Human Resources Committee on March 21st, 2022

[The Chair (Mr. Robert Morrissey (Egmont, Lib.)), Liberal, Bobby Morrissey]

I call this meeting to order.

Welcome to meeting number 13 of the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities.

Today's meeting again is taking place in a hybrid format pursuant to the House order of November 25, 2021. Members are attending in person in the room and remotely using the Zoom application. The proceedings will be available via the House of Commons website, and the webcast will always show the person speaking, rather than the entirety of the committee.

Given the ongoing pandemic situation, and in light of the recommendations from health authorities, I would expect all members attending to follow the appropriate health protocols that are in place for the pandemic.

To ensure an orderly meeting, I would like to outline a few rules to follow.

Members and witnesses may speak in the official language of their choice. Interpretation services are available. You have the choice, at the bottom of your screen, if you are attending virtually or using the earpiece here in the committee room. I would ask any member to get my attention if there is a disruption in the interpretation or translation services.

Before speaking, please wait until I recognize you by name. If you are on the video conference, please click on the microphone icon to unmute yourself. For those in the room, your microphone will be controlled as normal by the proceedings and verification officer. When speaking, please speak slowly and clearly. When you are not speaking, your mike should be on mute.

As a reminder, all comments should be addressed through the chair. With regard to a speaking list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they are participating virtually or in person.

This morning, as we continue our study on labour shortages, working conditions and the care economy, three witnesses will be appearing. We are still dealing with a technical issue for one witness, whose participation we are unsure of at this time.

I would like to welcome our witnesses: from the Canadian Federation of Nurses Unions, Linda Silas, president; from the Quebec Federation of Labour, Denis Bolduc, general secretary; and, from Service Employees International Union Healthcare, Sharleen Stewart, president.

I would mention that for each witness there is a five-minute timeline on your opening comments. For the benefit of committee members, to maximize their time, I will be enforcing the five-minute rule. At five minutes, I will ask you to stop, and we will proceed to questions from committee members.

Beginning for five minutes, I will now turn to Madam Silas, president of the Canadian Federation of Nurses Unions, for her opening five-minute statement.

Madam Silas, you have the floor.

[Linda Silas, President, Canadian Federation of Nurses Unions]

Thank you, Mr. Chair and committee members. Thank you for the invitation to appear before this committee on behalf of Canada's nurses.

As was mentioned, my name is Linda Silas. I'm president of the Canadian Federation of Nurses Unions, and I'm a registered nurse by profession.

The CFNU is Canada's largest nursing organization, representing frontline nurses—the RNs, LPNs, RPNs, or psychiatric nurses, and nurse practitioners—as well as nursing students.

When you say “front line”, that's us. Just last week I met with nurses in Manitoba to hear their stories and listen to their solutions on how to stop nurses from leaving our system. They said, “Show us respect at all levels of nursing. We need standardized education. Remove obstacles placed in front of internationally educated nurses. Stop the proliferation of agency nurses, because it's killing us, especially those of us who commit to employers in our province. Increase and fund nursing education seats. Increase support staff, because we can't do it ourselves.”

Lastly, one said to me, “I've had enough of mandatory overtime. I know there's not enough staff, but overtime won't fix it. If they don't fix our unit, we will be closing, and where will my cancer patients go then?”

Nurses take their jobs very seriously. They care deeply about the well-being of their patients, and they have a duty to uphold professional standards in their work. Over 80% of nurses report insufficient staffing in their workplace. Two-thirds are saying the quality of care has declined over the past year, and severe burnout is up to 45% from 29% just prior to the pandemic. These factors are pushing many nurses to leave their jobs and the profession itself.

Since the beginning of the pandemic, the number of vacancies in the health care and social assistance sectors has grown significantly, reaching over 118,000 as of the third quarter of 2021. Almost 34,000 of these job postings were for nurses, and many went unfilled for more than 90 days.

