Veterans Affairs Committee on April 14th, 2016

[Alaina Lockhart, Liberal, Fundy Royal, NB]

What you're telling us is all good stuff, which I think we're looking to hear.

Nonetheless, what are the barriers right now? What are the challenges? Where are the areas that we can be doing better, from your perspective?

[Dr. Cyd Courchesne]

I'll jump in. I never miss an opportunity to discuss how we can remove barriers.

Of course, people want access. We always hear that accessibility is a barrier. From our own network, which I'll reemphasize that we've been building for the past 15 years, we hear that the barriers are now starting to be physical, the physical space. Our clinics are saying that they have more clinical people who want to work for them but that they have no physical space to put them in.

When we established this network, there was an urgency that we had to start opening clinics. We opened them alongside long-term care facilities, because we already had a relationship with those hospitals. But hospitals are getting old and people are starting to be cramped. We've maximized the physical space. I would say that the biggest barrier today is physical space in our clinics. They want to expand because clinicians want to come and work there. If we could do that then, we could see more people. The capacity issue right now is physical. We would improve our access times and our wait times for all the clinicians, simply by having more space.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

So your wait time isn't necessarily associated with an application process; it's physical wait time.

[Dr. Cyd Courchesne]

Yes, it's really physical space. That is the choke point right now.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen.

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

Looking at the Auditor General's report, its first recommendation has to do with what we've been talking about, the barriers to timeliness in terms of helping veterans access psychological and psychiatric assessments.

It takes about 16 weeks after the veteran has gathered and submitted the necessary paperwork, and it takes another 16 weeks before they actually receive the benefit, assuming that there are no delays or glitches. At that point, they are reimbursed for any mental health care received after the date of a positive decision. The preceding 32 weeks in which they still required mental health care aren't covered. What impact does this delay have on care and coverage? If someone is under financial stress, that has to play on that person. Have you looked at the impact on mental health?

How is it possible that it could take eight months for the department to figure out that a veteran is suffering from these mental health issues and that none of that eight-month period is covered?

[Michel Doiron, Assistant Deputy Minister, Service Delivery Branch, Department of Veterans Affairs]

I'm going to start and then turn it over to Dr. Courchesne.

I think the first part has to do with when the OAG talked about 32 weeks. We have to recognize that during the first 16 weeks a lot depends on the delay. There is some interpretation that comes into that 16 weeks. Needless to say, there is a delay before we get a completed application and it's entered into the system. We've had lots of discussion with the OAG about the 16 weeks. Some of the data they were taking was from the get-go of the first phone call. It's hard to open a claim when you only have a phone call.

That said, we accept the fact that it's long. We accept the fact that we had to simplify. What we have done since the OAG report is to accelerate our disability process for mental health. We have done it for many other items, not just mental health. But since we're talking mental health, I will specifically talk about it.

If they have a diagnostic and they come in to us and they've served, especially if they've been in any SDAs or special duty areas, they are in the club. To really decrease...whether it's 32 or 16, to me at this point is not important. The important thing is to get that down. While they're waiting for this, there are avenues for them. We can't forget that we have the 1-800 network. We'll give the veteran 20 sessions with a psychiatrist or a psychologist within 24 to 72 hours. We pay for that. There is no adjudication process.

As long as they're a veteran or a veteran's family, we take care of the bill. There is no delay. There is no waiting. You call that number. You need help. Somebody referred to the crisis line earlier. If you need help, we will help you. We'll get you into mental health. It is not the OSI clinic, I agree, but at least you can get help immediately, pending a lot of this stuff. We pay. There's no billing. It's with Health Canada. They bill my division directly and we take care of it.

I'll turn it over to Mr. Courchesne or Dr. Ross.

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

I wonder what the pharmaceutical costs are. What are they and are they covered too? You talked about the psychologist. Are the drugs covered as well?

[Michel Doiron]

They're not covered under that program. But if the veteran is accepted into the disability, they are covered by the department.

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

Yes.

[Michel Doiron]

They need the diagnostic.

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

The word “if” bothers me a little bit.

I wanted to go back to what you said, Dr. Courchesne, about the barriers, the physical barriers regarding the OSI clinics. One of the suggestions I've heard is to embed psychologists in DND. Now, I understand VAC is different from DND. But the minister is a deputy in DND. It seems to me that this begins to make sense—you identify the problem before it becomes severe. We know that people experience mental health issues, and if they're left untreated, these issues can become catastrophic. I know that the psychological society has been talking about this. Is it something that you've discussed at VAC or with the minister?

[Dr. Cyd Courchesne]

Our partners at DND have similar clinics, and we consider that we're all partners. They have OTSSC—they have more complicated acronyms than we do. But they're the same. They're the OSI equivalent. They have psychologists in their clinics. I would say that they're stuck with the same problem as us with respect to physical footprints, because they're in older buildings than we are. So on both sides, we have psychologists on staff.

