HESA Committee Report

Bloc Québécois Supplementary Opinion
10‑Year Plan to Strengthen Health Care

the facts: Quebec and the agreement of September 15, 2004

Appended to the September 2004 agreement—the 10‑Year Plan to Strengthen Health Care—is a separate communiqué for Quebec, known as the “Quebec clause.”

This clause confirms Quebec’s full authority to intervene and make decisions with respect to health, over which it has sole jurisdiction. Furthermore, the agreement, which recognizes an asymmetrical arrangement between the federal government and Quebec, states that “funding made available by the Government of Canada will be used by the Government of Quebec to implement its own plan for renewing Quebec’s health system.”

The only constraint placed on Quebec by this specific agreement is that Quebec support “the overall objectives and general principles set out by the federal, provincial and territorial first ministers” in the agreement, including the objectives of “timely access to quality care and reduced wait times.” As it happens, reduced wait times were already a priority for the Government of Quebec well before September 2004. However, it bears re-emphasizing that Quebec’s health system differs from that of the other provinces and that the Government of Quebec must be able to make its own decisions, not have them imposed on it by the rest of Canada.

In this respect, the agreement explicitly states that “Quebec will apply its own wait time reduction plan, in accordance with the objectives, standards and criteria established by the relevant Quebec authorities.”

Lastly, the communiqué concludes by stating that “nothing in this communiqué shall be construed as derogating from Quebec's jurisdiction.” Consequently, Quebec is the sole decision-maker on health-related matters.

the Bloc Québécois’ position on the 10‑year plan to strengthen health care

From the moment the agreement was announced, the Bloc Québécois has denounced the restrictions underlying the specific agreement with Quebec. Because the agreement established benchmarks based on scientific evidence, Quebec will certainly be compared with the other provinces that publish similar data. Therefore, despite having no specific obligation with respect to how it manages its health system, it will have a political obligation to show results. It must remain on par with the other provinces in terms of wait times, investment and development or face criticism by its own population, regardless of the distinctive nature of care in Quebec or the variety of social services available.

Moreover, in reaching the agreement, the Bloc Québécois felt that Quebec should have been granted the “Quebec clause” automatically, since it is only right that Quebec receive unconditional federal funding, since health clearly falls under provincial jurisdiction.

Furthermore, it bears pointing out that the great difficulty Quebec and the other provinces have today in guaranteeing health care within respectable and reasonable wait times is because of the cuts, particularly to the Canada Health and Social Transfer, ravaged by the Liberals in 1994 to achieve a zero deficit. Quebec and the other provinces had to make snap decisions to make up for these shortfalls, and their respective health systems were certainly hard hit by the then Liberal government’s withdrawal. Still today the amount of money invested cannot alone close these massive gaps created by the cuts to Quebec and provincial budgets.

The Bloc Québécois therefore maintains its opposition to the federal government’s interference in the areas of jurisdiction of Quebec and the other provinces on the pretext of various pan-Canadian strategies, including the 10‑Year Plan to Strengthen Health Care.

STATUTORY REVIEW OF THE 10‑YEAR PLAN TO STRENGTHEN HEALTH CARE—TRUE RESPECT FOR JURISDICTIONS

1. The report must state that Quebec and the other provinces are accountable to their populations only with respect to their progress in achieving wait time objectives.

While the report sets out in paragraph 3 the special status of the 2004 agreement with Quebec, in which the federal government recognized an asymmetrical federalism and therefore established separate arrangements with Quebec, the Bloc Québécois deplores that the report does not fully cover this separate agreement with Quebec. In our view, these parameters must be brought to attention wherever necessary in the current report.

Therefore, Recommendation 1,

“that the federal government comply with the requirement of reporting on its progress on all components of the 10-Year Plan; that it fulfill this requirement by the end of the 2008-09 fiscal year; and that it encourage all jurisdictions to provide the required public reports within the specific 10-Year Plan deadlines,”

must take into account the fact that Quebec and the other provinces are accountable to their population only with respect to the progress made in attaining their objectives and have no such obligation to the federal government.

Again in the interest of respecting the specific agreement of September 2004 between Quebec and the federal government alongside the 10‑Year Plan to Strengthen Health Care, the Bloc Québécois believes that Recommendation 3 must be expanded on to address this specific status.