How do we prevent more nurses from leaving their jobs and attract enough nurses to address these ever-growing vacancies? We need a pan-Canadian health human resource plan that will equip the provinces and territories with the tools and resources they need to retain and recruit enough nurses and other health care workers to sustain our cherished public health care system.

From hiring guarantees for new graduates, as was done in Nova Scotia, to facilitating the transition from part-time to full-time positions, to providing opportunities to upgrade skills, to bridging programs or the New Brunswick “earn as you learn” program, these are the necessary initiatives. Let's recognize experienced nurses as mentors and provide accessible mental health programs for everyone.

For the sake of both our workforce and our patients, we simply cannot afford to lose any more of these critical frontline workers. This multi-faceted approach would allow the federal government to provide target funding to the provinces and territories so they can respond to the needs at the local level.

The CFNU is well placed to work with the federal, provincial and territorial governments around retention and recruitment initiatives. We have a track record that goes back two decades to when we were faced with a similar nursing shortage. We contributed to the final report of the Canadian Nursing Advisory Committee in 2002 and the nursing sector studies that followed. We produced integrated strategies for nursing resources in Canada, including the aboriginal workforce participation initiative, the AWPI. These are all federal government programs.

Following this, Health Canada approved a proposal by CFNU to implement 10 pilot projects in the provinces, as well as in Nunavut, to improve nurse retention and recruitment. One lesson we learned is that successful endeavour happens when the federal government works with unions, employers, governments, universities, colleges, and professional associations. We can accomplish a lot together.

In 2019, we spent over $175 billion on the health workforce. That's nearly 8% of the country's GDP. In spite of all this, we know very little about these workers. Along with 60 organizations in health care, the CFNU signed on to the call to action, urging the federal government to establish a national health workforce body to collect data, strategize and fund strategies.

Provinces and territories cannot manage the scale and complexity of this crisis on their own. It is long past time for the federal government to step in.

Once again, I thank you for providing me this opportunity to contribute to this important study, and I congratulate you for doing this important work for Canadians.

I would be happy to answer your questions. Thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madam Silas.

Mr. Bolduc, please go ahead, for five minutes.

[Denis Bolduc, General Secretary, Fédération des travailleurs et travailleuses du Québec]

Thank you, Mr. Chair.

Good morning, committee members.

I want to thank you on behalf of the Fédération des travailleurs et travailleuses du Québec, or the FTQ, for giving me the opportunity to speak about the important issues raised by the committee's current study.

The FTQ represents approximately 600,000 members in Quebec, from both the public and private sectors. It represents thousands of workers, including workers in the health care, social affairs and education sectors. The COVID‑19 pandemic and the rapid spread of the virus caught our institutions off guard in the first hours and weeks. No one anticipated the extent of the resulting emergency health measures and their impact on the economy and social and cultural life, but also [Technical difficulty—Editor] of some of our institutions. It placed renewed focus on the essential work done by thousands of men and women on the front lines of providing care. These thousands of jobs are often precarious, unknown and undervalued, yet they play a vital role in our daily lives.

The crisis also shed light on the systemic inequities that still too often define all these essential front‑line jobs. The jobs are predominantly held by women or immigrants, who often have low or poorly recognized qualifications and fragile employment situations. I'm pleased that the committee is taking the time today to shed light on this challenging period. There are certainly important lessons to be learned. The government definitely plays a key role in all this.

I want to draw your attention to a few points for consideration. The labour movement acknowledges that a number of employers have been facing recruitment challenges for several years now. These challenges can vary from region to region, from sector to sector and from province to province. There's also a shortage of good jobs. In terms of supply and demand, we often see major imbalances in professions or trades where the conditions provided aren't enough to attract and retain a skilled workforce [Technical difficulty—Editor].

With respect to labour shortages and working conditions in the care economy, I want to outline some of the key issues raised by our members who work in this sector on a daily basis.

