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Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue 66 - Evidence - September 11 (Afternoon)

OTTAWA, Wednesday, September 11, 2002

The Standing Senate Committee on Social Affairs, Science and Technology met today at 2:07 p.m. to review the document entitled ``Santé en français — Pour un meilleur accès à des services de santé en français.''

Senator Yves Morin (Acting Chairman) in the Chair.


The Acting Chairman: We are going to begin now and other senators will certainly be joining us. I want to thank the witnesses for being with us this afternoon. They are Mr. Hubert Gauthier, Chief Executive Officer of St. Boniface Hospital, who was Joint Chair of the Advisory Committee. In addition to occupying the position of President of the Federation, you were also President of the Fédération des communautés francophones et acadiennes, did you not? Am I mistaken?

Mr. Hubert Gauthier, Chief Executive Officer, St. Boniface Hospital: Initially, yes, Mr. Chairman.

The Acting Chairman: I believe you received an award in that capacity. Your expert qualifications are undeniable. We also welcome Mr. Jacques Labelle, who was the Chief Executive Officer of the Ottawa General Hospital, and Mr. Edmond LaBossière, Coordinator of Intergovernmental Francophone Affairs.

As I understand it — and correct me if I am wrong — this is a group of provincial governments who have formed a consortium with a view to examining a certain number of issues affecting francophones. Is that an accurate description?

Mr. Edmond LaBossière, Coordinator/Facilitator, Intergovernmental Francophone Affairs: Yes, that is essentially correct. The position involves coordinating intergovernmental cooperation on francophone affairs for the provinces and territories.

The Acting Chairman: That includes all the provinces and territories, does it?

Mr. LaBossière: Yes.

The Acting Chairman: As you know, this Committee was struck for the specific purpose of studying these two reports and subsequently reporting to the Senate. This was done in response to a motion by Senator Gauthier that was passed unanimously by the Senate. We will be reviewing these two documents — in other words, ``La santé en français,'' and the report to the federal government minister. So we are proceeding with this study. This afternoon's discussion is very important because ultimately, that is the purpose of our Committee. It was put in place specifically to review these two documents.

Mr. Jacques Labelle, former Chief Executive Officer, Ottawa General Hospital: I am here not because it was my intention to get involved, but because I was asked to provide input. Perhaps some background information is in order: I have held the position of Chief Executive Officer in institutions throughout Ontario, and specifically in Sudbury, Ottawa, Brockville, Smith Falls, Toronto, and Montreal for five years. So, having lived there, I am quite familiar with the Ontario environment. I am not as familiar with the Maritimes, and even less so, Western Canada, even though I have travelled extensively in that part of the country.

I believe the issue of health services in French has to be examined based on groupings of provinces. In my opinion, Ontario and New Brunswick are a special case because of the large number of francophones there. With the other provinces, such as the Western provinces, I believe the dynamic is completely different because Francophones are scattered over the area and relatively few in number.

The same applies to the Maritime provinces, with the exception of New Brunswick, which seems to take the needs of the francophone population very much to heart.

My comments will probably give people the impression I am playing the devil's advocate. What I say will not be seen as ``politically correct.'' I have to say I had problems with the report and with the connection made between the health status of francophones outside Quebec and the quality French-language services. There is no connection between the two. If francophones are experiencing health problems, the causes are socio-economic. If, one day, francophones have a status similar to that of anglophones in their province, I believe they will have the same health problems — no more, no less. If we had services in French for those who are socio-economically disadvantaged, the health problems would be the same. So, I challenge the connection the report makes between these two elements.

The term ``community'' that is used in the report also raises questions. The term ``community'' refers to a group of people who have something in common — more than just language, a society, or an ability to exchange views on a daily basis in one language. That has been the case in certain communities where there was a concentration of francophones.

At the time I was born raised in Ottawa, I could walk from the cathedral on Sussex Drive down to Notre-Dame de Lourdes cemetery, which was a two-hour walk. I would not have met a single anglophone during my walk. Every activity was carried out in French — be it a trip to the garage, the hairdresser, the pharmacist or the cashier in the convenience store. If I were to take the same route today, I would consider myself lucky if I met even one francophone. Similarly, if someone were to serve me in French in a store, I'd also consider myself pretty lucky.

To a certain extent, existing communities have been eliminated because non-francophones have become integrated into those communities and the francophones have become dispersed. Now there are francophones in Kanata, Rockliffe, everywhere; when I was young, that was not the way it was. And that causes serious problems in terms of providing services in French. Francophones who live in those communities certainly have less control over language than I did, when I was young.

If I look at my sisters, cousins and people living in the community nowadays, I see that their children are certainly a lot more comfortable in English than in French, which was not the case with people of my generation. The same phenomenon has occurred in Western Canada, such as in St. Boniface, Gravelbourg and other communities.

The report struck me as bureaucratic. I got the impression that people had been forced to present findings, and not knowing how to tackle the problem, they suggested bureaucratic structures, the way people do when they do not really have a clear idea of what should be done. It reminds me of the health councils that were set up. We had a list of issues but we didn't know what to do to resolve them. So, it was suggested that health councils be established; they meet on an irregular basis, conduct studies and draft reports. But what impact does that have on the quality of services provided to those communities? I have my doubts as to how effective they are.

The problem is that francophones in certain areas have not attained the socio-economic status they should have. That is the fundamental problem. And in every province in Canada, there is a shortage of francophones working in the health care sector. We need to focus here on two types of professionals: nurses and physicians. The others are important, but less so than nurses and physicians, who are at the very heart of the problem.

As I said earlier, the communities are becoming scattered across the country, and up to a point, you could say that the communities are rapidly shrinking; thus the possibility of finding health care professionals within these communities is also diminishing, because their numbers are decreasing. These people are disadvantaged. And their becoming professionals is still problematic.

It is important to recognize that the provinces, with the exception of New Brunswick, are not interested in this issue. This is their responsibility, because health care is an area of provincial jurisdiction. As long as we cannot ensure that the provinces will take the needs of their population seriously, it will be difficult to get around these issues.

As for networking, my concern is that we will create a bureaucratic structure. If we hire people to conduct studies and write papers, that will generate a great deal of bureaucratic activity. What effect will that have on the number of francophone nurses or physicians? That is the key point. We need francophone physicians and nurses in strategic locations.

As for training, there is discussion of a consortium. I am in favour of using existing training facilities where there are francophones. That would certainly include the University of Ottawa, and Laurentian University in Ontario. There are bilingual community colleges in Ontario as well; in Western Canada, there are francophone colleges. I favour concentrating training activities in existing colleges to see whether they can develop programs for francophones.

As regards medical training programs, that would be quite complex. It would be easier in the case of nursing. There are some possibilities there. Once again, the training could be provided in existing hospitals where, west of the Ottawa River — except for Montfort — all available training is given in English. These francophone students would be required to go to anglophone facilities to be trained.

With its Bill 8, Ontario has tried to make francophones feel more welcome. They designated certain hospitals as bilingual, and these hospitals were asked to prepare action plans setting out what had to be done to meet the needs of their francophone population. However, this seems to have had no effect on the daily lives of francophones who live in these areas. With the exception of Ottawa, which has a larger population, the hospitals haven't taken this seriously. Where francophones are in a minority position, very little has been done. Action plans were put together and there has been a lot of activity at the bureaucratic level, but the actual situation in these hospitals has not changed.

Another fundamental point is that the majority of francophones themselves do not demand services in French. Many are comfortable speaking English where complex and technical matters are concerned.

When I was Chief Executive Officer of the Ottawa General Hospital, a third of the correspondence I would receive from Franco-Ontarians was addressed to me in English: ``Dear Mr. Jacques Labelle.'' They would write to me in English and I would answer in English. That is the reality, and there is nothing I can do about it.

