Veterans Affairs Committee on April 14th, 2016

[The Chair, Liberal, Neil Ellis]

Good morning, everybody. I'd like to call the meeting to order.

Pursuant to Standing Order 108(2) and the motion adopted on Thursday, February 25, 2016, the committee resumes its study of service delivery to veterans.

Today, for our first hour, we have Mr. Ferguson, Auditor General of Canada. Also present are Mr. Martire, principal, Office of the Auditor General; and Ms. Campbell, director, Office of the Auditor General.

Good morning, everyone. Thanks for coming today.

We'll start off with your 10 minutes.

[Michael Ferguson, Auditor General of Canada, Office of the Auditor General of Canada]

Mr. Chair, thank you for this opportunity to discuss our audit work relating to the committee's study of service delivery to veterans.

Joining me at the table are Joe Martire, principal, and Dawn Campbell, director, responsible for audits of Veterans Affairs Canada, and National Defence and the Canadian Armed Forces.

For the benefit of new members, I would like to briefly explain the types of audits we are presenting to you today, which are performance audits.

Performance audits examine whether government programs are being managed with due regard for economy, efficiency, and environmental impact. We also look to see if there are means in place to measure the effectiveness of programs. However, while we may comment on policy implementation, we do not comment on the merits of policy, itself.

Since 2012, we have conducted two performance audits that focused on selected services and benefits provided to veterans. Veterans Affairs Canada was also part of a third audit that examined the delivery of online services by federal organizations.

In the fall of 2012, we reported on how National Defence and Veterans Affairs Canada managed selected programs, services and benefits to support eligible ill and injured Canadian Forces members and veterans in the transition to civilian life. We did not look at whether Canadian Forces members and veterans had received all the services and benefits for which they were eligible. Neither did we examine the fairness of departmental services and benefits available, nor the quality of medical treatment and care provided.

There are a variety of support programs, benefits and services in place to help ill and injured members of the military make the transition to civilian life. However, we found that understanding how the programs worked and accessing them was often complex, lengthy and challenging.

The lack of clear information about programs and services, the complexity of eligibility criteria, and the dependence on paper-based systems were some of the difficulties expressed by both clients and staff.

We also found inconsistencies in how individual cases were managed, as well as problems in the sharing of information between the two departments. As a result, forces members and veterans did not always receive services and benefits in a timely manner, or at all.

We found that the interdepartmental governance framework to coordinate, harmonize, and communicate the various programs, services, and benefits available to ill and injured forces members and veterans needed strengthening.

National Defence and Veterans Affairs accepted all 15 of our recommendations, which included streamlining their processes to make programs more accessible for ill and injured forces members and veterans.

In our fall 2014 report, we reported on mental health services for veterans. As of March 2014, about 15,000 veterans were eligible to receive mental health support from Veterans Affairs Canada through the disability benefits program. The proportion of the department's disability benefits clients with mental health conditions had increased from less than 2% in 2002 to almost 12% in 2014.

Our objective was to determine whether Veterans Affairs Canada had facilitated timely access to services and benefits for veterans with mental illness. We focused on the timeliness of eligibility decisions made by the department. We did not assess the appropriateness of the decisions made or the quality of care received.

For eligible veterans, the department paid for various mental health services that were not covered by provincial health care plans. These services included specialized psychological care, residential treatment, and some prescription medications.

We found that Veterans Affairs Canada had put in place important mental health supports. These included operational stress injury clinics, a 24/7 telephone service, and the Operational Stress Injury Social Support Program. However, the department was not doing enough to facilitate veterans' timely access to mental health benefits and services.

The rehabilitation program provides access to mental health care support for those veterans who are having difficulty transitioning to civilian life. Eligibility requirements are less stringent than those of the disability benefits program, but treatments and benefits end once a veteran completes the program. We found that Veterans Affairs Canada was meeting its service standards for providing timely access to mental health services through the rehabilitation program.

The disability benefits program provides lifelong access to benefits and requires that veterans provide evidence that they have a permanent mental health condition that was caused or aggravated by military service.

We found from the veterans' perspective that about 20% had to wait more than eight months from the first point of contact for the department to confirm their eligibility to access the specialized mental health services paid for by the department.

As in 2012, we found that a complex application process, delays in obtaining medical records from National Defence and the Canadian Armed Forces, and long wait times to access mental health care professionals in stress injury clinics continued to be some of the factors that slow down the decision as to whether veterans are eligible for support provided through the disability benefits program.

In addition, we noted that 65% of veterans who challenged denial-of-eligibility decisions for disability benefits were successful. While the department knew that most successful challenges rely on new information or testimony, it had not analyzed how the process could be improved to obtain this information prior to rendering decisions upon first application.

Mr. Chair, Veterans Affairs Canada agreed with our recommendations, and following our report, produced an action plan with implementation deadlines ranging from December 2014 to March 2016.