Compensation packages aren't always competitive when compared to other occupations that require the same skills or qualifications. In many workplaces, the disposable income of workers, especially the workers with the most precarious conditions, is decreasing given the constant pressure of private drug plan costs. This makes the workers poorer every year. Moreover, the labour shortage places additional pressure on the current teams, which are already stretched thin as a result of often mandatory overtime, rescheduled or split shifts, and the denial of leave. A number of workplaces denied leave during the pandemic, sometimes even for people infected with the virus. As well, workers are called upon to perform their work in multiple facilities, which are sometimes far apart. The working conditions aren't conducive to retaining or attracting workers to care settings. This issue must be addressed.

You have heard this before. In a number of workplaces, front‑line workers are leaving their jobs after only a few years on the job. The wage gap between men and women and between comparable jobs in different sectors can't be overlooked for much longer, especially given the current inflation. The federal government must provide more support to the provinces and territories. It must increase transfers for health care, but also for workforce training [Technical difficulty—Editor] of Quebec.

Thank you for inviting me to speak. I would be pleased to answer your questions.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. Bolduc.

The third witness is still unable to virtually connect with the committee. We will see as time goes on, but in the meantime we will start the first round of questioning.

We will begin on the Conservative side, with Mr. Liepert.

Mr. Liepert, the floor is yours.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Thank you.

Thanks for the presentation this morning. I think I speak for pretty much everyone around the table and across the country on the importance that the nursing profession has displayed over the past couple of years. It has gone very much above and beyond, in many cases, what would normally be expected.

I think doing this study on the heels of the pandemic is a little.... I'm a little concerned that it's going to be skewed by what we've been through as a globe over the past two years, but I think what it also showed to me is this. For background purposes, I spent two years as health minister in the province of Alberta, so I had some opportunities to deal with the system. It seems to me that we have some major structural issues with health care in the country. Number one, we spend all of our time, or almost all of our time, treating the ill—the sickness side of health care—and we don't spend nearly enough time on the preventative side.

I'd like to know, from both of the two union leaders who have spoken here today, whether you as organizations are working with provincial governments primarily, because they are the ones who deliver health care, to look at fixing structural issues in health care. I don't believe that simply throwing more money at a situation that is structurally in need of repair is the right answer.

I guess I'm more interested in what your two organizations are doing at the provincial and federal levels in trying to see if some of these issues can be worked back and whether we can say we have a structural issue here that we need to deal with before we can fix the problem your members are dealing with on a daily basis.

I'd just like a couple of comments on that.

[Linda Silas]

I'll start.

Mr. Liepert, I have to say that you must be a happy man that you weren't Minister of Health during the pandemic.

I will start with your comments around the study perhaps being skewed because we're still in a pandemic. That is a reality. If the committee reads any of the submissions of CNFU from prior to the pandemic, it will see that prior to the pandemic we had a health care human resource shortage. Today we're in a crisis. Nationally, 25% of nurses are saying they are going to leave health care completely, and 50% are saying they want to change jobs. Over my 18 years, I have never seen that.

When you say there is a problem structurally, one thing we have to admit is that we have a few too many queens and kings out there who are trying to manage their own health care system, when we have a country governed under the Canada Health Act and we need to work together. We're way too small a country to have so many different strategies, so many programs.

When you were part of the provincial government, but also the federal government, I'm sure you worked with the building trades and the building sector. They're big in Alberta. They have an agency that looks at how many construction workers we need in this country. That has existed for many years. We have nothing like that for close to a million workers who work in health care in Canada. That's when we say the federal government needs to have the proper data, proper strategy and proper funding for one of the largest human resources in this country. That's why we're talking about an agency or a body. We can call it whatever we want.

I totally agree with you that we need to switch gears. We need to talk about prevention. My first report to the federal and provincial governments, way back when, was in New Brunswick in early 1990. It talked about community health centres. We need to make sure we provide prevention and home care, and that we include mental health, of course, but we need to make sure we have a good acute care sector when we need it. That's truly important. I think all unions are willing to work with you and with all provincial and territorial governments on this.

