National Defence Committee on March 6th, 2008

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

You have finished with your health study. Thanks very much for that clarification.

Would you have any recommendations for this committee on where we should target our questioning, our studies, or which people we should talk to?

[Sheila Fraser]

Certainly focus on mental health care, because we didn't go into a lot of the detail on that. I'm a little reluctant to give any advice on that.

The main issue we found in this was that the department just didn't have the information systems to be able to manage this program well. Even patient charts are still paper. So to try to get information even about how many military members are suffering from mental health care issues, whether they are being treated by the public sector rather than professionals within.... That sort of information can be pulled together on an ad hoc basis, but you can't get that kind of information to be able to really understand what is happening, to see the trends that are happening right across. So we think it is really critical that the department get the proper systems in place.

It would be good for the committee to try to ask them when they are going to have those things in place, because until they do it's going to be very difficult for them to be able to manage it program-wide, rather than clinic by clinic.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

So it is a technological issue, then?

[Sheila Fraser]

It's easy to say it's a technological issue, but it's really about managing the program differently; rather than managing clinic by clinic, managing the program as a whole, trying to see where the anomalies are. We even talked about caseloads between the various practitioners to identify those kinds of things, to assess whether or not the costs were appropriate, and even to do more regular surveying of members or those sorts of things. I think the program needs much more attention in that area—and, yes, of course, technology will help enable it, but you need to want to manage it that way and to understand that you have to go to a much broader spectrum than just going individually.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

You talked about the caseloads. Did you find great variance between areas of the country in terms of the caseloads that individual practitioners were carrying?

[Sheila Fraser]

We did, and I'll ask Ms. Loschiuk to perhaps provide the specifics.

[Wendy Loschiuk]

Yes, we did. When we looked at how the different clinics had been staffed and why they had been staffed, we did note that some of the clinics had a lot of people coming in. Some doctors might see as many as 100 patients over a certain period of time, as I believe the chapter shows, whereas if you went to another part of the country, the workload was a lot less. We didn't explain why. We weren't able to get information as to why that was, but we did ask why clinics weren't staffed in a similar fashion, according to population. We also asked the department if they could show us information on whether an analysis had been done on the expected caseload. But they weren't able to do that; I don't think information on that was really available, which is another area that would be helpful for them to know. But as a result of having to work with a model based on the information they had, you did see these anomalies.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you very much.

[The Chair, Conservative, Rick Casson]

Thank you.

Over to Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you, Mr. Chair.

And thank you to both of you for being here. I have a number of fairly short questions, but I first want clarification on something that was in Dr. Brunet's report, that is, the 57% of people who had not sought or had not been in contact with mental health professionals—not those who had sought it and were satisfied with the result. That may be a little bit different.

We have talked about doubling the number of mental health professionals, or one of the recommendations was a plan to double those by 2009, from 229 to 447. Can you give an assessment of the impact of that? Would that increase be enough? I know it's hard to give a very definitive answer on that, but what's your assessment of it?

[Sheila Fraser]

Again, I think it would be more appropriate for the department to answer that, but certainly, I think one could expect it to reduce, perhaps, the contract dollars being spent to have professionals within the system, because there is currently fairly significant contracting of those services.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Following on what Mr. Bachand mentioned, that 40% of doctors are not providing care and that there's a balance between providing care and information management when one of the shortfalls of the system is, as you mentioned, information management, how do we reconcile those?

Personally, I have a problem with doctors doing a lot of information management. Obviously, there needs to be input there, but is the answer to have more medical administrators versus MDs doing that sort of task?

[Sheila Fraser]

I think the department should certainly look at what the doctors are doing and whether it is possible to have people other than doctors doing those tasks. I'm sure the department can respond more than I can, but they will tell you that they are involved in policy development and things like that. Obviously, you do need some medical professionals in those areas, but I think what we were trying to encourage was an assessment to see whether there are doctors doing tasks that could be done by others, which would then free them up to be able to do the clinical work.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

We also talked about credentials, and certification or licensing. That's an issue in Canada with the provincial requirements for licensing and the portability of military doctors. Is there a policy case to be made for CF doctors having portability? I know it's not something DND can solve, but for the medical establishment, if we are to have portability of licences nationally for military doctors, or even nurses, and so on....

[Sheila Fraser]

In fact, I understand they're not required to have licences in the provinces where they are working currently, as long as they work for National Defence. So registration, for example, with the College of Physicians and Surgeons--we have it here in section 4.44--is sort of an indicator of confidence. We checked just to see whether they were actually licensed and registered anywhere, and we found no problems with the medical doctors. But that was work the audit team did. We would have expected the department itself to know that people were licensed in some place and had all the qualifications necessary to actually practise medicine.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

I think maybe a wrinkle in that is when there's a military doctor in a place like Cold Lake who is also doing work in a civilian hospital. That would require provincial licensing.

[Sheila Fraser]

That's right.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

That may be more the issue we're talking about.

Is your concern about credentials or is it about certification, and is there a difference between the two? If somebody has a valid MD, and they're licensed somewhere--

[Sheila Fraser]

That's fine. We're not concerned if someone is working in, say, Petawawa and has been licensed in New Brunswick. That is not our concern. It is whether the people who are there are actually qualified, I guess, to practise medicine, and we certainly would have expected the department to have known that.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Yes, okay.

One issue, again, that was brought up was the potential for having provincial provision of this kind of service and your comments on the open deployability of military doctors, which would mean that they would need to be military. It is also important to have doctors who speak the patient's language, and I don't mean French or English, I mean military language. Would that be an important factor?

[Sheila Fraser]

I would presume that it would be important. Again, it's really a question of policy. We wouldn't comment on that. But as I mentioned earlier, I think the whole question of accessibility to care when needed and the question of continuity of care were certainly two issues that had been brought up in the past and that the department had worked very hard to address.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Could you comment on the overall effectiveness of the CF action plan that fell out of your report and so on? Do you have any views on how effective that has been or might be?

[Sheila Fraser]

To be quite honest, not really. Again, the information systems just aren't in place to do that. I think we see that the department has agreed with the recommendations, has certainly indicated that they take this seriously, and has put an action plan in place. So I guess we can say that we are cautiously optimistic that these issues will be addressed.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

The other thing you talked about was a concern for maintaining medical skills. There were some shortfalls in that area. Is that a function of not enough people, too big a workload--which is probably the same thing--or again, lack of data management and that sort of thing?

[Sheila Fraser]

I think it was difficult for us. It was probably, in part, because of workload. Again, there is a program available so people can get experience, the necessary experience, to keep their skills up to date. Not enough of them are actually going through and completing that program. So again, it's something that needs to be tracked by the department to understand why they aren't doing this, what the rate of success is, and whether they need to modify their program in some way to make sure that people are getting the training they require to stay up to date.