The situation in terms orientation/service facilities for francophones in the other provinces, where the population is even more scattered, is difficult to understand. I was a member of the Association canadienne-française de Kingston for many years. There are 5,000 francophones in the region, and yet no services are provided to francophones. There are French-speaking nurses and physicians, but there is nothing structured. Rectifying the situation could be difficult because francophones are scattered over a large area, are well-off financially and already have a physician. Getting these people to focus on providing services in French, rather than English, could well prove impossible.

The technological aspect of the report completely escapes me. It is claimed that using computers will allow us to revolutionize the world. A doctor has to stay in touch with colleagues and social agencies in his/her community. If the technology being used is in English, it could be a problem if someone is using a different system.

When I need to be referred, even though my doctor is a francophone, I want to be referred to a physician in Kingston. That is where I want to receive services — not in Ottawa or Quebec City. My doctor has to have contacts with other professionals in and around the City of Kingston. In that sense, having communication links with Ottawa or Sudbury may not be viable for the people who live in those areas.

In conclusion, the real problem we have to tackle is the assimilation of francophones. The fewer francophones there are, the more difficult it will be to justify services in French for them, because as the percentage of francophones goes down, the numbers of other groups are going up.

Second, because we need to find health care professionals within this francophone population, we don't want to see its numbers decrease, because the more they decrease, the less likely we are to find physicians and nurses within that population. I believe we need to convince the provinces with significant francophone populations to take action. If we go around the provinces, we may end up being the big losers.

At one time, Ontario had the two largest hospitals in Canada outside of Quebec. They were administered by francophones. The majority of their employees were francophone, as well as the members of their boards of directors, their senior managers and middle managers. Over the last five years, these two hospitals have been merged with English-speaking hospitals. Their boards of directors as well as their administration have been abolished. Middle managers from these hospitals have been transferred elsewhere. If you go to the Ottawa General Hospital, there is not one manager left. All of them have been transferred to the Civic Hospital. They will tell you that everybody is bilingual, but in fact there is no francophone representation.

Francophones used to play a role that contributed to the health status of Franco-Ontarians and Ontarians. That role has been taken away from them, although the same is not true for other minorities that also had independent hospitals. They were allowed to keep their hospitals — for example, Mount Sinai Hospital and St. Michael's Hospital in Toronto. However, there was no hesitation about abolishing French-speaking hospitals.

No one can redress the wrong that was done when the Ottawa General Hospital and the Sudbury Regional Hospital were dismantled. Having administered both of these facilities, I know whereof I speak.

The Acting Chairman: That is a different side of the story from what we have heard thus far. Mr. Edmond LaBossière, please proceed.

Mr. LaBossière: When I was in Quebec City several years ago taking a course, I was asked how long ago I had left Quebec to take up residence in Manitoba. I answered that it had been 111 years. Today, I could say that it has been 124 years, because it was in fact my ancestors who left Quebec to settle in Manitoba. My children are francophone. Our home is francophone and we live in the community of St-Pierre-Jolys, which is primarily French-speaking.

I could speak at length about this issue, but before I begin, perhaps I could tell you something about my background so that you can understand where I am coming from. I worked for the Government of Manitoba for ten and a half years as a special advisor on French-language services. Last December, I took up a new position created by the provinces and territories as a whole. That position is Coordinator of Intergovernmental Francophone Affairs.

I have provided you with a brief. It presents the ideas that I would like to address in our discussions this afternoon. Access to health services in French varies tremendously from one region of Canada to the next. Indeed, the FCFA report describes the current situation with respect to health care services in French.

Why this significant difference? Well, one might be tempted to believe that demographic and geographical factors (small numbers of francophones and the fact that they are scattered over different areas) are the main reason for a lack of services in French. However, these same factors did not prevent the establishment of French-speaking schools in practically every region of the country.

One must not believe that smaller populations and the dispersal of the communities prevent us from providing health care services in French. We have done so in the educational field. Why can we not do the same for health care?

Political and legislative realities for minority francophone and Acadian communities are very different from one province or territory to the next. Some governments, like those of New Brunswick and Manitoba, have constitutional obligations where linguistic matters are concerned. Manitoba and Quebec, although their circumstances are special, have the same constitutional obligations both from a legislative and legal standpoint.

Other provinces, such as Ontario and Prince Edward Island, have passed laws dealing with services in French. Manitoba also has a policy statement that is extremely clear and favourable to services in French — I could tell you a great deal about it, since I worked on the policy for ten and a half years in Manitoba.

Given that situation, it is also worth noting that those are the regions in Canada where health care services in French are currently evolving.

Other examples of that would be Georges-Dumont and Montfort Hospitals, health care centres in the Évangéline area, in St. Boniface, Sudbury and a number of other places. In Manitoba, with its policy of providing services in French, centres have been designated, some of which are partly bilingual, others, fully bilingual, but the fact is that their staff is still not completely bilingual. Some favourable changes have occurred, though, thanks to legislation or policies that are now in place.

When it comes to services in French, political leadership is absolutely critical. Action and support from governments can greatly contribute to the vitality of francophone communities and foster their development. The Official Languages Act and its implementation is an example of that. Political will and government commitment are absolutely key in implementing initiatives aimed at developing and acting on action plans for health care services in French. However, community participation is also critical. Based on my own experience, I can confirm that where government action was involved, it was very helpful to plan services in French by working directly with the community. That is an absolute prerequisite — otherwise, there is a risk that the solutions identified will not be the most appropriate — in other words, those that best address the needs of francophones.

The active offer of services in French can be accomplished by a variety of means and infrastructures that reflect the different demographic and geographical realities of Canada's francophone communities. However, there are two principles that must be adhered to. Even if we find different ways of providing services in French, the services must be offered in those areas where francophones live. That may seem a rather trivial point, but sometimes hospitals or centres are designated that are actually outside of the area where francophones are concentrated. If we want to provide services, let's provide them right where francophones reside.

To the greatest extent possible, the offer should be made by having francophone or fully bilingual units — it could be small units — or centres. There will be some exceptions. Sometimes you have to designate a certain number of positions in a large centre. I can tell you, based on my own experience, that having a few positions designated in a large centre does not guarantee quality services in French, because you can easily end up in a situation where people will say: ``I'm sorry, I don't speak French. Can you speak English?,'' or worse yet: ``Can you not speak English?'' or other turns of phrase that are even worse.

On the other hand, the language of communication between employees can be French, when you create units or entities that are entirely francophone or entirely bilingual. The St. Boniface Health Care Centre is a good example of that: it has 25 employees, all francophone, who communicate with each other in French. All the documentation is prepared in French. That is also the case in other regions of the country. So, I repeat: it is important to create separate entities — francophone or fully bilingual units — and francophones must be completely in control of these units.

Intergovernmental cooperation in the area of francophone affairs, particularly the matter of health care services in French, is not something that should be neglected. Critical masses can be attained where borders are not taken into account. It is perfectly true that there are not many francophones in Saskatchewan. There may be 50,000 in Manitoba, almost 60,000 in Alberta, about the same number in British Columbia, and very few in Yukon or the Northwest Territories. However, if you look at the francophone population as a whole in the West or in Northern Canada, the fact is their numbers are close to 200,000.

A call centre set up to provide services in French throughout the region would have an attractive critical mass to work with. This would also make it possible to group together a goodly number of service providers. Fortunately, we are starting to see initiatives such as this. In British Columbia, the Ministry of Health has just sent out a memo to ministries of health in the Western provinces — that was done this summer — to see whether they would be interested in setting up a phone line to provide information to citizens in English. The ministry has also said that there needs to be a francophone component. Indeed, the St. Boniface Health Care Centre is currently examining the possibility of setting up a health care information line for francophones. We have reached an agreement with the Western provinces and will be engaging in discussions to review the options in terms of creating a francophone health care information line.