[The Chair, Liberal, Bobby Morrissey]

That makes up your time.

I'm going to advise the committee that Ms. Stewart is now available. Some committee members may want to question her.

We'll need to do a short sound test with Ms. Stewart, but she is available. There she is.

[Sharleen Stewart, President, Service Employees International Union Healthcare]

Good morning, everybody. I apologize. Two years in....

[The Chair, Liberal, Bobby Morrissey]

Ms. Stewart, we're going to do a brief sound check.

We're going to suspend for two minutes and do a quick sound check. Then you will proceed with your opening statements. Then we'll resume questioning.

[The Chair, Liberal, Bobby Morrissey]

Could we have your attention at this time?

I'm going to ask Ms. Stewart to give her opening statement.

Madam Stewart, you have the floor for five minutes.

Go ahead, please.

[Sharleen Stewart]

Thank you so much.

Members of the committee, my name is Sharleen Stewart. Thank you for hearing from me today.

The Service Employees International Union, SEIU, represents two million members across the United States, Puerto Rico and Canada. I proudly serve as international vice-president of our union, as well as president of SEIU Health Care, which represents over 60,000 frontline health care workers in the province of Ontario.

As I stated to your colleagues at the Standing Committee on Government Operations and Estimates last year, our elder care system, [Technical difficulty—Editor] more broadly, has failed. It has failed working women, who make up the vast majority of frontline staff. It has failed seniors, who were robbed of dignity and life. It has failed their families, who rely on the care economy for that which they cannot do themselves. Again, the care economy is failing Canadians. We should examine the reality and the solutions through the lens of people, not partisanship.

Conservatives who hold dear the idea of the family unit ought to be outraged at how our sisters and moms and their children are robbed of economic stability and social cohesion. The Bloc Québécois platform presented itself as resolutely feminist, and rightfully so, as what we're talking about for the most part is a population of mostly elderly women who reside in nursing homes, a care economy labour market, the vast majority of whom are women, and child care, which again often falls on the shoulders of women. It was the NDP, as I understand it, and specifically Ms. Bonita Zarrillo, who challenged this committee to examine the care economy.

I want to thank Mr. Michael Coteau for informing me of Ms. Zarrillo's work to have this committee examine what the Canadian government and its parliamentarians can do to support women in the care economy. I also want to thank Liberals, under the leadership of Prime Minister Trudeau, who in the most recent federal election echoed the words of distinguished research professor of sociology, Pat Armstrong, that conditions of work become the conditions of care. That—the conditions of work in the care economy—is what I wish to focus on today.

I wish to paint a picture for you of the journey of so many care workers, starting with immigration. Canada has a robust immigration system, on which we rely for so many things, including economic growth. The truth, however, is that too often it is the start of an exploitative system. As a country, we devalue women's work, and we see that in the wages and working conditions of women in the care economy. After opening our country's borders to care workers, we do the opposite and forget them. What we enable is a system of poverty wages that denies them job security and basic benefits. These working women include personal support workers, domestic workers and child care workers.

Those in the health care system, like PSWs, are the women I'm proud to fight for in our union. Unfortunately, in the past, public policy has often been distilled down to campaign-style tax credits. Let me be clear: Boutique tax credits are not the solution to ending systemic exploitation. Those are consumer-side savings that do nothing to confront the conditions of work. We need provider-side solutions that give the women who care for our families the economic means to also provide for themselves and their own families. We need to support their efforts to unionize, because within a union, they can speak up collectively without fear of being fired or worse, threats of deportation.

Let me remind you of one such example of care economy exploitation in our nation's capital. There [Technical difficulty—Editor] during the day, living in a homeless shelter at night. These anecdotes are everywhere. We don't need more data, we need action. Now that the pandemic has brought into focus the everyday experience of care workers, as well as our reliance on them as a societal safety net, I'm urging this committee to bring actions to words, to reform the conditions of work for care economy workers in your community.

