ACCESS TO HEALTH AND SOCIAL SERVICES IN ENGLISH
Access to health and social services for English-speaking persons is a right conferred by Quebec’s Act respecting health services and social services (Article 15):
“English-speaking persons are entitled to receive health services and social services in the English language, in keeping with the organizational structure and human, material and financial resources of the institutions providing such services and to the extent provided by an access program referred to in section 348.”
While each public institution must develop a program of access to English-language health services and social services for the English-speaking population it serves, most access programs do not guarantee access to the full range of health and social services in English.
Almost all private providers providing publicly funded health and social services, such as private medical offices, pharmaceutical services, and certain types of institutional services such as foster homes and intermediary resources, etc., do not have contracts with public institutions that guarantee their services will be available in English.
The government must also create the following statutory committees:
A Provincial Committee on the provision of health and social services in the English language as defined in regulation.
Regional Access Committees (one per administrative region). The mandate of these committees is to advise the public institution in the development of their access program, evaluate the access programs and suggest modifications to them where expedient.
The 2018 government Guide for the development of access programs for health and social services in the English language, defines an “English-speaker” as “a person who, in his relations with an institution that provides health or social services, feels more comfortable expressing his needs and receiving services in English” (page 11). With the passage of Bill 96 on May 24, 2022, it is unclear as to whether this definition will continue to be used by the government. The 29 Access Programs submitted to the Minister of Health and Social Services in 2019 and 2020 and which are awaiting government decree were developed using the 2018 definition.
PROVINCIAL ADVISORY COMMITTEE
The Committee’s Role
Section 509 of the Act respecting health services and social services provides for the formation of a Provincial Committee for the Provision of Health Services and Social Services in the English Language, often referred to as the Provincial Advisory Committee. The Committee is created by regulation and its mandate is to advise the Government of Quebec on:
- the provision of health services and social services in the English language;
- the approval, evaluation, and modification by the Government of each access program developed by an institution in accordance with section 348 of the Act.
The Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies, adds two responsibilities to the Committee’s mandate:
- The approval of requests made by integrated health and social services centres for withdrawal of recognition, as provided for in the third paragraph of section 29.1 of the Charter of the French Language;
- The identification of organizations that promote the interests of English speakers in each region. These organizations will be consulted regarding the appointment of members of regional committees for access programs for health and social services in the English language.
The duties, functions and powers of the Provincial Committee, as defined in its regulation, include to submit observations or give its opinion on any administrative document produced by the Minister to guide institutions in the preparation of programs of access to health services and social services in the English language to English speakers, and on any other matter affecting the provision of services
The Committee’s Composition and Mandate
Updated regulations governing the Provincial Committee for the Provision of Health Services and Social Services in the English Language came into effect on January 1, 2022. The Committee continues to be made up of 11 voting members from the English-speaking population, with the specific composition being changed to:
- two members residing within the Montreal health region;
- one member residing within the Laval health region
- one member residing within the Montérégie health region;
- one member residing within the Estrie health region;
- one member residing within the Outaouais health region;
- five members residing within the other health regions of Quebec.
At least one member must be a doctor who has practiced in a centre used by a public health or social services institution or be a professional or middle manager who has been employed by such an institution; and one of the eleven members must be from an Indigenous community in Quebec.
A 12th member, without a right to vote, is the Secretary to the Committee and is named by the Minister.
The Committee has an observer appointed by the Minister in each of the following categories:
- the people assigned to Indigenous affairs activities by Ministère du Conseil exécutif;
- the people assigned to this department’s activities concerning relations with English-speaking Quebecers, as required.
Each observer participates in the Committee sessions but does not have the right to vote.
Members of the Provincial Committee serve in a personal capacity. They do not represent an organization or a social or political group. This is intended to prevent any conflicts of interest.
Members are appointed for three years, and their mandate can be renewed only once.
The new regulations also contained other modifications not related to membership.