There are also other interesting initiatives in the works. Last year, in Edmonton, the FCFA report and the Advisory Committee report were presented to the Ministerial Conference on Francophone Affairs. Indeed, Hubert Gauthier came to the conference to make a presentation. Following his presentation, the delegates passed a certain number of recommendations. They also wrote to Mrs. McLellan to make her aware of issues of interest to ministers of Francophone Affairs and to begin acting on the Advisory Committee's report. That question will be addressed and examined again at the Ministerial Conference on Francophone Affairs that will take place in St. John's, Newfoundland, in early October.

The provinces and territories are starting to hold discussions on these matters. Federal/provincial/territorial agreements and bilateral agreements may also be useful. At the present time, there are no specific federal-provincial agreements on health care. There are agreements on official languages promotion that are used to a very limited extent in the health care field.

There are some cooperative intergovernmental initiatives. We need to look at how resources can be used to ensure health care services can be provided in French.

Having national incentives makes for more equal access to services in French in the different regions of the country. Section 23 of the Canadian Charter of Rights and Freedoms, Section 41 of the Official Languages Act, and the federal funding envelope for school management by Franco-Manitobans are all examples of national incentives that greatly contributed to positive change as regards education in French. Is it not now time to consider similar measures in the health care field? That would be a way of making progress in this area as well.

To conclude, for many members of the francophone and Acadian communities, access to health care services in French depends on an appropriate mix of government leadership, intergovernmental cooperation — either through agreements or other projects or initiatives — and community participation.

The Acting Chairman: Mr. Gauthier, please proceed.

Mr. Gauthier: I want to begin by thanking you for taking the initiative of reviewing the matter of health care services in French for the 1 million francophones who live outside of Quebec. First of all, although there are a lot of things that could be said about me, the important thing is that I come from the land of Riel. In Manitoba, in Riel's time, the province was officially bilingual. The francophone community suffered every possible kind of attack from 1916 until the 1950s, and since then, it has been possible to turn the situation around somewhat.

If I am talking that way to you today, it is because I still remember my grandfather, who was a real fighter in Manitoba, and I know that were he still alive, he would be saying to me: ``Hubert, we should have done that 40 years ago!.'' I am a member of that race of Franco-Manitoban Gauls who refuse to give up and who firmly believe that they bring added value to the debate, and that they shouldn't have to beg for things that could be interpreted as gifts being bestowed on a small group of citizens.

Today's initiative is particularly appropriate, coming as it does just before the tabling of important reports, such as the Senate Committee Report, and financial decisions that will be made over the course of the next few months and will affect Canada's health care system for years to come. Of course, I refer to the Romanow Commission and to what is now called the ``Kirby'' Senate Committee. There is also the Dion Plan on Official Languages which is expected shortly.

The position we are taking is that we will be part of both debates, not just one. We want the circumstances of minority francophone communities to be taken into consideration in both debates and the decision-making. Concrete, aggressive measures are required to correct the current situation — namely that more than half of the francophones who have minority status in their area have little or no access to services in their own language, when they live in provinces where the majority speaks English. That is a fact.

Instead of theories, I prefer to talk about concrete cases involving services in French. I think it is worth taking the time to see what this means on the ground, and to that end, I will use examples from my own family.

First of all, my mother is 78 years old and requires home support services — specifically 22 interventions per week. Four are in French. People come to her home and prepare meals for her, and my poor mother has said to me: ``I have to tell them what I want to eat, but I'm not going to talk till I'm blue in the face to explain. They don't understand a thing I say, and the same goes for me.'' Result: my mother does not eat properly. What is the effect of that on an elderly person? This is just one example of people being unable to understand each other. Draw your own conclusions.

I have an elderly aunt who is 66 years old and has suffered a stroke. She was having trouble speaking and is now experiencing problems with the speech therapy she is receiving to learn how to talk again. This example is cited in a video we made. That aunt came to my hospital to receive care, and when it came time to give her therapy, it just did not work. They were trying to give her speech therapy in English. In her file they wrote: ``Does not respond to treatment.'' They sent her back home and then a miracle occurred. Her environment was a French-speaking one. In St. Adolphe, Manitoba, some individuals providing home support were able to give services in French, and all of a sudden, her language skills began to improve, without the assistance of experts in the field. The doctors were nonplussed. Draw your own conclusions.

My wife has liver disease. She is receiving treatment in Winnipeg, but they do not perform liver transplants there. They wanted to transfer her to an English-speaking environment, but she refused. Fortunately, she has been referred to Hôpital Saint-Luc in Montreal. I can assure you, since I experienced this myself over the summer, that it was an absolute pleasure to be able to explain our problems in our own language, our own culture. My wife told me there are a lot of things she had not understood, even though she is completely bilingual. She is only 52 years old, so she is young. Now she says: ``I'm back in my own environment and I feel well despite my illness.'' Draw your own conclusions.

The committee I chair jointly with Marcel Nouvet, Assistant Deputy Minister with Health Canada, was established in April of 2000 by the Department of Health to advise it on ways of maximizing its contribution to the development of minority francophone communities, pursuant to Section 41 of the Official Languages Act. Some people may be wondering what the federal government is doing acting in an area of provincial responsibility.

Our committee immediately wanted to get the provinces involved in our process because we knew we could not carry out this kind of work without involving the provinces. My colleague, Edmond LaBossière, mentioned that some provinces are already making provision for services to be provided in French in their communities. Others have already expressed, in a variety of ways, their interest in implementing such measures, albeit — and there I agree with Mr. Labelle — after ten years of health care system reorganization where francophones were completely ignored. Mr. Labelle made that point when he talked about the Civic Hospital and the Ottawa General Hospital; he told me it would be more accurate to refer to it as a ``take-over'' than a merger.

I want to emphasize that our approach is based on cooperation with the provinces and territories. Indeed, the provinces and territories have primary responsibility for providing health care services. In addition to community and federal government representatives, our committee also includes representation from three provinces — New Brunswick, Manitoba and Alberta. Curiously enough, we initially had only New Brunswick and Manitoba, but received a request for representation from Alberta. We have received requests from no other provinces or territories to date. Our work convinced us that with the support of the federal government, it would be possible to get a significant number of provinces and territories involved in the action plan that we have now developed.

I would remind you that the issue is that half of the francophones living outside Quebec have little or no access to services in their language. We based our arguments on health- and health care quality-related considerations, rather than on purely constitutional ones. Mr. Chairman, this issue concerns health, and health alone.

When we talk about language in Canada, we often make reference to the official languages question, but this issue goes well beyond the challenge presented by official languages. This challenge is health related. It's something we carry deep within us and that needs to be examined.

I want to come back to the fact that the international literature has shown — these are not our studies but international ones — that the connection between the inability of a user to communicate adequately in his or her language leads to consequences — consequences that I address in my brief about service delivery. I would say that my examples — I have twenty more I could cite — explain these kinds of consequences, which create problems for both the individuals and the health care system.

From our very first meeting, our committee chose to focus on front-line health care services: not on hospitals, but on front-line health care services. I am Chief Executive Officer of a hospital, so I could have made the argument that there is a need to talk about hospitals. I am convinced that primary health care services, family medicine services and front- line services in general have to be the priority, and that is also the view of members of our committee. I believe that the witnesses you heard from yesterday and this morning also made that point. The committee believes that is the best strategy for improving access to services by minority francophone communities. Our views are therefore consistent with those laid out in your report, and I quoted it in my brief.