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

I think the suggestion was that they should be part of the military personnel and that this would break down barriers. Was any thought given to that?

[Dr. Cyd Courchesne]

You'd have to raise that with the CF. I don't think I can speak to that.

[The Chair, Liberal, Neil Ellis]

Ms. Romanado.

[Sherry Romanado, Liberal, Longueuil—Charles-LeMoyne, QC]

First, I'd like to thank you for being here today and for the work that you're doing to address post-traumatic stress disorder. I have a couple of questions, but I am going to premise my questions with an apology because it may sound harsh.

We've just heard from the Auditor General, and I have to say that I'm a little concerned when I hear that 65% of cases are overturned, but I hear that in those cases, whether it be because of a lack of documentation or errors, the payments are not retroactive.

My questions are more for the ADM. Currently are there KPIs in VAC, or is there management by objectives with employees? Do employees have a performance-based incentive? What kind of quality control is in place? If there are errors happening, is there training so that these errors stop? If it's a performance problem, are people, are their jobs... I don't want to say that people are making... But they're making mistakes on the backs of the veterans.

Who is keeping track to make sure that if errors are being made, they are being addressed, that training is provided for folks, and that you're capturing the data of what kinds of errors are happening? But what happens to the data? Is it just in a report somewhere? My concern is what's happening.

I'm sure the employees wouldn't feel so great if they were told, “Well, we're going to take 16 weeks of your salary back.” My question is, what's happening?

[Michel Doiron]

I can probably answer all of those.

First of all, it is no longer 63%, but an 83.3% approval rate, on first applications. That has increased by 20 percentage points.

I have to back up to answer part of the question.

Army people—and I think a lot of people here have mentioned and Mr. Clarke has spoken of it—have this ethos that when you're serving with your group of people, you do not fill out the famous form, something 98, to say that you've been injured. It doesn't go into your medical file because you want to be a contributing member of your team and you want to support your partners and your colleagues. I think Mr. Clarke spoke to it well earlier.

Our legislation is written in such a way that two or three years ago we would go in to try to find proof that you were injured. That means we had to look over 500, 600, 700 pages of medical files to try to identify when you injured your knee and if you filled out a form that said you had injured your knee.

Now serious injury cases are not an issue. When we are talking serious injuries, there is a medical file. It is more about these injuries that happen over time, so what we've done is undertaken a review. Actually that started before the OAG came in, but we put a lot of effort after the OAG came in to move that from... Somebody at the OAG talked about the burden of proof, but shifting the burden of proof from the veteran to Veterans Affairs in the sense that, for an injury... I'm not talking illness, as I think I referred to last time. I'm really talking injury here. Illness is a little bit more complex.

If you were a SAR tech and you've jumped out of helicopters and planes for 30 years—who knows how many jumps you've had?—you're going to have bad knees. You're going to have a bad back; you're going to have a bad something. So we've done a lot of work with the institute of research that's over at the military site to say what the injuries are related to. Is it a certain trade? And if you come in, you have to have a diagnostic. I still need a diagnostic. A doctor has to say that your knees are gone.

[Sherry Romanado, Liberal, Longueuil—Charles-LeMoyne, QC]

I'm just going to stop you because what I'm referring to is performance. We're going to run out of time, so I'd like to have that answer, if possible.

[Michel Doiron]

Okay, so first of all, employees in Veterans Affairs are not paid per widget or whatever the right terminology is. They are at salary. They do get overtime and that. Executives, like other executives in the federal government, do have performance pay, but the employees do not.

The employees are held accountable. We have a quality assurance program that ensures that they are meeting the requirements of the program.

[The Chair, Liberal, Neil Ellis]

Sorry, could I just have that clarified? Employees, does that include management and all of it?

[Michel Doiron]

Yes, executives and directors have performance pay. That's like all employees in the public service, by the way. But our managers and our employees are not on performance pay. They're on salary and they do get overtime and things like that.

Work is tracked. People are held accountable for delivering their work. There is a quality assurance program that is relatively new, but there is a quality assurance program to ensure that the work performed by the employees is meeting the criteria or requirements of the acts. We have to remember that this is all in law, right? Our stuff is in law.

I forget if I answered all your points.

[Sherry Romanado, Liberal, Longueuil—Charles-LeMoyne, QC]

I don't want to single someone out, but it you have an employee who is making errors, is there training involved and, after training is provided, a performance evaluation? Are you managing that performance?

[Michel Doiron]

Absolutely, and we have gone even further. We have restructured that division and now have what I call “tech advisers” and managers. That used to be one position. I have split that position now, to have more accountability and to make sure that the performance is being managed.

The technical side—because there are some very technical cases here.... It's on them that the daily learning occurs, and people are held accountable.

[The Chair, Liberal, Neil Ellis]

I think we might have to trim one minute off everybody's time, if we are going to get everybody to their next meetings.