Lastly, in the fall of 2013, we examined whether the online services offered by some federal organizations, including Veterans Affairs Canada, were client-focused and supported by service delivery strategies with defined and measured benefits. We did not audit service standards.

We found that the government had introduced services to enable individuals to interact online with departments securely. However, multiple steps were required to set up a secure account and then enrol in a program. For example, a retired veteran wishing to interact with the Government of Canada online to access benefits and report taxes first had to set up a secure account and then follow different enrolment processes with Human Resources and Skills Development Canada, Veterans Affairs Canada and the Canada Revenue Agency, or CRA.

While a veteran would have had immediate access to a Veterans Affairs Canada account, the wait time to receive separate security codes in the mail from Service Canada and CRA was 5 to 10 days.

Mr. Chair, we hope the findings in these audits will be useful to the committee in its study. I should note, however, that we have not done other audit work since our reports were presented to Parliament; therefore, we cannot comment on progress the departments have made since then. We encourage your committee to ask department officials what progress they have made toward implementing our recommendations.

Lastly, the committee may be interested to know that on May 3 we will present a report to Parliament on the drug benefits program provided by Veterans Affairs Canada.

This concludes my opening remarks. We would be pleased to answer any questions the committee may have.

Thank you.

[The Chair, Liberal, Neil Ellis]

Thank you.

We'll start with Mr. Kitchen, for six minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you, Mr. Ferguson, for coming to us today. Please bear with me; I still have this mind that when I hear “auditor”, I'm thinking financial all the time. I'm hoping I can coordinate and make sure I don't dabble in questions that go toward financial versus the other way.

One of the recommendations that was made was to update the outreach strategy, including for family physicians. In particular, I'm wondering if you might want to comment on the issue of hosting workshops with family physicians and general practitioners and trying to get that information out to the practitioners. I assume we would provide these services across the country.

Likewise, when we talk about family physicians, there are other practitioners that the veterans deal with. Those can be chiropractors, physical therapists, occupational therapists, counsellors. Is the suggestion in this recommendation that those are also included in these workshops that we're providing that service for, and that we're getting that information we need for the veterans?

[Michael Ferguson]

I'll ask Ms. Campbell to provide us with some more details, but I'll just start off by saying fundamentally what we were looking at was, first, understanding that the department realized they had to do outreach, that they had to get in touch with family members and with other stakeholders in order to help identify veterans who were struggling with mental health conditions. I think we identified that they needed to do a better job of understanding how successful those outreach activities were being. Part of that was the types of people they should be reaching out to.

I'll ask Ms. Campbell perhaps to provide some more details.

[Dawn Campbell, Director, Office of the Auditor General of Canada]

If we refer to paragraph 3.52 in the report on mental health, it indicates that the reason we focused on the family doctors is...and here's a sentence there that's particularly pertinent:

According to the Mental Health Commission of Canada, “People are more likely to consult their family physician about a mental health problem or illness than any other health care provider.”

That doesn't mean others are not important. I think probably—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

No, I understand, but a lot of times, especially in rural communities, the family physician may not be the first access they might have. Speaking as a chiropractor who has dealt with a lot of veterans over the years, oftentimes I've had those individuals in my office dealing specifically with what I deal with in mechanical issues, but the reality is oftentimes they are expressing other things to me that would be of benefit to me as a practitioner because I might be the sole source they have.

There was a time in Estevan, Saskatchewan, when we had five doctors, so I was seeing medical situations that were outside my scope, but people were coming to me because I could get those people to where they needed to be, they had an avenue.

In a lot of rural communities, those aspects are there, and the practitioners who are there whether they are occupational therapists or physical therapists have some of that background and some of that training that they can utilize those skills. Those skills, if they had that outreach to them, would be of great benefit for our veterans so they could expand on that, and maybe get them to where they need to be, and assist them in those programs.

I'm wondering if that was consulted on or discussed, or is it something that could be looked at?

[Michael Ferguson]

Mr. Chair, again I think that's a very good point of discussion to have with the department.

What we were looking at here was primarily their approach to stakeholder outreach, which identified that it had primarily focused on family members and people very close to the veterans. Of course, it's extremely important for family members to be able to identify signs of mental illness.

We then said we felt they needed to put some more emphasis on family physicians, because as Ms. Campbell identified, a family physician is often a person who somebody will confide in.

We didn't take it a lot further than that to identify other types of stakeholders, but I think what you're asking is certainly something that could be put to the department to try to identify how they consider which types of stakeholders veterans might be in contact with could be in a position to identify signs that a person may need some direction with some mental health issues.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I agree, and thank you. It's something we need to pursue to make certain because in those areas where we don't have those services, we do have qualified people who can assist in that manner.

On the issue of the VAC mental health action plan, it talks about opening some new operational stress injury clinics. Do you know how many of those have been opened?

[Michael Ferguson]

Again, that would have been outside of the time we were doing the audit, so I think that's something the department would have to tell you.