I would like to draw your attention to some of the main aspects of the approach we are recommending to government — and you have copies of the documents we have prepared. We have identified five levers that should be used. No single lever, taken alone, will be adequate to make progress in this area. Those who think we can score a home run with this issue are mistaken. It is too huge for anyone to believe that a single lever will allow us to be victorious all along the line. Following discussion, we also concluded that our five levers should be in the three areas we will be working on over the course of the next few months, because the decisions will be made during that period.

First, development of a network — what we have termed ``networking.'' A lot of people have trouble understanding this. However, networking should make it possible to consult and spur the community to action, and to plan and develop health care services in French.

Second, roll-out of training activities. If we want an action plan that provides for more services, it is clear that if there are no physicians or nurses — and I completely agree with Mr. Labelle on that point — we will not get very far.

Third, we must have a service organization and infrastructure model for delivering services in French that francophones can relate to. Both the committee and our partners have done this work, and that work has prompted us to make a connection between research and training. In our brief, we make reference to trainer-related research. Research is an integral part of training for those of us who work in this sector.

As you probably know, the technology issue is very current. We are not talking only about computers on desks. Current technologies allows us to interact with each other. We believe telephone lines should be set up for francophones requiring services. I'm talking about a 1-800 line. That is a technological tool. When we talk about technologies, we are referring to these kinds of technologies, and innovations such as telemedicine, which didn't exist 25 years ago. Recent technologies can be used to improve access to services in the health care sector. That has been the single focus of all of our work.

The Honourable Stéphane Dion recently announced, on behalf of the Minister of Health, Mrs. McLellan, initial transitional funding of $1.9 million. Mr. Chairman, as I have already said, $1.9 million is not the be-all-and-end-all solution to this issue; it is a small chunk of money to help us make the transition between now and implementation of the plan we're expecting from government in the next few months.

Let me come back to the question of networking, which is the cornerstone of the strategy we are proposing. The idea is to establish partners' forums in each province that include health care professionals, community organizations, service facilities, training institutions and policy and decision-makers, and to sit them all down at the same table to draft plans, clearly identify needs, develop strategies and then implement them.

As director of a hospital, I have occasion to engage in discussions with members of English-speaking hospitals. My francophone doctors are members of the English-speaking associations. My 150 francophone nurses at the hospital tell us they never have an opportunity to get together and talk among themselves. The unions are English-speaking, as are the professional associations. Not being able to speak one's mother tongue leads to isolation. For these associations, services in French are not high on their agenda. In order to break down that isolation, we have to bring all the stakeholders together. Concrete examples show that bringing people together to prepare an action plan, for example, results in renewed energy. If there is no dialogue or consultation and no action plan, no matter how many people we train, our efforts will lead us nowhere! Networking goes hand in hand with one of the three basic realities you identify in your own documents.

It is important that that be said. You say there is a need to find mechanisms that will encourage all the parties — health care providers, facilities, governments and patients — to provide, manage or use health care services more efficiently. That is what networking is all about. We can show the way, and, when we bring the partners to the table in small groups, we realize that it does work.

People looking at this say to themselves that this could well be a solution. So, let's do more of that — not through structures that are superbureaucratic, but rather ones where you rely on people of action, such as Suzanne Nicolas, Élise Arsenault and other people working in our health care network.

The second lever has to do with training of personnel, and as your report points out, human resources — and we all know this — is one of the areas of the health care system where we can legitimately talk about a crisis. The situation is made worse by the fact that for 20 years, francophones paid so much attention to education that they forgot to train health care professionals. There is a tremendous amount of catch-up to do now, and I agree that as our communities shrink in size, it will be even more of a challenge to find francophone applicants.

St. Boniface College introduced a nursing program last year. The objective set was a total of 20 enrolments, and ultimately there were 18. This year — the second year of the program — the objective was 20 enrollments, and there were 33. If courses are offered and they're funded, we will achieve results.

Human resources are the primary focus of our strategy. We believe that it is possible, as part of a national effort, to respond both to the shortage of health care professionals and the needs of francophones. We have forcefully told the federal government: ``Our francophone professionals will, of course, provide care not only to francophones but to anglophones as well.'' We kill two birds with one stone.

People have told you about the consortium, which essentially is a partnership between colleges and universities that want to tackle this problem head on. The consortium is a new element of the approach we are suggesting, and has resulted in close cooperation with training institutions with a view to defining and implementing common strategies and avoiding duplication.

Also, we are seeing that close cooperation is developing with other health care partners, such as facilities, communities and political decision-makers. These universities and colleges are agreeing to accept the challenge of identifying their needs and priorities. That is resulting in our building a solid case which is supported by the population. Young francophones will want to receive their training in the health sciences in French if they see that it will be possible for them to work in French in that sector.

I had to go on site to convince nurses to register at St. Boniface by telling them that I had work for them and that I was making a commitment to them. That is very important. If we give them opportunities and environments in which to practice their profession for the benefit of their community, they will need settings in which to complete their apprenticeship. Even Ottawa, with l'Hôpital Montfort, is seeking other good training and apprenticeship environments all across Canada, because available resources are inadequate. That is an important aspect. You don't only learn things in school. In the health care sector, practical training in an actual facility is a necessity, and if that is not available, we will also be neglecting part of the equation.

That being the case, environments where health care can be delivered in French are urgently needed. We're not talking about creating hospitals. I am not a hospital administrator. I am part of the university hospital network, and I am not afraid to say so. We have to emphasize primary health if we want to create settings in which care can be provided in French. We need to organize and reorganize those health care settings, possibly by targeting small communities first, so that people feel at home. However, there is no doubt that health care delivery must move in that direction. The big problem in Canada, as you state in your report, is that if we do not reorganize medicine and basic services, we will not resolve much.

I would like to draw your attention to a central feature of the approach we have developed — the active offer of services. It simply is not enough to greet callers as follows:


Bonjour, this is the Ottawa General Hospital or the St. Boniface General Hospital. How may I direct your call?


... for people to feel that they can request services in French and receive them. What we need to do now is create places or centres where francophones, when they come through the door — whether physical or virtual — will feel that life unfolds in French and that they will not be bothering people if they ask for services in their language. When someone is ill, and therefore vulnerable, we should not be asking him to fight to receive services in French. People don't even have the energy to do it with Air Canada when they end up in the wrong line, so why should they have to do it at the emergency?

My mother has had to go to the emergency at my hospital several times over the last two years. When I told her I was going to find services for her in French, her answer was: ``Hubert, don't make problems for me here.'' There simply is no active offer. When I find services for her in French, she is happy about it, but when she is ill, she has no desire to wage that battle. When there is no proactive offer of services because it simply isn't available, then it's just not going to happen. When we talk about the majority, that says:


Services are offered and advertised, but this is not good enough.


Yet the Évangéline Community Centre, francophone health centres in Ontario and the St. Boniface Health Care Centre clearly demonstrate that when services are offered in their language, francophones use them to such an extent that the institutions themselves find their waiting lists becoming impossibly long. We have to broaden our platform. When the offer of services is there, it is clear, people talk about it and it has a ripple effect.

That active offer of services, even with a small number, can be structured and tied into education, early childhood education and the work of other community organizations. We should be looking at what francophone and Acadian communities are doing across the country for innovative examples such as those, and the majority should use them as a template.

It is important and urgent to put responsive services in place based on the needs and means of each of the communities. We have never said that clinics should be set up in Saskatchewan all across the province. People are more realistic than one may think. My wife is originally from Saskatchewan, and when we go back there, we are struck by the fact that everything has come apart, become shrunken, the institutional bases are simply non-existent. We have to find other ways to provide health care services in their own language to those people who deem this to be important. We're not talking about having hospitals all over the place; we're talking about front-line services. Our paper includes an appendix showing a gradation of the type of services that can be offered, depending on whether it is a very spread- out community, or a geographically concentrated one in North-Eastern New Brunswick. We are talking here about multi disciplinary teams, about floating staff or flying squads and professionals who can practice on their own, but with assistance from other professionals, in the form of telemedicine or health services phone lines.

