn't there. You have to be proactive and see how you can lead Francophones to request those services and to use them. There's a whole process of sensitization and training to be done, and a proactive approach is needed. If you haven't done it, you can't say that Francophones don't use the service. It's not just up to the communities to tell people to complete Revenue Canada forms in French. People have always done it in English. What must be done for them to change their habits? They don't understand because it's so complex.

There are other examples. I cite that one because it's obvious. Revenue Canada publishes advertisements in French-language newspapers to encourage people to complete their forms in French. It produces no results because people have always completed their forms in English.

À (1030)

Mr. Raymond Simard: Would you agree on the idea of identifying certain regions where we know that the Francophone population would use services, or do you think we must absolutely legislate across the country?

Mr. Georges Arès: I think you should legislate across the country. As I said, I wouldn't want anyone to continue creating second-class citizens by saying that there are enough Francophones in such and such a region. What happens to the Francophones in Whitehorse, in the Yukon, or in Vancouver, when you talk about population percentages? In the big cities, Francophones don't all live in the same area or in the same neighbourhood. And what do you do about small villages?

We have an urbanization problem. The population of some rural areas is leaving and going to the major urban centres. What do you do about those who stay in the region? If the population of a village is now only 500, 5,000 or 200, do those people no longer have any rights? I have a lot of problems with that. I think we should get rid of this notion that you have to meet a specific number and be in a bilingual region in order to have rights as Francophones in this country. I no longer accept that. I think that the youth of our country are telling us that that doesn't work anymore. The polls tell us where Canada is heading, and we need leadership from the federal government. The government must not wait for our communities to press it for the services it needs. It must establish a vision of the country and move forward. It must show the necessary leadership and not limit those services to the bilingual regions. Linguistic duality, a fundamental value of this country, means that everyone in the country has a right to and must have access to those services. The idea is to find a way to do it.

Mr. Raymond Simard: Mr. Arès, isn't it a fact, for example, that the Health Sciences Centre in Winnipeg receives funds to provide services in French but allocates that money to something else? That's the situation. What should be done? Resources are essentially limited and it must be ensured that Francophones and minorities benefit from them.

Mr. Georges Arès: The federal government should definitely set conditions when it allocates funds. We've been asking the federal government for decades to set conditions for the provinces when it sends them funds for education. It's taken time, but some provincial governments are starting to spend their own money for education in French. For example, in Alberta, the provincial government has spent $30 million out of its own funds over the past two years to improve and expand French-language schools. It's unheard of. Twenty years ago, federal money was used for highways, but I think the attitude of the provincial governments is changing. The federal government should be more proactive and demand accountability and results.

Canadians have said, in particular before the Romanow Commission and the Kirby Committee, that they want the money to be used the purposes for which it was allocated and for there to be results.

Mr. Raymond Simard: Thank you, Mr. Chairman.

The Chair: Mr. Castonguay.

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): I would like to come back to the question of the sixth principle and share a few thoughts with you. If we adopt that approach, I wonder whether, from a practical standpoint, that might become more a source of headaches and cause an outcry. It's possible to do it while doing something else, but my fear is this. You say in your text:

We're talking about cooperation and programs of services to minority Francophones and Anglophones. Isn't that a better approach to achieving the desired result? I believe that we ultimately all have the same objective.

I'm not speaking as a doctor, but rather as a politician, and I'm not an expert in this field. I wonder where we could trip up and miss the boat, whereas, if we take a different approach... My questions are along those lines.

À (1035)

Mr. Georges Arès: I think that's a valid question that you should ask: that's the approach to achieving the goal. But I think the goal should be the sixth principle.

If we look at what's happened in education, we see that the federal government implemented the Official Languages Act, but that it did not specifically address the matter of a funding program for education in French. The program was subsequently established, with the provinces, and then there was section 23 some 12 years later. That section was necessary in order to confirm the right to schools and schools management. However, the program began well before section 23.

It will be up to you to decide. However, section 23 was necessary, even though the program was already in existence. It resulted in the expansion of schools and schools management. We have now come to the point where the cornerstone of community development has finally been recognized, first by the act, and then by the Charter and the program. We have to get there as well. It will be up to you to decide whether to start with the sixth principle or to secure the commitment of the provinces by other means.

In my opinion, the networks that Société santé en français is establishing are an excellent opportunity to sensitize the provincial governments. They're going to recognize that working jointly with all major stakeholders in the health field will make it possible to target the problems and implement solutions together. I think it's possible to secure their cooperation. It will be up to you to determine what is better from a political standpoint right now. But I emphasize: we have to come up with something and include the sixth principle in the Canada Health Act.

