Thank you, Mr. Chair.
Thank you for the opportunity to explain a little about the Canadian Forces health care system, and more specifically how we provide health service support to the troops in Afghanistan.
My name is Commodore Margaret Kavanagh. I am the director general of health services and commander of the Canadian Forces health services group. Joining me, as you have said, is Brigadier-General Jaeger, the surgeon general.
I'd like to preface my comments by providing a brief explanation of why there is a separate military health care system in Canada. The Constitution Act of 1867 assigned sole responsibility for all military matters, including military health care, to the federal authority. The National Defence Act gives the Minister of National Defence the management and direction of the Canadian Forces, who in turn gives management and direction of the medical and dental services to the Canadian Forces.
In addition, the 1984 Canada Health Act specifically excludes Canadian Forces members from the definition of “insured persons”. We are also excluded from insurance coverage under the public service medical and dental care plans. Accordingly, the Canadian Forces leadership has a strong legal and moral obligation to provide comprehensive health care to Canadian Forces members, whether in Canada or abroad. In return for the commitment and unlimited liability to serve their country, Canadian Forces members must be provided with health care comparable to that which is provided to all Canadians, yet tailored to meet their unique needs.
The Canadian Forces health care system has many facets. In today's construct, it is inextricably linked with the Canadian health care system, both federally and provincially. You may want to understand more about how we provide health care in Afghanistan. To do so, it is important to first understand what we do at home.
Our activities in Canada, medically and dentally, prepare personnel for deployment and provide care to those who need it upon their return. We carry out public health and health protection functions; acquire medical equipment and pharmaceuticals in conjunction with the civilian sector; train health care professions; and provide direct patient care, predominately in the primary care setting. Almost all specialty care, in-patient, and rehabilitative services are now acquired from the civilian system, through a variety of arrangements.
Health care in general in the 21st century is very complex. It requires appropriate professional oversight. As the director general of health services, I am responsible and accountable to the CDS, through the chief of military personnel, for the leadership, management, and administration of the health system. As the commander of the Canadian Forces health services group, my job is to generate and sustain combat-ready health services units, subunits, and individuals who are capable of supporting the navy, the army, and the air force in operations. This includes the professional development, training, and preparation of health care personnel in order to meet their operational roles. Within the Canadian Forces health services, there are 19 different occupations, ranging from specialist medical and dental officers, to a variety of medical and dental technicians, all of whom have unique training and professional development requirements.
The surgeon general, as the senior Canadian Forces physician, focuses on the professional oversight of the clinical practice of medicine in the Canadian Forces. Likewise, I have a counterpart to the surgeon general, the director general of dental services, who has professional oversight of the practice of dentistry.
Brigadier-General Jaeger's main duties include the setting of clinical policies; the delineation of clinical scopes of practice, which in layman's terms means deciding what health care providers should be authorized to undertake what types of tasks; the determination of clinical and professional content for both formal CF courses, such as those offered at our school in Borden and what we call the “maintenance of clinical skills programs”; and the final review of complaints pertaining to clinical care or the occupational health aspects of CF practice. The surgeon general sets the CF's priorities for medically related research, acts as the interface between the CF health services group and the various provincial licensing bodies, and is the guardian of the clinical professional ethics of the suitable practice of medicine in the CF context.
An approximate civilian comparison to the two of us would be that of a hospital CEO with his or her respective chief of medical staff. I say approximate, because the health system aspects of a military health care organization makes the duties far more complex than those experienced by a single institution. I myself, my command team, along with the medical and dental professional leaders, work together to provide a continuum of health care to military members at home and on overseas missions.
To do so, the Canadian Forces health care system carries out many of the policy functions of Health Canada and the Public Health Agency, the health care delivery functions of the provincial health systems, the occupational health functions of the workmen's health and safety system, plus the equipment and pharmaceutical acquisition and distribution of the civilian sector. We also work closely with several other federal government departments, especially Veterans Affairs Canada, to ensure the most appropriate service for Canadian Forces members while still serving or as they transition to civilian life.
When the Canadian Forces health services group is directed to deploy on operations, we commence an operational planning process to determine what health services are required for each and every operation. First and foremost, we assess the risks based on the mission, the tasks assigned to the Canadian Forces personnel, and the geographical location of the mission. Through our medical intelligence, we know what naturally occurring health risks exist in the area of operation—for example, malaria—and we recommend the appropriate countermeasures.
Likewise, our intelligence gives us information about the state of the host nation's health care, so we can determine exactly what Canada, or Canada in conjunction with its allies, needs to provide to the mission. We must include everything from preventative measures to routine care, both medical and dental, to full specialist and surgical capability. We must have a robust chain of evacuation on the ground and/or in the air to meet the tactical need, but we must also have strategic air evacuation to bring patients back to Canada.
All of these aspects of health care are currently being met in Afghanistan through robust multinational arrangements and our facility located on the Kandahar airfield. We also have arrangements with our coalition partners that in the event of a mass casualty that overwhelms our facility they will take our patients.
In conclusion, providing effective health service support to the troops in Afghanistan requires not only a robust capability on the ground, but also the appropriate pre-deployment preparation and post-deployment rehabilitation. To accomplish all of these tasks, the Canadian Forces requires health care personnel who meet a high level of excellence as military and health care professionals, supported by an effective civilian health care system.
Finally, we are providing this level of support at a time when all western nations are struggling to meet the personnel demands of their health care systems. Nonetheless, the military and civilian health personnel working within the Canadian Forces health care system are dedicated to the health and welfare of the men and women serving in the Canadian Forces.
This concludes my opening remarks. I'll ask the surgeon general to address some of the clinical issues relevant to the current operational tempo.