Finance Committee on Oct. 11th, 2023

[Joanne Thompson, Liberal, St. John's East, NL]

Thank you.

Again, welcome to both witnesses. I'm Joanne Thompson, the MP for St. John's East.

I have to start with the nursing union, because I began my career as a nurse and went back to it. It was part of my community work quite a number of years ago. I speak regularly with nurses in the province. I've been very active in trying to support certain community collaborative approaches, but nurses are the backbone of much of that work.

Thank you for the recommendations. Actually, I think they're incredibly helpful. The level of preparation is no surprise.

I want to give you the time to speak in more detail about all the priorities, probably, but also about the understanding that with the health transfer, which is quite spectacular, the federal government was able to work an arrangement with provinces and territories around accountability with regard to how the transfer of funds will be allocated. Within that context and the understanding that ultimately the delivery of services sits with the provinces and the territories, I'd be interested to hear your thoughts, please, on the real role that the federal government can play around that accountability and ensuring that there's particular focus in the funds on nursing and health care.

[Maria Richard]

Well, for sure I think the magic word is “hear” and the most important word is “accountability”. We cannot have an agreement that has no accountability on the province side.

We talked in our brief about steering the boat; the federal government has to steer that boat. To be perfectly honest with you, if we leave it to the provinces, it's going to be a hodgepodge of God only knows what. The thing is that in our recommendations, one of them is not more important than the other, but I think if we're....

I just arrived on Sunday from an international conference in the United States. The problems are the same across the world. There's a nursing shortage, and this nursing shortage is directly related to retention and recruitment. In the States and other places where it's private for-profit health care, they have a unique situation. They're telling us in the United States that they don't have a retention problem. They know they have a million nurses who are not working in the system because the private for-profit industries are keeping them out of the system.

In Canada we're seeing a retention and recruitment problem that is causing, for current nurses, what becomes a domino effect. Nurses are overworked. They're asked to stay. In New Brunswick and across Canada, we have nurses who are working 16- and 24-hour shifts. There needs to be a balance. The federal government can work on controlling this by putting in some incentives and restrictions on work hours. We see it in the civil aviation and transport industry, where the federal government has put in some restrictions. It works for them.

My husband is a trucker. After 13 hours of work, he has no choice; he has to stop. The truck is computerized, and at one point, the truck will stop, so if my husband is a trucker and he has to stop, how can we explain that nurses are working 16- and 24-hour shifts? They're supposed to be working safely. They're supposed to be giving optimum care to patients. We know that the more nurses work and the longer they work, the more it has an effect on their work injuries, on their own health and on the safety of patients' care.

We know that in Canada, medical errors cost an estimated $2.75 billion in additional costs every year due to errors. Are all errors caused by nurses being overworked and tired? No, but there is a correlation. We know that nurses' fatigue is related to work-related injuries. That costs $989 million annually. We're at a point in Canada where we need to implement safe hours of work. When we look at other jurisdictions across the world, there is a direct correlation between the nurse-patient ratio and optimum health care. Patients are not staying as long in the hospital, which means there's a cost savings, and the quality of care is better.

We talked about our recommendation for tax benefits for nurses and other health professionals. Nurses have told us that they would stay longer if they were paying less income tax. We're encouraging the federal government to look at incentives. We have commissioned an accounting firm to provide recommendations on the design of hypothetical federal tax incentives. The firm is almost done. We will be sharing that with the committee.

There are other recommendations, such as mental health support for nurses.

Nurses were already working short before COVID. What COVID has done to nurses and health care professionals.... Nurses need mental health help. The information we have is that one in 10 nurses, if not more, is dealing with mental health issues.

I'm sorry. Being a nurse means you get emotional.

Right now, the fact that nurses are working short all the time, and so much, means they're having to deal with the moral and ethical dilemmas of doing their job. They're going home routinely, if not every day, feeling like they've not given the care they were trained to give, and it's taken its toll.

We're going to get through this. I'm going to get through this.

We're recommending that nurses get mental health support. The Public Health Agency of Canada has expressed a strong interest in partnering with CFNU and the research team behind the Internet-delivered cognitive behavioural therapy program called PSPNET to tailor it to nurses. This program has already been set up through a $10-million federal investment for Public Safety Canada staff.

We commend the government for supporting the mental health of public personnel, but we call on it to help with support for nurses, who exhibit equal and higher rates of mental disorder symptoms.

The big thing right now in New Brunswick—

[The Chair, Liberal, Peter Fonseca]

Madame Richard—

[Maria Richard]

I'm so sorry. I could go on....

[The Chair, Liberal, Peter Fonseca]

We are allowing for a lot of leeway with time, but I'm sure other members will have many similar questions, and you'll be able to expand upon them.