The means are varied and can be tailored to needs. We now have access to opportunities that did not exist previously, all of which require close cooperation with partners. Without that cooperation, we will not move forward. In order to consolidate that dialogue and cooperation, we are preparing a convention to found a national network of French-language health care services that reflects local realities. These are local units that will form a federation at the national level and will be meeting next November with partners from every region of the country, care facilities and health care professionals. Whether people like it or not, this is a necessary step.

Since April of 2000, the advisory committee has produced the report that you now have and which sets out a plan of action. We believe our committee has fulfilled its mandate. There has not been as comprehensive a report on health care. There have been ad hoc reports. We took inspiration from them and they are the basis for the other important study conducted prior to our report.

Our plan of action is not the work of only a committee of 15 or 20 people. We had it validated by about 250 people at a forum in Moncton in November of 2001. It received unanimous support. This was a forum on health with people who work in the health care system, nurses, physicians, representatives of health care institutions, government officials — even Edmond was there.

Mr. Chairman, we brought together key stakeholders with a view to implementing this plan. The communities have rallied and have started to take action. This was urgently needed. People are making progress, despite the fact that they are not receiving a lot of support. Yes, St. Boniface College offers training programs for nurses, but it didn't wait to receive the necessary funding. It now wants to enhance that program, so let's give it the assistance it requires.

Yesterday and this morning, you heard from people working in different regions of the country who are trying to improve the situation — in many cases with a great deal of commitment and only limited means. The provinces have expressed their desire to follow suit. In my view, the federal government has to play its rightful role. It cannot replace the provinces, but it does have an important role to play in terms of providing support and showing leadership. Its intervention should not be half-hearted, but aggressive and substantial. Half-measures, at this stage of the game, and in light of the current situation, simply won't be enough. We are no longer groping in the dark. That's the beauty of this. A new course has been clearly charted, with the approval and cooperation of the communities and all our partners.

We believe that your committee and the report it will soon release — if I could just digress for one moment to say that you probably know that decisions will be made over the next few months — will emphasize the fact that there is an urgent need for action so that we can move forward in this area and improve access to services in French in every region of the country.

We have to include francophones in efforts to reform the health care system. We firmly believe that not only will these efforts help to enhance the quality of health care services provided to francophones and minority francophone communities, but also contribute, by being innovative, to health care reform all across Canada.

Help me to ensure that my mother has better access to home health care.

The Acting Chairman: I would like to recognize Senator Keon first, because he has to leave soon.


Senator Keon: Mr. Gauthier, your presentation was very clear, so I do not need to revisit it. You mentioned technology links in particular, which have also been mentioned by other witnesses.

I believe we will eventually move to an electronic health record for every Canadian. I do not know how soon. It would be interesting to know where you think an electronic health record would fit in the system that you just described. For example, at St. Boniface Hospital, if a French language electronic medical record on the patient were to come out of the network of francophone community clinics, translation of the language itself would not be very complex. Translation of some of the technical data would be more difficult, I suppose. I should like to hear from you in this regard.


Mr. Gauthier: I'm very pleased that you asked me that question. I would like to touch on two specific points in my answer. I cannot help putting on my hospital CEO hat. To begin with, we will have to create a real electronic health record for patients. In my hospital, I am having problems obtaining core funding. Having said that, however, our goal over the next two years is to obtain funding for just this kind of project.

We believe it is both possible and necessary for there to be a single patient health record, whether it be in the community, at the doctor's office, a community organization or ultimately my hospital. That will save the patient having to run around in circles every time. My hospital has reached an agreement with a certain number of francophone doctors' offices. We are trying to develop a project together, because we believe that it could be used as a model.

According to what the experts have told me, translation technology is not a problem; it is certainly much less of a problem than is access to information and issues associated with privacy, et cetera. Computer people tell me that if we decide to do this, in terms of the technology — just as for 1-800 phone lines — the software and the programs will be translated, which means that we could have a screen with French on one side and English on the other at all times; that would help health care professionals use the appropriate terms, which can sometimes be difficult to translate. So, that is feasible.

Of course, there could be significant translation costs attached to that, but these are not insurmountable obstacles. A francophone patient health record could easily move around. We are already experiencing difficulties, because at the St. Boniface Health Care Centre, the patient records are written in French. In my hospital, we have been asked whether all the records should be written up in French. But there are tremendous concerns in that area.

My answer was:


No one said you would all have to be bilingual.


I have 4,000 employees. Ten per cent of them are bilingual. I am sure you understand that a whole group of them are quite concerned. But no one has told them they should all be bilingual.

We have provincial budgets for translation. Our computer people tell me that this would not be a problem, and that it would be easier to mechanize the process.

I am in favour of a single patient health record, that would not be only the hospital record. My clients consider it an awful thing to have to provide the same background information over and over at their doctor's office, the medical clinic, the social services centres and at the hospital, sometimes on three different floors. So, Dr. Keon, I am very much in favour of an electronic patient record.

Our basic systems don't usually allow us to make those kinds of changes. We would therefore have to modify our basic system. I imagine people in Ottawa don't even know that we do not possess the basic technology that would allow us to create such systems. In terms of transferring patient records in Manitoba, we have some pilot projects underway, and we are trying to achieve a cost effective record. We'll see what happens. Did I answer your question?


Senator Keon: Do you think in Ontario that we can get back to having some French hospitals in addition to the Montfort Hospital, for example, in the Sudbury region?


Mr. Labelle: I don't think that's going to happen. The integrated health care structure implemented five years ago will remain in place. Only the Liberal government could make changes, and I don't think it will. If we remove French- speaking hospitals from the merged system, we will have to do the same for Catholic hospitals. That will lead to problems.

There is no demand for this, and francophones are not complaining. A merger has occurred and they couldn't care less. When they go to the General Hospital, things are really no different. The only thing that has changed is that francophones no longer play a political role in health care service delivery in Ontario. Before, we were accomplishing something. Francophones were proud to manage the hospital and achieve even greater success at it than most of the other hospitals in the province. That is a role that we were unable to appreciate. People see things differently.

We always said that services needed to be maintained at the General Hospital. But with the merger, it was decided that some services would be provided at the Civic Hospital, and others, at the General Hospital. Now they want to make the entire hospital system bilingual. At the General Hospital, 75 per cent of staff members were bilingual. But if that staff is split equally between the Civic Hospital and the General Hospital, that means that 35 per cent of the staff will be bilingual in one location, and 35 per cent in the other. Francophones will lose their critical mass. That critical mass will diminish and francophones will become a minority. That is what would happen if the entire system were to become bilingual. The savings achieved through the merger are so significant that no one will ever dare dismantle it.


Senator Keon: What about the community clinics? Do you believe in having a network of francophone community clinics?


Mr. Labelle: Where numbers warrant, yes, certainly. Unless it's possible to have a clinic servicing 95 per cent of the francophone population, we will end up with a clinic that serves half of the francophone population and half of the anglophone population. It can be difficult for a clinic to operate in English with certain patients. People can communicate in English or French, but the health records of francophone patients are in French, and vice versa. Within a single clinic, that would complicate matters for me as an administrator, and probably as a physician as well. Where there is a high percentage of anglophones in a specific program, the patient records end up being written in English.

I should point out, however, that at the General Hospital, that had the largest francophone patient population outside of Quebec, everything was done in English, although the patients could speak to their nurse, social worker or psychologist in French. If they wanted a report, we would offer to have the report translated for them. However, all the records were in English because of transfers and exchanges between multiple hospitals.


