Good morning, everybody.
Mr. Chairman and members of the committee, I'm very pleased to have the opportunity to appear before you today to provide an overview of the provision of health services to Canadian Armed Forces' members and respond to your questions pertaining to the scopes of practice of Canadian Forces Health Services Group clinicians.
The Canadian Forces Health Services Group is Canada's 14th health care system, providing high quality care to Canadian Armed Forces personnel wherever they serve. The system comprises an integrated team of military and civilian health professionals, which offers a patient-focused comprehensive spectrum of care in evidence-based health services.
While making use of provincial and territorial health resources within Canada, it is unique among jurisdictions in its integration under a single command of almost all elements of a comprehensive health system, including: education; training; research; occupational health; public health; professional regulation; clinical services, including medical, dental, pharmaceutical, emergency medical services, etc.; and supportive aids and benefits, such as home aids, return to work programs, and peer and family support. It also must uniquely maintain mobile and medical defensive capabilities to deal with hostile and environmental hazards that are generally not encountered in Canada.
The health needs of Canadian Armed Forces personnel is a top priority for the Department of National Defence as they must be employable and deployable at all times. The Canadian Forces Health Services Group is obligated to provide health services in order for Canadian Armed Forces personnel to maintain and improve their health and mental well-being; to prevent disease; to diagnose and treat illness, injury, or disability; and to facilitate return to operational readiness as quickly as possible. With the closure of our static hospitals in the 1990s, we've become far more dependent on the civilian health sector for domestic in-patient care and now access a significant amount of specialist and hospital care through provincial and territorial health systems.
The Canadian Forces Health Services Group comprises approximately 6,300 regular force, reserve force, and civilian personnel. Our mandate is based on three tenets: one, to deliver health services; two, to provide a deployable health services capability for operations; and three, to provide health advice to the chain of command.
The Canadian Forces Health Services Group provides health services to Canadian Armed Forces personnel in two distinct environments: in garrison and on deployment. In Canada, the primary health services system is based on a standardized approach through the primary care clinic model. The nucleus of this system is the care delivery unit, which consists of a primary health care team comprised of a medical administrative clerk, medical technicians, a physician assistant, a primary care nurse, a nurse practitioner, and a family physician, all operating within established scopes of practice. The CDU team works collaboratively with patients to assess their needs and to provide and coordinate their care.
Additionally, physiotherapists, pharmacists, and a variety of mental health professionals provide care in collaboration with the team or through direct intervention. In support of patient care, the Canadian Forces Health Services Group has implemented a pan-Canadian electronic health record system, a robust quality assurance program, a performance measurement platform, and a comprehensive health promotion and public and occupational health protection system.
We must also provide full-spectrum health services anywhere in the world that the Canadian Armed Forces elements deploy, whether on land, in the air, at sea, or under the sea. We must therefore be able to rapidly deploy and sustain medical, surgical, and preventive health capabilities, including tertiary care hospitals, anywhere for humanitarian or military missions without supporting local infrastructure.
In addition to being broadly clinically skilled, our staff must be trained to survive in hostile environments, deal with diseases, exposures, mass trauma, and other health threats that are generally not encountered in Canada. They must also be able to provide superb care with limited resources and intercontinental medical evacuation and supply chains in extremely dangerous and austere conditions.
Such circumstances require that the military health system be structured in a manner that makes the most efficient use of all health resources and occupations. This is facilitated by the military culture's prioritization of mission first, welfare of subordinates second, and personal interest last, as well as by the surgeon general's control of all clinical matters, including scopes of practice, distribution of occupations, health education and training, allocation of clinical resources, etc. During Afghanistan operations, we would not have achieved history's highest war casualty survival rate without the subordination of individual and professional interests to the mission, nor without expanded training and scopes of practice under physician supervision for certain occupations like physician assistants and medical technicians.
The health team in the Canadian Armed Forces is composed of both military and civilian personnel from over 45 occupations and specialties. Many of these occupations are regulated by professional bodies and have mandated scopes of practice, which, when necessitated by unique military operational exigencies, may be modified by the surgeon general. Health professionals are expected to register with their respective regulatory body. For example, in order for a military physician to practise within the Canadian Armed Forces, like their civilian colleagues, they must be registered with a provincial or territorial professional regulatory authority such as the College of Physicians and Surgeons of Ontario.
Given that we span the country we face challenges with respect to scopes of practice for some regulated professionals as they are not consistent across provincial jurisdictions. There may thus be differences for some occupations in some of our clinics. Additionally, we have an internal credentialing process and a practice review board to address issues with respect to registration and clinical practice. Our professional culture is based on a patient-centred philosophy that strives to provide access to the right care at the right time by competent caregivers. This philosophy is supported by a multi-interdisciplinary collaborative care model hinged on a high availability of caregivers and referral of care, as necessary. The clinicians' achievement of optimal professional practice is supported through a robust maintenance of clinical readiness program, coupled with access to a variety of continuing professional education and recertification opportunities.
At one time, the Canadian Armed Forces were the sole national jurisdiction that trained, educated, and employed two unregulated health occupations: medical technicians and physician assistants. With the rising national demand for allied health professionals to extend physician services, civilian physician assistants are now produced by select Canadian universities and employed in several provinces. The Canadian Forces Health Services Group was instrumental in the establishment of the Canadian Association of Physician Assistants, which certifies physician assistants through an examination and ongoing, annual continuing professional education requirements. Our medical technician training includes certification as a primary care paramedic through external civilian programs, community colleges, and internal guidance for ongoing maintenance of clinical readiness. Canadian Armed Forces medical technicians can also obtain registration from a provincial or territorial regulatory authority. They receive more advanced clinical training to have the skills necessary to deal with the urgent needs of deployed Canadian Armed Forces personnel in austere, hostile, and geographically dispersed environments.
In closing, like many other health jurisdictions, the Canadian Armed Forces are very committed to providing the right care to the right person by the right caregiver to optimize care and resource utilization. The Canadian Forces Health Services Group is broadly engaged with national professional authorities and organizations to contribute to the dialogue and to keep abreast of new initiatives that may benefit the Canadian Armed Forces.
Thank you once again for the opportunity to be with you here today.