As far as solutions go, I want to acknowledge those honourable parliamentarians who voted to support the financial resources to fund a new framework to deliver child care in Canada. Foundational to the national child care framework are good-paying jobs that put people before profits. We should extend that child care framework into health care, a system in the midst of a worsening health human resources crisis. It's on that basis that I look forward to working with you all to support the women who care for all of us.

Thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Stewart. You concluded below your timeline. Thank you.

We will now resume questioning, and I will go to Mr. Coteau for six minutes.

[Michael Coteau, Liberal, Don Valley East, ON]

Thank you very much.

I want to thank all of the witnesses today. Thank you so much for sharing your stories and representing your members so well.

There's no question that during the pandemic a lot was revealed about our health care system in Canada. Ms. Stewart, I remember reading the story you mentioned. It was in the Ottawa Citizen. There was a personal support worker.... In fact, I think there were a couple dozen. I think something like 25 personal support workers were in the shelter system in the evenings and at night and then going out to work in the day. There's really, without question, a huge problem in the system today.

I was hoping you could talk to us a bit about the minimum wage today and the cost of living. What is a suitable rate for women—mostly minority women—living in urban centres, taking care of our most vulnerable? What is a livable salary when it's broken down to a minimum wage?

[Sharleen Stewart]

Yes, it was devastating. It was not uncommon to hear of women in shelters or finding other places, such as living with other family members.

The minimum wage in home care right now is $16.50 an hour. That's barely over the minimum wage in the province of Ontario. Of course, we all know there's an economic crisis, with the price of gas and home care workers depending on their vehicles. A minimum wage should be closer to about $27 an hour, at the very minimum. That would be the start of a living wage.

Again, home care personal support workers have to use that income to travel from client to client. With the price of gas, they're basically using their own wages to pay for gas to do that. They don't get the travel time as well.

When you take a look at the system as well, what we desperately need across the provinces are universal wages. Minimum wage for PSWs is $16.50. It varies in long term care and hospitals, which just creates a competitive market for health care workers. This causes shortages in places like home care, where the wages are so devastating.

On your point about a lot of immigrant women, studies have shown that in 2021 the majority of caregivers were women of colour and Black women. A lot of them are migrants to our country as well.

[Michael Coteau, Liberal, Don Valley East, ON]

You also mentioned the cost of travel. The price of gas has obviously increased. When I spoke to a couple of personal support workers a few weeks ago, they talked about the misalignment between the time spent travelling in between jobs. The cost of travelling today actually pulls their salary a bit down from the $16.50 minimum wage.

Can you shed some light on that? Is that an issue?

[Sharleen Stewart]

Absolutely. Some of these women, especially in the last week, have [Technical difficulty—Editor] by the dozen, saying they can't do it anymore. What's sad about that is that the home care services they provide [Technical difficulty—Editor] at home. It's a financially responsible way to deliver services in the province.

Yes, they end up paying to go to work. That is what they've said to me. At $16.50 an hour, when they were getting paid only for the time they were in the client's home and not for the travel between clients, with gas being almost $2 per litre and when they were paying for their own gas, it didn't seem reasonable or sustainable for them to be providing this essential service. It cost them money. They were losing money by going to work. As I said, dozens have quit home care, which we should be concerned about.

When it comes to groceries, I've talked to caregivers who talk about how they provided food for their children and ate one meal a day because they couldn't afford to buy enough groceries for the entire family.

[Michael Coteau, Liberal, Don Valley East, ON]

It's unbelievable, the stories you hear out there.

President Silas, you brought up two facts, which were that 25% of nurses have left the profession and 50% are thinking about leaving.

Can you talk about that a bit more?