Mr. Jeannot Castonguay: I had the impression that the ultimate goal was to ensure that people receive health services in their language.

Mr. Georges Arès: Yes, but protection measures are necessary.

Mr. Jeannot Castonguay: I'm going to think about that.

Mr. Georges Arès: As I've already said, we have the Official Languages Act and section 23 of the Charter of Rights and Freedoms. That protection is still necessary even if we can say that we're able to offer the services; in addition, linguistic duality must be recognized as a fundamental value and characteristic of the country. That should be included in the laws. It has to be.

We must not disregard that and say we're not going to talk about it. In my view, once we've managed to include that in the act, it's there forever, unless the act is amended. I think that young Canadians are telling you that, in their minds, the country should be much more respectful of linguistic duality than it appears to be now or than it was in the past.

Mr. Jeannot Castonguay: Do you mean by that that the provisions of the Charter and the Official Languages Act are not sufficient?

Mr. Georges Arès: No, I'm saying that, with section 23, the Official Languages Act and the education support program, it's enough. That's why I answered Mr. Sauvageau saying that I saw the three as going together, even though they were implemented at different times. What's needed is to decide how to proceed. On the political side, it's not up to me to decide how you're going to deal with the provinces.

The Chair: Ms. Thibault.

Ms. Yolande Thibeault (Saint-Lambert, Lib.): No, it's all right.

The Chair: I would like to tell my colleague about certain aspects of my experience and knowledge in education.

Although the Charter is entrenched in the Constitution of Canada and nearly all Canadian provinces comply with it, 15 years elapsed before the rights were respected and there was a practical application in the field. Despite the Charter, the Official Languages Act and the support programs, it took 15 years for that to happen. So what we're committing ourselves to today won't be resolved tomorrow.

However, I nevertheless think that it is our duty to adopt a long-term vision. I want to ask Mr. Arès a few questions on that.

You said earlier that the Canadian government could or should set conditions. First I would like to ask you--I think I know the answer, but I want to make sure it's the same for you--whether you think that, even without amending the Canada Health Act to include a sixth principle, the Government of Canada could henceforth include conditions in its health transfers to the provinces.

À (1040)

Mr. Georges Arès: I think so.

The Chair: Thank you.

Mr. Georges Arès: Under its spending power, I think the federal government can require that those amounts be used for that purpose.

The Chair: Since 2000, we have witnessed two negotiations: one in 2000, which led to an agreement, and the other, earlier this year, which followed the tabling of the Romanow and Kirby reports.

Is the FCFA tempted to meet with the government, to take part in negotiations and ask that transfer agreements include conditions?

Mr. Georges Arès: We took part in discussions with the people from the Health Canada Advisory Committee, but we made no official request.

The Chair: Thank you. Are you well enough informed of the New Brunswick situation, including its legal aspects, to answer my questions?

Mr. Georges Arès: No.

The Chair: I would like to come back to Mr. Bellemare's comment on demand and the expressions “where numbers warrant” and “where there is significant demand”; research could be conducted on the subject.

I would like to know whether, in New Brunswick, the only officially bilingual province--I don't know whether my colleague Mr. Castonguay is aware of this--this notion of “where there is significant demand” or “where numbers warrant” exists. Are all citizens of New Brunswick entitled to health services in their language or are they subject to this question concerning sufficient demand? Can someone answer that? Otherwise I'm going to put the question to our research officer.

Mr. Georges Arès: I think you should have the research done because I'm not sure.

The Chair: All right. Thank you.

Mr. Sauvageau.

Mr. Benoît Sauvageau: I'm going to catch the ball off the bounce and tell you that the library has already done some research. Unfortunately, I don't have it with me. However, I requested some research so that I could do my homework before coming to committee. I don't know whether Mr. Ménard or someone else from the library did it. It was research on Bill 142 in Quebec and on the New Brunswick legislation. Have we received those answers?

Mr. Marion Ménard (Committee Researcher): Yes.

Mr. Benoît Sauvageau: I haven't completely memorized them, but I know the research is done. I have a copy in my office.

The Chair: Is it something you'd be prepared to share with the committee, Mr. Sauvageau?

Mr. Benoît Sauvageau: With pleasure.

The Chair: You have permission?

Mr. Benoît Sauvageau: Since we're one big family, we share everything.

The Chair: And it will be a public document?