The Provincial Committee 2018 – 2021
The Provincial Committee that operated between August 2018 and December 2021 had an overarching objective of ensuring that the healthcare system’s contribution to health outcomes for the English-speaking population is comparable to that for the Francophone population of Quebec. For this objective to be implemented, the achievement of successful clinical interventions requires “effective communication”.
During its tenure, the Committee produced four activity reports summarizing its work and provided a professional opinion for each of the 29 access programs submitted by the public institutions to the Ministry in 2019 and 2020. These programs represented the first access programs submitted to the government in a decade, and the first programs for several institutions created by the mergers of the 2015 health and social service reforms.
The Committee also prepared a global opinion entitled Ensuring successful clinical interventions for the English-speaking population of Quebec. It contained 10 recommendations intended to address systemic issues and challenges found across the access programs that hinder the Ministry of Health and Social Services’ and the public institutions’ ability to fully meet the objectives of the health and social services Act. Three critical areas requiring attention were identified: 1) the lack of client data; 2) the necessity for better coordination across the network; and 3) the development of service program guidance for each of the target clientele who cannot effectively communicate in French, and for whom English services are not able to be provided. All the opinions were submitted to the Minister on July 20, 2021.
The fifth duty of the Provincial Committee described in the regulation is to “favour the preparation and circulation of the documents and programs to inform on the provision of health services and social services in the English language”.
“Furthermore, for the purpose of performing its functions, the Committee maintains relations with the English-speaking communities of Quebec. The Committee also holds consultations as required, solicits opinions and receives and hears requests and suggestions by persons, organizations or associations.
While the Annual Activity reports for 2018-2019 and 2019-2020 are available publicly in French and English on the Ministry website, the reports for 2020-2021 and 2021-2022 have yet to be made public. The Provincial Committee’s opinions on individual access program are ordinarily provided to the public institutions and Provincial and Regional Committee members. The global opinion prepared in 2021 is the first of its kind and several members of the 2018-2021 Committee agreed it should be made public in keeping with the duty to inform the English-speaking population.
It is important that the English-speaking population and the public have easy access to the findings and recommendations of the Provincial Committee. To ensure this, the QCGN is posting these reports by the Provincial Advisory Committee received from a trusted source. These have been confirmed with past Provincial Committee members.
The mandates of all advisory committee members were terminated on Dec. 31, 2021. Past members who reapplied to sit on the new advisory committee were not selected.
ACCESS TO HEALTH AND SOCIAL SERVICES PROJECT
In 2021, QCGN’s Access to Health and Social Services project was designed to help English-speaking Quebecers and the community’s organizations and institutions better understand how the right to access health and social services in English in Quebec operates.
With funding from the provincial Ministry of Health and Social Services, we developed a series of information tools. These tools:
- provide an overview of Quebec’s public health and social services;
- explain how the right to access these services in English is structured; and
- spell out the opportunities to participate in – and contribute to – the governance of the network.
We produced a series of short, informative video capsules: dedicated and seasoned volunteers from across our community share their perspectives and provide advice developed through their extensive experience and involvement. Each capsule also touches on how to pursue the right or opportunity discussed. There are also three slide presentations that explain the Organization of Quebec’s Public Health and Social Service Network, the Right to Health and Social Services in English, as well as one that lays out Opportunities for Participation in Governance for English-speaking Quebecers.
It is essential that all English-speaking Quebecers better understand and thus are able to fully exercise their rights to access health and social services in their own language. We strongly encourage everyone to share these tools widely within your networks and communities.
The Right to Access Health and Social Services with Tania Callender
For members of the English-speaking community in Quebec, it is essential to be able to receive health and social services in our own language. The importance of this goes beyond simply language. “We … have found that culture plays a really important role as well,” Tania Callender explains. Service in English “is a right, and everyone who would like to have access to services in English has a right to do so,” adds Callender.