What we were looking at was how they were operating during that period of time rather than whether they have opened any of them.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

A lot of what we've heard around the table over the last couple of months has been talk about when we're dealing with injuries in the sense that someone, for example, who might be in the artillery and is going to have hearing loss, we anticipate that a parachuter who is jumping out of planes and jarring his knees is continually having issues that deal with orthopaedic injuries, be it to his knees or the discs in his spine, or a trooper who jumps off a tank continuously can have issues with his back.

[The Chair, Liberal, Neil Ellis]

Sorry, we've run out of time.

Next is Mr. Bratina.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you.

Perhaps I'll follow up because in the 65% of veterans who challenged their denial of eligibility, the department knew that the most successful challenges rely on new information or testimony. Would some of the new information be, as Mr. Kitchen suggested, old information, which is the reason that my knees are bad is because I made 400 parachute jumps? It seems that this information wasn't captured or was not available on your initial denial.

Are you satisfied, because this is from your 2012 report I understand? Have you followed up on the remedies for things like that?

[Michael Ferguson]

The reference to the 65% is actually in the 2014 report on mental health, but that's all right because it's fundamentally the same issue.

The issue we were raising was that, once somebody gets turned down for access to these types of long-term mental health services, they go through appeal and then they are approved for it. It's because somewhere in that appeal process what we've referred to as new information has come forward, but you're right, it may simply be that new information may be information that already existed but was not brought forward during the original evaluation.

Really the point of this, I think, is to understand why 65% of the appeals are successful. If there's information that can be learned from that, it says that if people brought forward this type of information early on, then they would have been approved originally and wouldn't have had to go through the appeal process.

That's exactly the issue that this is raising, for the department to be able to analyze the reason that they're overturning appeals and to feed that back into their original process to try to make the original process more efficient for the veterans trying to access the services.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Often you'll hear when you call somebody, “This call may be monitored for quality control purposes.” My concern in many of these kinds of cases and issues is burnout by the staff, so I wonder if you actually monitored the intake in a direct way, whether it be by phone call or.... How did you audit that performance in terms of how the veterans were being dealt with by the staff?

[Michael Ferguson]

We weren't really looking at all of those individual interactions per se, but what we looked at was the length of time the process took. Originally, we were looking at how long it took from the point in time that an application came in until they made the first decision.

In fact the department had in place a standard for how long they would take to make that original decision, but part of what we also identified was that, in measuring that time period from when an application comes in until when a decision is made, that doesn't take into account how long it takes a veteran to complete the application in the first place. We found that the application was complex and it was difficult for them to complete.

So you can end up in a situation where the department, because they are measuring the time period from application to decision, is saying that they have met their standard, but the veteran is frustrated because the veteran had to try to navigate all of the time to prepare the application in the first place. That's really the issue that we're raising in that.

[The Chair, Liberal, Neil Ellis]

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Thank you, and you actually led right where I was going.

First of all, I appreciated reading the report. It really put a lot of analysis around a lot of the anecdotal stories that I've heard from veterans that I spoke to, so thank you for that.

In that period, knowing that it's taking up to 32 weeks from the time someone identifies as needing mental health services to an application being approved or disapproved, are there any interim services? Is there any safety net for these people in the interim?

[Michael Ferguson]

I'm glad that you raised that, because when we're talking about that time period, it's in the disability benefits program, which is the access to the longer-term services. They also have the rehabilitation program, where I believe the decision was being made within two weeks, which was for shorter-term services.

I'll ask Ms. Campbell if she wants to add anything to that.

[Dawn Campbell]

Sure. Thank you, Mr. Ferguson.

In addition, there are certain other services the department does provide, such as a 24-7 hotline that is actually administered by Health Canada. They have an OSISS program, which is operational stress injuries social support program. There are certain other programs that they have. Generally speaking, the services provided by case workers would be for those who have been deemed eligible for one of the programs, as Mr. Ferguson said.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Can you just clarify for me, when someone is discharged due to mental health, are they automatically qualified for some of these programs, or do they start the process again?

[Dawn Campbell]

There is eligibility criteria that must be met for either of the programs we have looked at. There is the disability benefits program and then there is the rehabilitation program. For the rehabilitation program, the criteria to be met are not as high.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much.

Thank you, Auditor, for your report. It is certainly very thorough and very helpful.

I have a couple of questions and I wanted to go back to the Veterans Review and Appeal Board. You talked about the fact there were fewer appeals granted in 2015-16 than in the previous year. What I took from that is the quality of the interaction between a case worker at VAC and the veteran had improved slightly. There was less need for an overturning of the VAC decision. Is that accurate?

Would you say there has been some improvement with regard to the interaction between the veteran and VAC, or were you able to discern that?

[Michael Ferguson]

That really wasn't the focus of what we were looking at in this area. Really, we were looking at the appeal process, so that if the original decision gets overturned, how the department learn from that process to improve its original process, as opposed to specifically the angle of the question you are asking.