Thank you, MP Thompson.

We'll go over to the Bloc and MP Ste-Marie, please.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you, Mr. Chair.

Good morning, Ms. Richard and Mr. Théberge. Thank you for being with us.

Ms. Richard, your testimony is very moving and reflects the situation everywhere. What nurses are going through is appalling. Overtime is mandatory in Quebec. Nurses work for hours and hours. Our hearts go out to them and to you. We want things to change.

My questions are for Mr. Théberge.

I'm the member for Joliette, a riding northeast of Montreal, in what's known as New Acadia, a territory made up of four villages: Saint‑Liguori, Saint‑Jacques, Saint‑Alexis and Sainte‑Marie‑Salomé. The inhabitants of these villages have very deep Acadian roots. Many have the last name Richard, Gaudet, Cormier, Leblanc or Landry. In fact, former Quebec premier Bernard Landry was from Saint‑Jacques.

It is a pleasure to meet our witnesses today and hear what they have to say.

Mr. Théberge, I can't believe that National Acadian Day isn't part of the celebrate Canada program and isn't recognized as a national holiday. At least a pilot project was launched in 2019, but it wasn't renewed in the last budget.

Did the Minister of Finance, the former Minister of Canadian Heritage or the new Minister of Canadian Heritage explain why the pilot project wasn't renewed? Is it because your nation no longer counts?

[Martin Théberge]

I will answer by asking the following question: What would happen if the same thing occurred to the people of Quebec?

We have indeed done a lot of work.

For example, there was a letter campaign. As I mentioned, 67 communities received funding last year. They sent more than 20 letters to the new Minister of Canadian Heritage. Among the organizations that sent letters were the Association francophone des municipalités du Nouveau-Brunswick, which carries a lot of weight, as well as other municipalities. So the letters weren't just from community organizations. They are very important; I'm not saying that one organization is more important than another. It's just to illustrate the range of organizations that received funding last year and answered the call with over 20 letters.

There's also an online petition. I didn't check the number this morning, but I know that it has more than 400 signatures.

This clearly shows the community's desire, the Acadian people's desire to get this funding and see it continue.

I think one of the challenges with the pilot project is that it was under the celebration and commemoration program, not under the celebrate Canada program. That's always been kept separate. That's why we're asking not only that the funding be renewed, but also that it be incorporated into the celebrate Canada program, in order to make it permanent.

As for the reason, the officials tell us that they have no idea. All they know is that the funding has stopped. Several MPs we spoke to have told us that it was simply a program review after a pilot project. In any event, the result is that this funding is not in next year's budget. Personally, when I don't have the money to go to the movies, I don't go and I don't plan to go. The Congrès mondial acadien will be held next year. During the year when this congress is held, artists are in high demand and much more is happening. Not having access to funding will make the process even more difficult, and there will be much more impact. Planning a festival or event on the scale of National Acadian Day takes place 12 to 18 months in advance. Right now, there's no money in the budget, which prevents us from doing the planning. If we were ever granted funding, we'd have to do the planning at the last minute, which would reduce the impact of the event.

This isn't just for communities in Acadia or the Atlantic provinces. For three years, National Acadian Day was celebrated in Yellowknife, Northwest Territories. It was also celebrated across Quebec. For example, I know that New Acadia received funding. So that has an impact on Canada as a whole.

It was indeed a great challenge not to have received confirmation of the return of this funding at the end of the pilot project, despite all the work we had done.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you for that information. Rest assured that the committee will do everything it can to bring this request to the attention of Pascale St‑Onge and Chrystia Freeland and her team. The situation is unacceptable.

The second important point you raised was the international aspect. Why is it important for Acadian artists, both men and women, to have visibility on the international stage?

[Martin Théberge]

You have to understand that this is one angle of approach, but that there are a number of others.

As I mentioned, the agreement between France and Acadia is the only bilateral agreement that the French government has with an entity that is not a government. We are the only ones with whom it has such an agreement. The next version of the agreement, which should be signed very soon, will have my signature as president of the SNA board of directors, rather than that of a prime minister or a minister.

This has been said many times, but I think we need to take the time to think it through: The artist is a key ambassador for speaking about our culture and values, as well as for bringing a sense of the imaginary and exotic to our space. When an artist appears on the international stage, it's not just the artist and their work that are presented, but the whole people or country they represent. It's important to keep this in mind. It has an impact on recruitment, on immigration and on the economy, since people tell themselves they should come visit our country.

The impact is huge and goes beyond the few thousand dollars you can give an artist to pay for things like their plane ticket. After all, plane tickets are far too expensive, so obtaining this funding can be a determining factor in deciding whether an artist will tour France or not. Let's not forget this aspect.