Mr. Benoît Sauvageau: Yes, it's a library document.

The Chair: If it's a document requested by a member, that member's permission is required for it to be made public.

Mr. Benoît Sauvageau: I give you permission.

The Chair: There we have it.

Mr. Benoît Sauvageau: I had two questions. The first was about the conditions relating to the transfer of health funds. You answered Mr. Bélanger on the subject. Now I have three more.

Quebec and New Brunswick, which have passed legislation to help Francophones--and Anglophones in Quebec--obtain health care in their language, didn't have a sixth principle. Do you think we should impose a sixth principle on the other provinces in order for them to pass similar legislation to that of Quebec and New Brunswick?

Mr. Georges Arès: No, that's not what I said.

À (1045)

Mr. Benoît Sauvageau: No?

Mr. Georges Arès: I said that I would like to include the sixth principle. You could start in the same way as authorities started with education. But it should not be forgotten that, in this area, the Official Languages Act was in existence and that it gave rise to the education support program. I also think that the networks that will be in place will promote the commitment of provincial political decision-makers and those in the health boards. I think those people should be sensitized.

I don't believe that the provinces will cooperate if things are imposed on them, unless it's in the Constitution. That's why I say that, from a political standpoint, it will be up to you to decide how to deal with the provinces. One thing is certain: funds are an excellent incentive for the provinces.

Mr. Benoît Sauvageau: That's true.

Mr. Georges Arès: The money...

Mr. Benoît Sauvageau: In the context of the transfers and negotiations of the health ministers, we--or the FCFA--could put on the agenda, for provinces that have not legislated in the area, discussions on the implementation of bills such as those passed by other provinces. In that way, we could proceed with transfer X, within time period X. It seems to me there is less of a risk that that incentive--as my friend, Mr. Castonguay, said earlier--will meet with opposition. We agree that we should achieve the same goal. Thank you; that forces us to reflect on the question.

I'm also wondering about the meaning of the expression “where numbers warrant”. I was looking at Senator Gauthier's assistant earlier; I know he's very interested in the subject. Mr. Simard made me think about the meaning of the words “where numbers warrant”. In theory, I entirely agree with you, Mr. Arès. It should be applied everywhere; there's no doubt about that. In practice, however, I have some reservations.

The Treasury Board designates bilingual regions. We know that 33 percent of the public service is bilingual and that there are also bilingual regions. For example, if you live in a region where Francophones represent 0.5 percent of the population, there is no obligation for the federal government to offer services in French in that region.

For example, if I decide to settle in a rural area of Quebec where there are only eight school aged children, but I don't want to be considered a second-class citizen--I want schools and school buses--I may be faced with a purely practical problem. I'm a Quebec citizen and, under Quebec law, am entitled to education, but, if I settle in a suburban area of James Bay, for example, I may in fact be faced with a practical problem in having that law applied.

So to use the resources properly, shouldn't we start with areas designated bilingual by the Treasury Board, for example, so that those services are eventually offered to everyone, rather than try to offer them to everyone from the start?

The Chair: Mr. Boudreau would like to answer that question.

Go ahead, Mr. Boudreau.

Mr. Armand Boudreau (Director General, Société Santé en français): Thank you, Mr. Chairman.

I'd like to tell you about something that makes the health field more complex; I believe it's a phenomenon that doesn't occur in the education field. I don't mean by that that education isn't complex. However, in health, a number of provinces or territories, as you know, are not self-sufficient. Consequently, a number of specialized services must be bought from one province or another--it's the same case in education--in order to train professionals, as you said earlier. For example, New Brunswick doctors are trained in Quebec. So in situations “where numbers warrant”, you also have to bear that in mind; what services are you talking about when you say “where numbers warrant”?

I went to Iqaluit last week. As you know, the Francophone population in all of Nunavut is at most approximately 600 or 700 persons. No direct services are offered to meet the needs of those persons, in any case.

Some of the nurse practitioners are said to speak French, but the talk was mainly about specific agreements with the Ottawa hospital and adjustments to those agreements. As a result, Francophone patients from Nunavut could go to Montfort hospital, where the required service is available, rather than to the Ottawa hospital, where the specialist might be an Anglophone.

Since we're talking here about designating regions of the country, I wanted to tell you that the complexity of the health field makes matters difficult, among other things because of service delivery.

The Chair: Mr. Arès, do you want to add anything?