[Linda Silas]

One in two nurses are saying they're considering leaving. When I say nurses, that's all categories of nurses. That's over 50% in the next year. That's why we have such a small window to convince them to stay within the health care field.

We see 19% of nurses saying they've had enough and they're completely leaving. That's either through retirement—that number is quite low, at around 7%—or just leaving and finding other jobs, such as in real estate.

Similar to what Sharleen was saying, we have to fix the workplace. We have to fix the working conditions so we will retain those educated health care workers.

[The Chair, Liberal, Bobby Morrissey]

Ms. Chabot, you have the floor for six minutes.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I want to extend my greetings to all the witnesses and thank them for their presentations. I would especially like to acknowledge Ms. Silas and Mr. Bolduc, with whom I had the opportunity to work in a previous life.

Our study concerns the labour market and the care economy, among other things. I appreciate the picture painted for us. Unfortunately, I would say that this picture isn't entirely unfamiliar. There were already issues with shortages, the attraction and retention of workers, working conditions and the organization of services. These issues have been exacerbated by the pandemic. It's troubling to see how much the economically and socially critical health care field can be compromised by improper working conditions. Our study will give us some insight.

The great thing about our Canadian and provincial health care legislation is that it seeks to protect universal and free health care. Each province has the right to organize its system, health care and services. In each province, our major unions—which work very hard and which I acknowledge—advocate not only for quality public health care services, but also for working conditions to improve the lives of their members. In Quebec, we also have pay equity legislation, which has been in place for 25 years. I think that tools are available. I would like to applaud the witnesses for all their comments.

Mr. Bolduc, I have a question for you. There's something disturbing about our health care system. For years, while needs have been increasing in each province, federal budgets have been decreasing. Currently, the federal government contributes 22% of the funding for health care, while each province, simply to maintain services, is increasing spending by 5% to 6%. That's the largest budget provided by each province. Unfortunately, the federal government isn't pulling its weight.

Don't you think that the request made by Quebec and the provinces to increase health transfers to 35% of costs would be a good way to steer our health care and social services systems in the right direction and to support workers?

[Denis Bolduc]

Thank you for your question, Ms. Chabot.

The clear answer to this question is yes. The FTQ is asking that federal health transfers to the provinces be significantly increased from 22% to 35% of costs. There are two priorities: health care and education. Health care has faced budget cuts over the years. Every time austerity measures are applied to the health care system, they weaken the system. It has been weakened year after year. It's time to turn things around. In order to keep staff in hospitals, service facilities and home care, it's necessary to provide working conditions that will make them want to stay in the system. If the conditions aren't good enough, people will leave. In recent years, we've seen people come into the system bright‑eyed and bushy‑tailed and then become disillusioned fairly quickly as a result of mandatory overtime, challenging working conditions and a lack of support. They simply leave their jobs after two, three or five years. We see this very often.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you.

My second question is about workforce training.

I don't know about the model in other provinces, but the Quebec system is quite unique. There's a commission of labour market partners, which consists of both employers and the major unions, in addition to government departments. We know how much worker support includes training. We saw that during the pandemic.

Can the federal government play a role in increasing training budgets and targets? Mr. Bolduc, could you answer my question?

[Denis Bolduc]

Increasing federal transfers for labour market training is one solution. As you said, Ms. Chabot, we have a unique system in Quebec. We can do something about workforce training.

To address the labour shortage issue, a number of employers are turning to digital transformation, for example. I often compare it to [Technical difficulty—Editor] workplace transformations that will quickly become mandatory to deal with climate change. It's necessary to assess how jobs will change, because action is needed.

Some current jobs will disappear, and some will be created in the next two to five years. Many jobs will be transformed by the changes [Technical difficulty—Editor] to deal with climate change. Workers must be supported during these transformations.

We're talking about skills development and requalification. It's important to increase federal transfers for workforce training.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Mr. Bolduc.

Now we'll go to Madam Zarrillo for six minutes.

Madam Zarrillo, you have the floor.