[Gabriel Ste-Marie, Bloc, Joliette, QC]

Thank you very much.

[The Chair, Liberal, Peter Fonseca]

Thank you.

We'll now go to the NDP and MP Blaikie, please.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you.

Mr. Théberge, earlier you talked about a budget of about $1 million. Approximately how much of that funding came from the celebrate Canada program?

[Martin Théberge]

I would like to add a nuance: The Société nationale de l'Acadie has not received any of that funding. We have done the work of promoting and advocating for that funding to be available for the communities.

That said, the annual envelope is $500,000, and it is divided in two.

The first $250,000 is allocated to an organization to organize the official celebration of the National Acadian Day. When we think of Quebec's national holiday, we think of the show on the Plains of Abraham. It's the one that is televised every year. In Acadia, we want to showcase each of our communities, so the celebration takes place at a different location every year. This year, it was in Bouctouche, last year, in West Pubnico, and the year before, in Moncton.

In addition to the $250,000 from Canadian Heritage, the department also provides its own resources to meet the needs in terms of technicians, camera operators, the whole management team, trucks and so on. That accounts for between $115,000 and $135,000, depending on the year. In the case of the 2022 show, the organization that organized it, the Fédération culturelle acadienne de la Nouvelle-Écosse, subsequently requested funding from the provincial government and the Atlantic Canada Opportunities Agency. Last year, for instance, the show cost about $700,000. So there is a very strong leverage effect.

In short, the first $250,000 is earmarked for the TV show.

The other $250,000 is used to fund activities in the communities. Communities can request up to $5,000 each to hire an artist or organize an activity. As I was saying, in the case of many English-speaking communities, without this funding, there would be no National Acadian Day celebrations. Without this funding, I can guarantee that a mini tintamarre celebration and a show for the National Acadian Day could not have been organized in Yellowknife. It's good for Acadia because it gives it incredible visibility, but it's also good for Canada as a whole because it celebrates one of its cultures and peoples.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

So the loss of this federal funding leads to the loss of funding from other levels of government.

[Martin Théberge]

Yes, absolutely. It's major.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Every time you lose a dollar, you lose even more.

Thank you very much.

Madam Richard, one experience in Manitoba that we found frustrating that resonated with me when you were talking about mandated overtime was that we had a government that is now on its way out, but the Conservative government of the day was not coming to the bargaining table to negotiate in good faith with nurses. The working conditions were causing a lot of nurses to leave. They would go into a private agency and then be hired back into the very spaces, in some cases, where they had been working before. By working on contract through a private agency, they were able to get the kinds of accommodations in the workplace that they wanted but that governments weren't willing to negotiate at the collective bargaining table.

I'm just wondering if you could speak a little bit about the effort to try to get some of the improvements in working conditions that nurses would like to see through the collective bargaining process and the extent to which that helps to feed the very expensive proposition of using private agencies to staff our health care centres.

[Maria Richard]

We know that an agency nurse costs two to three times more than a regular nurse. Here in New Brunswick, we know that there was a private agency nurse who was paid $300. We know that this $300 does not go directly to this nurse. We know that two to three times a nurse's salary in New Brunswick does go to that nurse, and what happens is that the rest goes to the private, for-profit agency and then accommodations....

For us in New Brunswick in 2022, in a six-month period, it cost $9 million for agency nurses.

Yes, there's a shortage of nurses. Yes, these agencies are.... We don't have a choice. Up north here in New Brunswick, agency nurses are keeping a specific hospital running. That's the reality. Just as you've probably seen in Manitoba, where nurses are seeming to favour the urban sites, we're also seeing that in New Brunswick. Young nurses want to be where there are more social activities, so they are choosing to live in urban areas of New Brunswick. That's the reality.

We're hoping that the federal government is going to spearhead and encourage the provinces to do as Quebec has done with its Bill 10; it is hoping to be able to have agency nurses out of the province by 2026. That's what we're hoping is going to happen.

The thing is that it becomes—you're right—a vicious circle. Nurses are overworked. They're fed up. They figure that, well, they can go and work as agency nurses and make more money.

[Daniel Blaikie, NDP, Elmwood—Transcona, MB]

Thank you very much for that.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Blaikie.

Members and witnesses, we are moving on to our second round. Times are a little bit different in this round, but as I said, I'm being generous and very lenient with our timing.

We're starting with the Conservatives and MP Duncan.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

Thank you, Mr. Chair, and thank you to our witnesses for being here today.