Senator Keon: If a francophone community clinic were built here, where you used to walk when you were young, how heavily would it be utilized?


Mr. Labelle: If I live in Kanata and require services, I am not prepared to drive all the way into downtown Ottawa to obtain them. Perhaps my father or mother would be, but my brother or myself will not want to; we will want to access services as quickly as possible, just as an anglophone would want to obtain the services he needs across the street. People are not about to spend a half hour on the road in order to obtain services in French, because they are so comfortable in English that that simply is not necessary. If you need to consult a physician, you will consult one across the street from where you live — at least for people of my generation. That certainly is my belief.

The Acting Chairman: I note that the Senator has to leave, and I want to thank him for his comments. We will give everyone a chance to speak, as we usually do. Senator Gauthier, please.

Senator Gauthier: Mr. Gauthier said that networking is important; Mr. Labelle does not believe in networking, though. Did I understand you both correctly?

Mr. Labelle: I don't believe it will change much. As I see it, that is not the answer; the answer involves having more francophone, bilingual professionals in the communities. Whether there is networking or not, if we don't have a greater number of physicians tomorrow to provide those services, it will have been pointless. Look at the shortage of physicians across Quebec and elsewhere. If we don't recruit 200 or 300 additional French-speaking physicians every year, even if we have the best network one can image, that won't change much.

Senator Gauthier: I am not talking about the physicians, but the patients. I'm talking about people who want to be served in their own language. I saw a case recently. You are certainly familiar with the example of the mother who, speaking in French, told a doctor at an Ottawa hospital that her son had an upset stomach (``mal au coeur'' in French, or literally, ``heart pain''). She was sent off to a section to see heart disease specialists. If I come to a hospital and say in French: ``Mon muscle adducteur me fait mal,'' they won't understand me. But if I say: ``My hamstrings are sore,'' they probably will understand.

I was ill for more than two years. I had an interesting experience at the General Hospital. I had been told that it was a bilingual hospital. That is not true; everyone worked in English there, Mr. Labelle — both the physicians and the nurses. Once in a while, one would come along and explain to me what was going on. When I lost my hearing after taking a certain medication — Amicasin, and I advise you never to take it, Mr. Labelle — I asked: ``What's going on?'' So, they sent a nurse to explain things to me. But I am not a blithering idiot.

We managed to hang on to the Montfort Hospital, after building and presenting a strong case. And we managed to get French schools — not because numbers warranted, but because the right of parents to have their children receive an education in their own language is a fundamental right. And a parent's right to have his children receive health care in their mother tongue is just as fundamental.

I believe in networking. And I'll tell you why, Mr. Labelle. In this day and age, with telemedicine and satellite communications, it is possible to set up centres with expertise in a certain number of fields — for example, infectious diseases, or lung disease. That is not particularly difficult to do. Mr. Gauthier said that with a 1-800 line, we could create information networks. I think that is certainly something we could do now.

I took a lot of notes, and I am going to read over everything you said. Why isn't Ontario part of the network, Mr. LaBossière. Do you know? It includes Manitoba, New Brunswick and one other province, Alberta.

Mr. LaBossière: When you say the network, are you referring to participation in the advisory committee?

Senator Gauthier: I'm talking about Hubert's committee.

Mr. LaBossière: No, I don't know why. Some provinces were invited to take part, but only two or three decided to do so. However, we did find ways of keeping all the provinces and territories informed of the committee's work. Indeed, a presentation was made and several meetings were organized by the advisory committee with various directors of Francophone Affairs. The committee also made a presentation to the Ministerial Conference on Francophone Affairs. So, we did keep the provinces and territories informed of what we were doing, even though they were not all taking part in the Committee's work.

Senator Gauthier: I find it rather strange that the province with the largest number of francophones — Ontario — would not have been present for discussions about an issue as serious as health care.

Mr. Gauthier, you asked that the federal government take concrete actions — that it make a commitment, get involved and provide support. What kind of action is most critical, in your view? Certainly, the federal government has spending power. With respect to communications and research, you made reference to a pilot project. Who will be funding that project?

Mr. Gauthier: I referred to the steps that need to be taken and three areas that should be emphasized. Our report refers to very important supporting documents that set out the issues to be resolved by order of magnitude. I believe you have a copy of those documents, Mr. Chairman, because we have been gradually sending them to you.

As far as the network is concerned, we're talking about $5 million annually. For training, we are talking about between $18 and $20 million annually.

The Acting Chairman: I would ask you to be more precise, because the funding issue is very important to us. I would also like to refer to what Minister Dion has said, because this is the official document being used as a basis for discussion.

Mr. Gauthier: Our report?

The Acting Chairman: The report where it talks about $5 million for the network and $15 million for training.

I also note the speech made by Minister Dion in Whitehorse, where he said that initial discussions and expectations had been seen as rather unrealistic, which meant that the amounts being requested were too high. But instead of getting discouraged, you continued your work, and the recommendations of the Advisory Committee are now being made on the basis of a much more realistic financial framework.

Based on what I understood the minister to say, funding requests have been modified. Is that correct?

Mr. Gauthier: In terms of the proposal you now have, no, that is not correct. There was the perception within Mr. Dion's Department that our funding requests were extravagant. After several meetings, they came to understand the content of our report.

I attended meetings where they were trying to tell us that the government has limited means, and that we should be more reasonable. Our response was to make specific proposals.

At Health Canada, discussions took place with Mr. Dion's Department, and the amounts we're talking about are still the ones mentioned in our proposal. Mr. Dion's impression was that we were talking about something much more massive. I met with Mr. Dion to discuss every element of that proposal.

The trickiest issue is how to develop orientation/service centres or facilities. That issue, more than any other, certainly falls within the jurisdiction of the federal government and the provinces.

It seems the proposal concerning the network is now well understood. The $1.9 million is intended to help us get that work underway.

The Acting Chairman: That is my second question. However, I would like to stay with the figures set out in the report, because what you are saying is something completely different. You talk about the primary health care transition fund.

Mr. Gauthier: On the basic question, the proposal we are making is the one you have in the folder that has been provided. The weakest component is the one dealing with front-line services, infrastructure and service/orientation structures. That one worries me.

After giving this matter a great deal of thought, I have come to the conclusion that this part of it is somewhat soft. What worries me is that it is possible to develop plans and train staff, without necessarily having places where services can be adequately delivered. I am making everyone aware of that concern, because I believe that this particular component has to be firmed up more. As planned, we placed three priorities on the table for which funding would be required. The size of the budgets as set out in the document you've been provided has not changed.

The Acting Chairman: Just to clarify, the $5 million a year to operate community networks is still applicable, then?

Mr. Gauthier: Yes.

The Acting Chairman: And the amount of $15 million per year for training and recruitment of francophone personnel is also still applicable?

Mr. Gauthier: Yes, at the very least, because the proposal presented by the consortium is for more than $15 million a year over five years. It could be as much as $20 million.

The Acting Chairman: Let's stick with what this document says.

Mr. Gauthier: Yes, that would be the very minimum.

The Acting Chairman: And when you talk about establishing service/orientation facilities, is that for front-line care?

Mr. Gauthier: Yes.

The Acting Chairman: And you're saying that the figure of $25 million is possibly a little soft?

Mr. Gauthier: That amount is currently under review. We have examples of how this could be carried out, but what is not so certain is how we can ensure that number is included in the proposals that are accepted and funded.

The Acting Chairman: We will have to study the report and make recommendations. In order to do that, we need to have direct testimony from witnesses. We cannot do that over the telephone. We have to rely on what you are telling us today; we have no choice. That is why I am asking you all these questions.

So, should the $25 million per year for patient service/orientation facilities remain in the final report we will be drafting? Is this a request from your committee?

Mr. Gauthier: Yes, absolutely.