She is Executive Director of the African Canadian Development and Prevention Network. Drawing on her extensive experience with community members seeking services in English, she notes that this is of even greater importance during crisis situations. She describes how our right to access to service in English works: In Quebec, “institutions that offer services are required to develop a program that ensures access to services in English.” Simply put, we have the right to know what services are available in English and where we can get them.
The Right to Service in English with Rachel Hunting
Our rights to receive health and social services in our own language across Quebec “are linked to something called an access program,” Rachel Hunting explains. “Depending on where you are in the province,” she adds, “the service level may be different.” These differences are largely determined by the organizational structure of each institution, as well as its human, material, and financial resources.
Rachel Hunting is Executive Director of the Townshippers’ Association and also serves as an independent board member of the Centre Intégré de services de santé et services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke, which governs health services for the Eastern Townships region. For access programs to work properly, she emphasizes, “the really important part is to have community input.” This is how community members can aim the spotlight most effectively on “where the public health partner needs to focus,” in order to obtain the best results from an institution’s access program.
The Role of Regional Access Committees with Andrew Holman
Andrew Holman relates from personal experience how effective Regional Access Committees have proven in practice — both in designing access programs and then in making sure they are fine-tuned based on results and community feedback. “It’s incredibly rewarding to help shape the process” of how health and social services are delivered to members of the English-speaking community, adds Holman.
Andrew Holman is the president of the Regional Access Committee at the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec. He is also the president of the Centre for Access to Services. “This is always a work in process,” Holman says. He provides an example that demonstrates the willingness of regional health-system administrators “to hear our concerns” and improve the system: “We feel very much heard, and understood. And our concerns have actually been addressed in our current version of the access plan. So we’re very happy with that.”
The Provincial Advisory Committee with Sara Saber-Freedman
“The right of access to English services is not an absolute right,” explains Sara Saber-Freedman, who has served as both chair and vice-chair of the Provincial Committee for the Provision of Health Services and Social Services in the English Language, commonly referred to as the Provincial Advisory Committee. The access program system is structured with one overall goal in mind: “What we are really aiming for here is comparable outcomes for English speakers and French speakers” across Quebec’s health and social services system. In practice, Saber-Freedman adds, this means that if a particular service in not available locally in English, your local institution needs “at a minimum to be able to refer you, and explain to you how you can go about getting that service in English, either in another institution in your region or, if you’re prepared to travel, at an institution in another region.” Ambulance services everywhere in Quebec remain in dire in need of access programs, she notes: “Not one single ambulance service is in an access plan.”
Your Right to Complain with Elizabeth Pusztai
Regardless of whether you are more comfortable speaking English or French, “every citizen has the right to get the care that they need from the health and social services sector,” counsels Elizabeth Pusztai. Don’t hesitate about asking for information and assistance to help you, family members, or friends you are accompanying navigate through a very complex and often confusing system, she adds. You can ask at any time for help from the institution’s Complaints Commissioner regarding aspects of services you did or did not receive, including whether these services are or were accessible in English, notes Pusztai. She is a former Quality and Complaints Commissioner at Batshaw Youth and Family Centres and at the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal. Pusztai advises that this is a useful and readily available recourse – whether or not a particular institution is designated as bilingual: “The goal of this process is truly to find solutions.”
The Right to Serve: Community Representation in Network Governance with Judy Martin
“We need to have our voices heard” in order for the English-speaking community to continue to receive proper access to health and social services and ensure these services are provided in the language with which we are most comfortable, says Judy Martin. This is particularly important for our anglophone and allophone young people inside the youth-protection system who speak English at home, she adds. After several years as Board Chair at Batshaw Youth and Family Centres, Martin successfully applied through the Regional Access Committee to become an independent board member of the Centre intégré universitaire de services de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal: “Whenever you’re getting services … you want to make sure that you’re understanding everything that’s coming back at you from a professional. The right is there. And so we need to make sure that it stays. And that everybody understands that.”