Ms. Richard, my sister Jill would be proud today. She's an operating room nurse in my riding in eastern Ontario. She served in emergency before and also in a long-term care setting, so she's had experience on the front lines from different perspectives and certainly shares a lot of the comments that you've made, particularly about the mental health of nurses and the sustainability of the work and the pace at which they do it. I don't envy it at all.

I want to elaborate on a couple of points from your opening testimony. I appreciated the reference to working to reduce workplace violence in health care. Our Conservative colleague, Todd Doherty, from Cariboo—Prince George in B.C., has a private member's bill, Bill C-321, to make assaults against frontline health care workers an aggravating factor when considering sentencing.

You mentioned about working to reduce violence, and you mentioned some of the initiatives. From a budgetary perspective, not only is that piece of legislation important.... For example, we tried to get that passed through unanimous consent, based on that 2019 health committee recommendation, and couldn't. However, when we talk about the awareness in and around that, what do you envision from the union's perspective of what's needed—not only in the law to do that, but also in terms of whether it's internal or what we could do at a national level to help reduce workplace violence?

[Maria Richard]

I think there were nine recommendations that came out in 2019 from the Standing Committee on Health. We would encourage them to have a public awareness campaign to sensitize the public to the fact that it's happening and to make them realize that yes, when they are in front of a health care professional, when it's an emergency and they're at the ER and things are not going well, that the nurse, that the health care professional, is a person. Yes, these are stressful times, but by sensitizing Canadians, maybe we will diminish the amount of abuse—verbal and physical—that nurses and other health care professionals are facing.

We are also looking at a pan-Canadian framework on preventing violence in health care settings, similar to the PTSD framework that was enshrined in federal legislation. We're recommending targeted funding to upgrade infrastructure in health care facilities, which would include devices linked to security for nurses and personal alarms.

We know that patients come in with.... We've had in Moncton, at a hospital here, a patient who had a machete in his pack. If this person has psychological problems, it might get dangerous.

We commend the government for Bill C-3, but we realize that we must better inform prosecutors and public safety personnel of this updated Criminal Code to strengthen protection for health care workers and ensure that these changes are enforced. I think some of them are not cognizant of it, so it's not being enforced.

[Maria Richard]

We look at recommendations that we've made for pan-Canadian nurse workforce planning. In that pan-Canadian planning, as we bring in more internationally trained nurses, the reality of what you're seeing is that they come in, and by the time they get.... You can't just say, “I'm a nurse” and that's how it's going to happen. We have seen some advancements whereby they've streamlined or fast-tracked that process, so that is working well.

What we are seeing across Canada is that the process needs to be reminded that these nurses have a different culture from us ethically, so there needs to be a balance. If we're going to bring these nurses from the Philippines or India or other countries, we need to support them culturally as well, because they're not going to stay. They're going to move on to another province, and that won't help. We see the poaching that's happening.

[Eric Duncan, Conservative, Stormont—Dundas—South Glengarry, ON]

I appreciate the context, the additional parts of that.

We talk about the magnitude of the mental health crisis that we face in the country, and to me, it's just stunning, almost, in the one sense. Again, a public awareness campaign, particularly in the legal community, to say that these tools are there.... We're proposing additional ones as an extra factor, for sure, but just the magnitude of where we're at, that we have to go out and say that this is necessary in today's day and age.... When we talk about mental health and we talk about some of the rising crime rates, the fact that this is even on there, despite all the other factors you face, is incredible, to say the least.

Another part of the testimony that you gave in your opening was about having the credentials of international students or health care workers recognized. I think “chaos” would be an understatement of where the current system is at. Even in my part of the country—eastern Ontario, the city of Cornwall—the number of Filipino Canadians, for example, who have immigrated here and have a health care background but are unable to work at all, even in health care....

Can you talk about some of the things that the federal government can do?

We've been proposing, for example, a “blue seal” program, similar to the Red Seal program, that could help provide a path—not an automatic one, but a testing regime for provinces to opt in to, as they do for the Red Seal program. Could you elaborate a bit more about the current chaos around that and how that's hurting retention and attraction?

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Duncan.

We'll now move to the Liberals and MP Atwin.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you very much, Mr. Chair.

I'm the member of Parliament for this beautiful riding, so welcome.

Mr. Théberge, it is a pleasure to welcome you to our committee. On behalf of my New Brunswick colleagues, I want to tell you that we appreciate you and that we are here to support your work, as always. There really was a funding error, and we will make sure that it doesn't happen again. I think some good news is to come on that front.

This is important for Acadia, but also for all francophones and francophiles in New Brunswick and elsewhere in Canada. To me, it's about history, justice, resilience, heritage, family and the future. It's so important.

So thank you for being here and contributing to this conversation.