National Defence Committee on March 6th, 2008

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Do I still have time?

[Rick Casson, Conservative, Lethbridge, AB]

A little bit.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thanks. I wasn't expecting it to come my way.

I wanted to pick up on another comment you had made about multidisciplinary primary care programs. You mentioned there were programs piloted at three bases. Is this the same program we're talking about here? Could you expand on that? Could you describe this to us?

[BGen Hilary Jaeger]

I think my French in my remarks was not terribly perfect.

What we were trialing on three bases is in fact a systematic peer review process, wherein a certain number of files of each practitioner would be reviewed on a periodic basis for quality assurance reasons.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Okay. Thanks for clarifying that.

I just want to come back briefly to my question about EMDR. I had a feeling that perhaps Lieutenant-Colonel Fillion wanted to comment on that.

Did you have any comment on EMDR?

[Lieutenant-Colonel Joel Fillion, Senior Staff Officer, Mental Health, Department of National Defence]

Yes. In fact, what I would say is that we don't have the specific numbers of how many people are using these techniques.

I think all those who provide service to the different clients who are being referred to them will use their own skill sets and the skills they have acquired. So it will happen that some might not have been trained in EMDR and some have. Most of the people who have been trained will, most of the time, use these techniques if they feel it is the best fit for the clients.

I do know that in most of the major clinics, providers are using EMDR.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

You don't have any comment in terms of the satisfaction rate of people having this type of therapy versus other types.

[LCol Joel Fillion]

No, we do not.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you.

[The Chair, Conservative, Rick Casson]

Very good. Thank you.

Mr. Bouchard.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chairman.

Thank you for testifying. I asked the Auditor General two questions. The first concerned the system. Ten years after the department identified a need for oversight of its health care system, there is still no mechanism in place for bringing all stakeholders together.

Is that mechanism recommended by the Auditor General important for you?

[BGen Hilary Jaeger]

I'm anxious to see it myself. I think this is a return to governance issues, which goes beyond a chain of command.

Personally, my chain of command is working very well. It's starting to move little by little. About four or five months ago, they didn't know they were responsible for giving us priorities and for reporting on what we had accomplished with regard to those priorities.

So we really didn't have a system that clearly told us where our efforts should be; it was up to us to decide where the priority of effort should be in the health services system. If you look at the difference between the CEO of a hospital and the board of governors of the hospital, it's the board of governors that says what the priorities are and sets the strategic plan for the hospital. The CEO's job is to implement those.

I have been the CEO and the president, as have my predecessors. We would like to move away from being the president of the board; we would prefer being the CEO.

[Robert Bouchard, Bloc, Chicoutimi—Le Fjord, QC]

That's good.

[The Chair, Conservative, Rick Casson]

Mr. Murphy, I'll give you just a couple of minutes, as I hear the bells ringing.

[Shawn Murphy, Liberal, Charlottetown, PE]

Thank you very much, Mr. Chairman.

I have just one question, if I may.

Brigadier-General, when I read the report and listen to your evidence—and of course you were before the public accounts committee discussing this before—the one figure that strikes me is the large percentage of your trained medical professionals not providing care to our forces. It is significant—at least I think it's significant. It suggests to me a systems problem. But you're dealing with a tremendously challenging situation. You're organizing and implementing the health system for 65,000 people spread out all over the world. It's basically an all rural, rather than urban, system. You're in an environment that is extremely competitive. The IT seems to be an issue; the measurement seems to be an issue; the governance seems to be an issue. And of course you have to operate in a command and control environment, which is not normal.

But as far as the whole health system is concerned—and this really is a specialty unto itself now, as a lot of the people doing this are not physicians or surgeons, but are trained in this area—do you feel you have the people around you who are really up to scratch in the whole area of modern health management? I say this because it is an extremely important issue with the challenges you face, which I think are very high. The whole recruitment issue is brutal, for example, and I don't think it's going to get any better over the next five or ten years.

[BGen Hilary Jaeger]

Thanks for that question. It's very interesting.

First of all, I'd like to clarify that the 40% in administration—of which I, of course, am one—are uniformed physicians; the 40% is not the overall percentage of physicians providing care to members of the Canadian Forces. So when you look at whom you can replace with a civilian, you can't really replace the more senior people. All of the people in these supervisory roles are uniformed providers: the lieutenant-colonels and colonels, all of whom count toward that 40%. Also, my public health experts, my occupational health experts, and the people who review recruits' medical files to see if the recruits are fit to come into the forces, are counted as administrative positions, but those jobs can only be done by physicians.

Regarding the management side, we've had a tremendous improvement in the professionals. We do have a separate occupation, as health care administration is a separate occupation. It feeds into another classification, known as health services operations officers. General Mathieu was the first person to start as a health care administrator and then command the system. We are fully part of the Canadian College of Health Service Executives. We participate in their professional development programs. We encourage the attainment of certified health executive designation through the college to improve our baseline level of health care management and capability.

We can still do better, but compared with the situation when I first joined, when, to be honest, a health care administrator was somebody who wanted to be a pilot and failed, or who wanted to be an infantryman and was hurt and couldn't be an infantryman any more, we have come light years from those days.

[The Chair, Conservative, Rick Casson]

Good.

Thank you very much.

[Denis Coderre, Liberal, Bourassa, QC]

On a point of clarification, Mr. Chair, it's been a while since I asked for the number of troops on medication. Through the chair, I am expecting you to get those numbers. It is imperative for our own understanding of the issue.

Thank you.

[The Chair, Conservative, Rick Casson]

We'll make sure of that.

Thank you very much for being here again, and thanks for your contribution to the study.

The meeting is adjourned.