Therefore, Recommendation 3,

“that the federal government specifically report on funding provisions relevant to the populations for which it has direct responsibility,”

must be amended to reflect what is put forward in paragraph 59, namely that Quebec and the other provinces are voluntarily accountable to their citizens, not to the federal government. Furthermore, no such obligation may be imposed on Quebec or the other provinces, given that health falls under provincial jurisdiction and that they are not accountable with respect to spending in their own areas of jurisdiction. Accordingly, federal health transfers cannot be subject to conditions or objectives.

2. Pan-Canadian collaboration on health care must respect the areas of jurisdiction of Quebec and the other provinces.

We also have reservations about the wording of Recommendation 2 in the report:

“That the federal government, in collaboration with the provinces and territories and in partnership with the Health Council of Canada and the Canadian Institute for Health Information, agree on a set of comparable data and indicators to ensure proper assessment of progress under the 10-Year Plan; that the federal government ensure that this set of indicators is relevant to its client groups; that this work be completed by the end of 2008-09 fiscal year.”

This recommendation refers to the establishment of indicators by the provinces, territories and the federal government to ensure proper assessment of progress under the 10-Year Plan. Yet it does not refer to the agreement with Quebec, which addressed this exact subject from the perspective of asymmetrical federalism. To be acceptable to the Bloc Quebecois:

• consideration must be given to the “Quebec clause,” whereby Quebec has its own plan to reduce wait times based on its own standards, criteria and objectives;
• the Quebec authorities shall agree to work closely with the provincial and territorial governments and the federal government, by sharing information and best practices;
• the Quebec authorities shall promote the use of comparable indicators, mutually agreed upon with the other governments;
• Quebec shall continue to work with the other governments on the development of new comparable indicators.

Finally, recommendation 4 refers to the need “to revive the idea of a common pan-Canadian vision to strengthen health care and to put mechanisms in place to make this vision a reality,” while also suggesting that “the federal, provincial and territorial governments publicly recommit to the nationwide collaboration envisioned in the 10-Year Plan.” Although pan-Canadian collaboration may be helpful, the fact remains that health falls under the jurisdiction of Quebec and the provinces. As such, they have the power to decide whether or not they wish to work together, and collaboration must not be used as a pretext for federal interference in their areas of jurisdiction.

In our opinion, the 2004 agreement with Quebec should accordingly be reflected in the Committee’s recommendations. The “Quebec clause” should be reaffirmed, whereby in matters of health Quebec exercises its responsibility for planning, organizing and managing health services within its jurisdiction. Similarly, Quebec shall implement its own plan to reduce wait times, based on the objectives, standards and criteria established by the appropriate Quebec authorities.

3. The federal government must look after its own client groups

The Bloc Québécois wishes to take this opportunity to point out that the federal government too often seeks to interfere in the areas of jurisdiction of Quebec and the provinces, as regards health in this case, citing national strategies as a justification. How can the federal government justify these too frequent incursions relating to health when the First Nations, one of its client groups, receive mediocre services?

Consider the overwhelming statistics regarding the health of Aboriginal peoples:

• The infant mortality rate is 2 to 3 times higher among the First Nations than in the general population;
• The life expectancy of status Indians is 5 to 7 years less than in the general population;
• The suicide rate is from 2 to 7 times higher than in the general population;
• At least 33% of First Nations and Inuit live in housing that does not meet the standards for quality, size and affordability, according to Canada Mortgage and Housing Corporation figures. Yet there is a known link between inadequate housing and a whole range of health problems;
• In the 1990s, the rate of tuberculosis among the First Nations was seven times higher than in the general population;
• Smoking is much more prevalent among the First Nations (over 50%: 56% among Aboriginals and 71% among Inuit in 2004) than the general population. Despite these figures, the Conservative government cut ten million dollars from the anti-smoking program designed to raise awareness among pregnant women and young Inuit and Amerindians of the harmful effects of smoking;
• Aboriginal peoples continue to be overrepresented in the HIV epidemic in Canada. They represent 3.3% of the population of Canada, but account for an estimated 7.5% of all existing cases of HIV;  
• 9% of new HIV cases reported in 2005 were among Aboriginals, 53% of them related to intravenous drug use, as compared to 14% among the general population.

Based on these figures, which amply demonstrate how much has to be done to improve the health of Aboriginal peoples, the Bloc Québécois is of the opinion that instead of asking the provinces to report on progress on wait times and how federal health transfers are used, the federal government should address the alarming health problems among the First Nations and report to them on the progress they have made.

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