The Role of Advisory Committees with Kimberly Buffitt
Isolation and relatively small concentrations of English-speakers in some of Quebec’s regions often present particular challenges when it comes to maintaining and on occasion improving delivery of health and social services in English. That’s even more the case when an integrated-services centre starts to tinker with overall policies and procedures. The Lower North Shore provides an example where the quiet work of an advisory committee has exerted a significant, very positive difference on the quality of services. “A small change can make a huge impact,” for instance with transportation policies, explains Kimberly Buffitt. Without citizen input and participation, she emphasizes, “little things get missed that are very important to us as a minority community.” Buffitt is president of the Advisory Committee for the Centre multiservices de santé et de services sociaux de la Basse-Côte-Nord of the Centre intégré de services de santé et de services sociaux de la Côte-Nord. The presence, role, and impact of the advisory committee is not always well understood by other organizations and individual citizens. However, because of its work the local English-speaking communities involved with a previously independent institution have been empowered to maintain their collective voice and policy-development influence. As Buffitt notes, “once policy is built, it’s very hard to change.”
The Role of the Users and Residents Committees with Mary Robertson
“It’s really important that everybody knows that there’s a group that is on their side that they can become involved with,” says Mary Robertson, president of the Jeffrey Hale – Saint Brigid’s Users’ Committee in Quebec City. She lays out the difference between users’ and residents’ committees, underscoring that both are representative groups. Each provides a properly structured path to speak up, raise concerns “if something is bothering them,” and work to resolve complaints. Robertson also reflects on one of the most important but poorly appreciated roles of such committees – to safeguard and protect “the individual identities and histories” of their individual institutions. Given “all this standardization” and the constant push for centralized management, the strengths provided by this heritage would otherwise be shunted aside. Rather, Robertson observes, “we want to keep the history.” With relentless standardization, she warns, “you also can lose the ownership that the community has” in each institution. After all, “it’s the community that provides the volunteers. Anglophone volunteers and francophone volunteers. It’s a real mélange. I think it’s really important to keep that identity.”
The Role of Foundations with Faye Dumont and Dr. Gerald Boos
Foundations serve an essential role in Quebec’s health and social services system. They enhance and supplement as well as protect services and the quality of life provided for residents in our public health-care institutions. “Our mission as a foundation is to make sure that the quality of care, which includes the service in English… remains exemplary, remains the way it was before” more centralized system management was introduced, explains Faye Dumont, treasurer of the Lachute Regional Residence Foundation. The Lachute seniors’ residence was founded to serve the English-speaking community across the region. “We have one mandate,” adds Dr. Gerald Boos, the foundation’s president: “Our responsibility is to the residents…. We raise money to pay for things that would not be paid for by the Ministry of Health.” As Dumont explains, “people, as they get older, their memory goes. But their mother tongue doesn’t go until the very end…. It’s a basic right for the English people to be served (in their mother tongue), especially at the end of their lives.”
Institutional Property Ownership with Dr. Abraham Fuks
“The right to function under Quebec law as a bilingual institution … is a very important provision” for the English-speaking community across many hospitals, clinics, rehabilitation centres, and other resources throughout Quebec’s health and social services sector, says Dr. Abraham Fuks. Many institutions were founded by – and remain profoundly rooted within – their communities. Their lands and their buildings were supplied using community funds, without financial support from the government of the day. “I always like to use the metaphor of a tree,” Dr. Fuks adds: “You want a tree with rich fruit, then you need a tree with deep roots…. that’s where you get your viability, that’s where you get identity, that’s where you get diversity.” A former Dean of the School of Medicine at McGill University, Dr. Fuks is now Chair of the Board of Governors of the Corporation of Centre Miriam. Such corporations and their boards represent the community’s interest, Dr. Fuks explains. Their responsibility is to ensure continuity, “maintain … integrity,” and thus safeguard “access to services that have to do with the cultural or linguistic characteristic of that institution.” They also have a veto right over any sale of an institution’s land and buildings, use of the proceeds, and any change to its linguistic mandate.