The Acting Chairman: So, there has been no change there?

Mr. Gauthier: No.

The Acting Chairman: The last amount in this report is for the purposes of gradually putting in place a health care infrastructure for a one-time and non-recurring amount of $20 million. Is that item staying?

Mr. Gauthier: No. The last amount of $25 million includes technology. Mr. Dion realized that we were being more reasonable by saying that the $20 million could be included. Technology costs over five years would amount to several million dollars per year and can in fact be included in the $25 million amount we have just discussed.

The Acting Chairman: Did you say there is documentation providing rationale for these amounts?

Mr. Gauthier: Yes.

The Acting Chairman: Would it be possible to get them?

Mr. Gauthier: Yes, absolutely.

The Acting Chairman: I'm sure you understand that if we use the figure of $25 million, we have to provide a rationale.

Mr. Gauthier: It's a little like the Treasury, which is asking us for the same thing.

The Acting Chairman: I want to move on now to the primary health care transition fund. As I understand it, Health Canada has earmarked $8 million, which is still in the bank and remains unused after almost a year, and perhaps even two years. When Mr. Nouvet appeared, I asked him what he was going to do with that money. He answered that it would soon be spent and that this was simply a matter of days. He appeared several months ago. He also said that if there were urgent requirements, an amount of $8 million — which is still a sizeable sum of money — had been earmarked for you, and was intended to be used for the provision of health care services in French outside Quebec. Minister Dion took $1.9 million of that money, which means that there is still $6 million left. Have you received any information that would lead you to believe that this money is going to be allocated to you and by what mechanism that will occur?

Mr. Gauthier: As regards the $1.9 million, the discussions are well underway. As a hospital administrator, I am always a little impatient and find that obtaining the necessary authorizations takes a great deal of time. They have all our documentation. What we want from them are answers. I even brought this matter to the attention of the incumbent deputy minister this morning, saying to him that Mr. Dion had made the announcement in June, and that we were waiting to see some progress. I got the impression that Mr. Green would like to see things move forward rather quickly.

Secondly, we were told that work was underway to develop criteria that should be released shortly and that we will have to meet those criteria. We decided to make a proposal to Health Canada without hearing about the criteria, because we may have to wait. Two years have already gone by. On our side, there is certainly some impatience, as you will have noticed, but we intend to do our homework. For the $1.9 million, for example, we put our proposals on the table. We thing it is now time to go through the same process for the $6 million, in order to get things moving. The question Health Canada is asking is who will take responsibility for what comes next. This is a transition fund. We are saying that follow-up will occur through the Dion plan or whatever action is taken in response to the Kirby and Romanow reports, et cetera. As far as they are concerned, this is not a solid enough answer.

The Acting Chairman: Yes, but the money is there all the same.

Mr. Gauthier: There doesn't seem to be any problem in that respect. The money is there and the situation is as I have described it.

The Acting Chairman: Thank you very much, but I must insist that you send us your rationale for the amounts being requested. It is absolutely critical in our view that we be able to justify these allocations if we request the funding.

Senator Gauthier: This morning I referred to the sixth principle. Perhaps we should set out or make reference to such a principle in the Health Act. I would like to have the views of each of our witnesses on that. Do you think a sixth principle would be helpful?

The Acting Chairman: The idea would be to incorporate a sixth principle into the Health Act that would include universality. That is one of the conditions. The sixth principle would have to do with linguistic duality and the requirement to provide services in one or the other of Canada's two official languages.

Mr. Labelle: In both official languages, or in one or the other of the official languages?

The Acting Chairman: One or the other, depending on the patient. We need to ensure that a patient is entitled to receive care in one or the other of the two official languages, on request, whether he is an anglophone living in Quebec or a francophone living outside Quebec. That would become a sixth principle. That is what Senator Gauthier is asking you about. What is your view on that?

Mr. Labelle: It is certainly a principle one cannot disagree with. However, what actions will be taken to ensure that the law is enforced across the country? I live in Kingston where we are about 5,000 francophones. What are you going to do to ensure that tomorrow, I will be able to receive services? Also, do you mean all services will be provided in French, or only primary health care? If I require very sophisticated surgery, are you going to guarantee me that the surgeon who performs cardiac surgery will be able to communicate with me in French? But there is no doubt this is good legislation.

Mr. Gauthier: The legislative base is always important. In that sense, I am in favour of what you suggest. However, my mother would say: ``Will that help me access more home care services in French?'' I would be hesitant about focussing all my energy on that. I think there are people such as Mauril Bélanger, Senator Gauthier and others, who will do that. I will certainly support their actions, but I will also work very hard in the short term to see that improvements are made. I believe that even without the principle, we can make progress in certain areas.

The Acting Chairman: This morning, Dr. Schofield told us that principles are fine, but action is even better!

Mr. LaBossière: I stated in the brief I presented, in the second last paragraph, that there are a certain number of things that we have observed. In the education sector, national incentives have been extremely helpful. So, draw your own conclusions. In the health care sector, maybe we need something. I am not saying we necessarily need to incorporate a sixth principle in the document, either as part of a specific program or a federal funding envelope. In my view, we need national measures because it could take a great deal of time, in certain regions of Canada, to make progress on health care services in French.

The Acting Chairman: Do you have the answer to your question, Senator Gauthier?

Senator Gauthier: I would like to make an analogy. When I go to have my car fixed, I don't ask the mechanic who trained him, do I? I ask him to do the job properly. Whether he learned his trade in German, French or English is completely irrelevant, as long as he knows how to fix the car. I am not interested in knowing whether the surgeon speaks my language; what concerns me is whether he knows how to perform surgery properly. I want the person whom I first have contact with in a facility to be able to respond to my needs in my language. When I go to the Ottawa General Hospital and the nurse says to me: ``I'm sorry, I don't speak French,'' I have to admit that kind of puts me on the defensive. Yet I grew up here. Maybe that's the way it is in Kingston, Mr. Labelle, but this city has not been designated bilingual by the Province of Ontario. Even so, the federal government has a lot of facilities in Kingston, including the Military College. That was one of the conditions for designating Kingston a bilingual city. But they didn't — even though there are students from Quebec and all across Canada who go to study there.

Senator Losier-Cool: The witnesses we heard from yesterday from the FCFA are recommending, in addition to the sixth principle, that the federal government implement a program similar to the Official Languages in Education Program, or OLEP. Could you comment on that recommendation?

Mr. Gauthier: We talked about quantums and the money that would be required to manage such a program, which has to be a Health Canada program. Because there is shared jurisdiction, we would probably agree that a federal- provincial social/health program be integrated, so as not to end up with piecemeal initiatives, and constantly have to be chasing after funding. We have already said that this program should be with Health Canada. It has groups in place and appropriate structures for consulting the provinces and that could be the right vehicle. The communities have an important role to play in acting as a link between the provinces and the federal government. As silly as it may seem, we don't want to be caught between the federal government and the provinces in major federal-provincial debates on these issues. At the same time, when it comes to service delivery, we can act as a catalyst between the provincial government and the federal government to resolve certain issues. We have already seen, as demonstrated by our own matrices, that such alliances exist. So, I would say yes to developing a single program that could have both purely national dimensions and federal-provincial dimensions.

The Acting Chairman: Do you have any other questions?

Senator Losier-Cool: Once the witnesses have finished, I would like to put a question to committee members.

Senator Léger: This is the first time we have heard from a devil's advocate. It has been a difficult process, but we really have met a lot of people who are working hard in this area. In the end, we find ourselves wondering whether the province of Ontario is the only one to be isolated like this.

We heard from two or three other Ontario witnesses and their testimony was less negative. As far as I'm concerned, it was negative; we would not be here today if we had always just sat back and accepted assimilation and all the rest of it.