Mr. Georges Arès: Mr. Boudreau explained the situation well. However, it also applies to education. In a village where there are eight students, recognizing the right to education in French does not necessarily mean a school is going to be built for them. A way has to be found to provide the services. My idea is precisely that we recognize the right of all Canadians to receive health services in French. If there aren't enough people in a village to warrant a hospital there, another way has to be found to recognize their rights and provide them with services.

À (1050)

The Chair: Thank you.

Gentlemen, madam, I would have you know that it is 11 o'clock; we must leave the room since there is a meeting of the Agriculture Committee. So we will do a final round. I reserve two minutes at the end to provide you with an overview of what's upcoming.

Mr. Arès, would you like to conclude?

Mr. Georges Arès: I wanted to talk about the funds question. To get the provinces involved, money often has to be provided, as was done in education. As I explained earlier, the provinces are starting to allocate their own funds to that. So there's the legal approach, the sixth principle, the act and so on, and money must now be provided to induce the provinces to get involved. The provinces are concerned about recurring funding. When they're asked to provide services to the French-speaking minority, they wonder who's going to pay and for how long. If we're not prepared to establish a program similar to that in education, instead of waiting for the provinces to agree and start allocating their own money to it, we won't be going anywhere.

Mr. Gauthier referred to an amount of $20 million. That's not a lot to encourage the provinces to get involved. And there's one thing he didn't say: the provinces can't have access to that $20 million if they don't guarantee recurring funding. Are they ready to do that? I don't know. Some provinces will refuse. Only the Francophone communities of the provinces that are prepared to get involved will receive certain services. The others won't receive any because they're not prepared to guarantee recurring funding. So a way has to be found to induce the provinces to get involved and that's often done with money.

The Chair: That's noted, Mr. Arès. Thank you.

I believe we've had a good introduction. Naturally, I would like to invite you and Société santé en français to follow the committee's proceedings. If you wish to attend in person, you'll be welcome. You can also do so on our Web site, where the minutes are posted three or four days after the meeting.

The Clerk of the Committee: Twenty-four hours afterwards.

The Chair: What efficiency!

So I invite you to monitor our proceedings. If you have any comments to send us, we'll welcome them. Thank you very much for your presentation; it was very much appreciated.

Members, tomorrow we'll meet with representatives of the Department of Health Canada, in particular Mr. Marcel Nouvet, who is Assistant Deputy Minister, and Co-Chair of the advisory group that was created, and also Co-Chair, I believe, of Société santé en français.

Mr. Armand Boudreau: He isn't Co-Chair, but rather a member of the board.

The Chair: We'll also hear from Ms. Mandy, who is Director of the Canada Health Act Division.

I had hoped that the minister's parliamentary secretary would also attend the meeting as a witness, but he prefers to take part as a committee member.

Mr. Jeannot Castonguay: I'll be more comfortable if I'm not questioned.

The Chair: We would have liked to question you, dear colleague.

À (1055)

Mr. Benoît Sauvageau: And how.

The Chair: I'm now going to make my confession and seek my colleagues' absolution. If I don't get it, we'll act accordingly and cancel, but I must give you an explanation.

I've had a chance to speak with some of you about something that has nothing to do with health. There is currently a situation with regard to the capability of our independent Francophone television producers outside Quebec following funding announcements made by the Television Production Fund and Telefilm. As a result of some criteria, funding for Francophone television production outside Quebec, or outside Montreal, as some say, is being virtually eliminated.

A number of submissions were made to me, and on the Wednesday preceding the adjournment week, I met with the President of TFO. I was aware of the problem, as are some of my colleagues as well, but she explained to me that, since there are two funding blocks a year--the next is in the fall--if the same rules remain in place, it will be over for most of those producers.

I left this afternoon, like most of you, and I took the initiative of asking the clerk to call the following witnesses for the two meetings next week: Telefilm and the Canadian Television Fund, Radio-Canada and TFO, the Alliance des producteurs francophones du Canada and the Department of Canadian Heritage. With his usual efficiency, the clerk invited them all for Tuesday and Wednesday of next week.

If you're willing, we could address this question in two meetings and prepare a report that may have a beneficial influence. Do you agree to our proceeding in this manner next week?

Mr. Benoît Sauvageau: I agree with all your comments, except the “may have” part. Such a report would definitely have a positive impact.

The Chair: Thank you. That's it for next week.

On June 10, the Minister of National Defence, Mr. McCallum, will be here, and we will continue our study on health on the eleventh and the following week.

Thank you and until tomorrow afternoon.

The meeting is adjourned.