Mr. Labelle, you said that socio-economic status is a problem in Ontario. Is the entire picture negative for Franco- Ontarians? I am familiar with the New Brunswick case, and I would say that we responded by getting involved and being inventive. I imagine it's the same in Ontario, is it not?

Mr. Labelle: The report itself points out that there is a disparity of socio-economic status between francophones and anglophones in Canada. The research shows that this is one of the main causes for fewer health services being made available to young people. If francophones are less better off, less well educated and have less power, they probably will not be as healthy as others. That is my view. Francophones have to get an education and turn things around so that they play a more significant role. That is what we must focus on.

Senator Léger: My feeling is that that has already begun. You're not so sure?

Mr. Labelle: Well, yes. If you have $5 million to spend, do what it takes to obtain an additional 200 French-speaking physicians here in Canada. Concentrate on that and then you will get exactly where you want to go.

Senator Léger: According to Dr. Schofield, that has already begun, and whatever is already in place must be in Ontario as well, I imagine.

Senator Pépin: Mr. Labossière pointed out that services have to be provided in the areas where francophones reside, and Mr. Gauthier said we need to develop our delivery mechanisms, and certainly, primary care is extremely important. We know that if current trends continue, people will go to hospitals only when they need surgery or are gravely ill; otherwise, they will stay home when they're ill. I think we need to develop home care with the available technology and develop our human resources as well, whether we're talking about physicians or nurses, so that in future, we have a lot more of them working in the regions and providing home care.

Mr. Labelle, you said that Franco-Ontarians are not all that involved and that in your case, you would just as soon be treated by a physician who speaks English. But when we're talking about health care services, it is important they be available in French. What if all francophones decided to receive treatment in English? Young people would study in English as well. It would be easier; there would be more services and they would naturally decide to focus on what is available in English and abandon services and programs for francophones.

Do you not think the fact that francophones are using services and programs in English is part of the problem?

Mr. Labelle: It isn't accurate to say that people go to the hospital to die. Hospital clinics, even university hospitals, are all filled to capacity. People go there for tests or because they have long-term illnesses. Often people go there throughout their lives. It is more important for these people to have regular contact with a medical specialist, because their illness forces them to maintain this relationship for 10, 15 or even 20 years before they die. So it just isn't true to say that hospitals don't have a role to play.

Senator Pépin: I am saying that medicine will increasingly be practised outside of hospitals.

Mr. Labelle: A francophone who does not live in an area where there are services available within a five-mile radius but sees he can get what he needs across the street, and happens to be perfectly bilingual, will basically have two choices: either he can spend 20 minutes driving to the facility where he can receive care in French, or he can walk across the street to a clinic where he can receive care in English. What is he going to do? He'll go across the street! That's what I am saying: once people are comfortable with English, health care becomes just another service, like buying a car or going to the hairdresser.

Senator Pépin: If people asked for your assistance to set up a clinic with French-speaking physicians, would you agree to get involved?

Mr. Labelle: Yes, no problem. If we could have ten extra physicians, we would be very happy.

The Acting Chairman: Mr. Labelle, you mentioned earlier that you and your wife were looking for a family doctor but were unable to find either a French-speaking or English-speaking one, and that you would take anyone you could find, whatever language he or she spoke. You pointed out that 40 per cent of those who were looking for a family physician over the last year were unable to find one. So, there is a shortage of physicians.

Mr. Labelle: As far as I'm concerned, any effort that diminishes the possibility of obtaining more bilingual or French-speaking physicians is misguided. Getting more bilingual or francophone physicians is really the only goal worth working towards.

The Acting Chairman: The report ranks this as the No. 2 priority and in terms of funding, training health care personnel is the top priority. That is what the report recommends.

Mr. Labelle: I'm saying we should not be spreading ourselves too thin, and that it is preferable to focus on increasing the number of bilingual or French-speaking physicians.

Mr. Gauthier: My comment is about the connection between training and networking. We know that we need networking partners so that training can be provided. Training institutions are starting to see those partners come forward, asking for assistance in convincing people to study in their universities.

Universities are realizing they can no longer provide training in isolation, and that today's watchword is partnership, because you have a better chance of being successful if you accept the fact that it is a necessity.

Mr. LaBossière: As regards services in French, as Hubert mentioned earlier, the term ``active offer'' means that appropriate efforts will be made to find a way to reach francophones. I pointed out in my brief that we have to try to offer services in areas where francophones reside. If we look at the French school system, for example, that already gives us a very good indication of where the health services should be made available. We could offer them through the school system or using public or mental health nurses. That would be an effective way of reaching much of our francophone clientele.

We should also start to sit down with the community and set priorities, so that we know where it is important that this be done and find appropriate methods of achieving those goals. I don't have the perfect answer, but having worked in Manitoba, I discovered that as a general rule, it was more logical to provide government services in multidisciplinary centres.

In Manitoba, six government services are about to be provided at the St. Boniface Hospital, in Notre-Dame-de- Lourdes and in three other locations. Services of professionals in various departments are now available in some centres, including about 30 types of professional services at the government services centre in St. Boniface. In my opinion, this centre is a good example of what can be done when professionals are brought together under one roof.

Senator Pépin: Yesterday we heard a very positive presentation to the effect that educational models need to be developed in order to recruit professionals. For my own personal edification, I would like to put one last question to Mr. Labelle.

Among francophones, there are Catholics and non-Catholics, and the two seem to be at daggers drawn. Perhaps you could explain why francophones are tearing each other apart over access to services in French, apparently because some are Catholic and some aren't.

Mr. Labelle: Let's take the example of a community where there are two high schools: one English-speaking and one French-speaking. Taken individually, these two schools might be considered mediocre, but if you put them together, they would certainly benefit from better facilities, and better training programs.

Senator Pépin: Why can't the Catholics and non-Catholics work together?

Mr. Labelle: In Ontario, Catholics have always had their own school system, and the same applies to non-Catholics. What happened is this: because the Catholic system did not provide education in French at the secondary level, the public school system began setting up free secondary schools. A lot of francophones now attend those public schools, as do their children.

Senator Pépin: So, why don't they merge them?

Mr. Labelle: Because the Catholics do not want to attend public sector schools.

The Acting Chairman: This was a most interesting afternoon and I want to thank each of you individually. Mr. Labelle's comments seem to suggest there is a certain malaise.

On the other hand, I should point out that we received very enthusiastic testimony from witnesses representing the Maritime provinces, New Brunswick and Manitoba. In the case of Ontario, there is an undeniable malaise and that is what Mr. Labelle made clear in his comments.

Mr. LaBossière told us that Ontario is not part of the consortium. It's important to remember that half of the francophones outside Quebec live in Ontario. This is clearly a serious problem and we don't sense the same enthusiasm and dynamism that is evident in other communities. This may be a problem that Franco-Ontarians will have to look at more closely, and it may be a special situation that has to do with the provincial government currently in power.

I would like to thank Mr. LaBossière for his excellent comments and the parallel he drew between the education system and the health care system. I think he is absolutely right to say that if the education system is working well, there is no reason why the health care system, within the same communities, should not work just as well.

Finally, Mr. Gauthier presented a very special viewpoint on this issue. He is Chief Executive Officer of a university health care facility and we know that he is a very busy man. We know the kinds of problems he may be facing, particularly in a climate of budget restrictions.

In addition to being a member of the Canada Health Research Institutes Council, Mr. Gauthier has demonstrated remarkable determination and devotion through his involvement in the issue of French services outside Quebec.

He makes weekly pilgrimages to Ottawa, and so I want to commend him for all he has done and tell him that committee members are well aware of the time and singular effort he has devoted to this cause.

Mr. Gauthier: Thank you.

The committee continued in camera.

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