National Defence Committee on April 28th, 2023

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Historically, having psychiatrists, psychologists, therapists on the mental health side has always been a challenge. I think a lot of that has to do with location, and money talks. The other side of it, of course, is the overall crisis in mental health itself, not just in the forces but right across the country.

[The Chair, Liberal, John McKay]

It's a good question. Unfortunately, you're going to have to answer it at another opportunity.

With that, we have Ms. O'Connell for six minutes, please.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Sorry, Mr. Chair, but we're getting the French translation on the English channel.

[The Chair, Liberal, John McKay]

Very well. You have the floor for six minutes.

[Some hon. members]

Oh, oh!

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

I can't hear anyone else, so it's not just for me: It's that I can't hear the witnesses. Can you make sure that this is fixed?

[The Chair, Liberal, John McKay]

Do you want to move on until we correct that? What's the issue?

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

No, I can answer, but I'm just saying that it's translating into French, so I can't.... I turned off the sound to hear the answers, so can that be corrected before I start?

[The Chair, Liberal, John McKay]

Okay.

Can you talk about the weather for a second?

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Hi, Mr. Chair.

I'm home in my riding. It's beautiful and sunny.

[The Chair, Liberal, John McKay]

Okay. It sounds as though it's fixed.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Okay. Thanks so much.

Thanks to all of our witnesses for being here.

General, you spoke in your opening statement about some of the gaps, in particular with respect to health services for women and persons of diverse backgrounds.

The presence of women in the Canadian Armed Forces is not new, so I wonder how long these gaps have existed, and I'm very concerned to see that these gaps exist currently. Can you elaborate on what some of these gaps are?

[LGen Lise Bourgon]

When we look at the CAF—and some of you have probably heard me say it before—we see that the CAF was built for men by men. Those are the policies. Those were the services that we provided to the majority, and that's what we need to change, and we are changing to become more inclusive.

A big part of that is looking at the health services, doing the gap analysis and coming up with programs whereby women and gender-diverse members will feel valued and we will look at each member as an individual.

I think I'm going to pass the floor to General Bilodeau, who is responsible for the women's health and diversity file.

[Major-General Marc Bilodeau, Surgeon General, Canadian Armed Forces, Department of National Defence]

Thank you, General Bourgon.

Mr. Chair, that gap in the women's health data and research is not unique to the military. It exists in society. Most of the research in health care, unfortunately, historically, has focused on males, and there's very little data on many conditions related to women. Obviously we're impacted by that in the military, which means that more research is required in order to inform better care for women.

That goes from preventing injury and diseases to managing health conditions in a military environment, which is the area that is unique to us and one that we need to study more.

We're doing an honest job regarding women's health. In our screening for breast cancer and our data on cervical cancer, for example, we're on par with Canadian society. That being said, we can do a lot better. That's why we're very fortunate to have been funded through the last budget with a significant amount of money to build a women's health program. That program will be based on four pillars, one of which is improving the health care that we provide to our women. That speaks to the quality of the care but also to the spectrum of care itself, because there are some items currently not covered that women would benefit from having covered.

We're looking at injury prevention, and for that we're in partnership with our partners, the directors general of morale and welfare services, who are, basically, our fitness providers.

With respect to research and engagement, I spoke about research. There are lots of gaps there. We are going to engage with our research partners in order to fill those gaps from a research perspective and have better data to be able to monitor the health of women as well as the efficacy of our preventive measures and treatment measures.

Finally, we need to measure what we do. We need to have better quality and performance measurements regarding the health of our women. We lack data, and we need to build that data in order to make sure that what we do ultimately leads to improvement and better results.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you.

In a previous answer it was stated that there are clinics around the world for serving members and that if the services on the ground or for the mission can't accommodate the injury, a member can be moved to a clinic.

How many clinics are there around the world, or is that in relation to the number of missions there are? Could somebody perhaps elaborate on what those clinics look like and how they are employed? Are they CAF members, or do you rely on the local expertise to staff those clinics?

[LGen Lise Bourgon]

Thank you for your excellent question.

It depends on the location of our troops.

I'll give the floor to you afterwards, General Malcolm.

In some areas we have our own clinic, but in some areas we only have our own integral medical support. We can also tap into the environment, so if it's a NATO alliance, we will use other alliance medical capabilities. If we're deployed around the world, in some countries we will also tap into the national medical services, depending on where we are.

Scott, do you want to add to this one?

[BGen Scott Malcolm]

Thank you, Ma'am.

To carry on, in Canada proper, including our clinic in Geilenkirchen, Germany, and in Belgium, we have 37 clients. We would characterize those as enhanced primary care, meaning that you don't just have access to doctors, nurses, physician's assistants and nurse practitioners; in most of those clinics you also have access to a pharmacist and, in some of our larger centres, to X-rays, and in some of our largest centres, a CT scan.

You also have access to labs, and in 31 of 37, you also have access to mental health services, which could include psychiatrists, psychologists, social workers and mental health nurses. That's why I would say it's more of an enhanced primary care.

In our overseas deployments, currently in Kuwait, Latvia, Poland and the Indo-Pacific on our ships, we have integral medical support, meaning it is provided by our folks. Both overseas and in Canada, as was alluded to by Lieutenant-General Bourgon, if there's a service that's required that's not immediately available or is not of the right type, we're able to refer members out, whether it's in Canada to our civilian partners or overseas to validate—

[The Chair, Liberal, John McKay]

Unfortunately, we have to leave the answer there.

Thank you.

Madame Normandin, the floor is yours for six minutes.

[Christine Normandin, Bloc, Saint-Jean, QC]

Thank you very much.

It is always a pleasure to have you here. Thank you for being with us today.

I want to follow up on the discussion started by Ms. O’Connell about the status of women. I also want to touch on the sharing of information by the CAF with other entities. Yesterday at the Standing Committee on Veterans Affairs, it was said that data gathered by the CAF were not necessarily adequately shared with other organizations, such as Veterans Affairs Canada.

We know that many female members are released from the armed forces for medical reasons. For instance, military equipment is not always adapted for women, even if things are improving in that regard. Veterans Affairs Canada, in that sense, is sort of like an insurance company that only considers symptoms while ignoring root causes. There is no feedback loop.

Are you aware of this problem? How can that situation be handled?

[LGen Lise Bourgon]

Thank you very much for that excellent question.

We need to keep working on this issue. We know that there are gaps in information sharing. The Veterans Affairs working group, among others, is examining ways to streamline the flow of information. That work will have to be extended to provinces and territories in the future, because the data is vital for handling the situations veterans find themselves in after they leave the forces.

I would like to turn to Major-General Bilodeau, who will give you specific examples of what is being done currently and what is projected to remedy this in the future.

[MGen Marc Bilodeau]

Thank you.

I think this is a major issue for me as surgeon general, because my job is to ensure the safety and quality of health care. Mismanaging the transfer of information has a negative impact on the transition from military to civilian life. Transferring information, in that context, is critical. We recently launched a great initiative to give Veterans Affairs officials access to CAF members’ electronic medical files in order to simplify data sharing. That is done internally between two federal departments.

As far as information sharing between the federal and the provinces is concerned, that is another question entirely. That is no easy task, because we have to find 13 different solutions, one for each province and territory. There is a lot to do on that front. Currently, we give CAF members a copy of their medical file when they are released, so they can have the information if they need to give it to another organization. There is no way to do that electronically, because there is no single medical file per province. Some have only one, but the majority have many different electronic medical files. We will need to pay close attention to this to make sure that information transfers are done safely and securely.

[Christine Normandin, Bloc, Saint-Jean, QC]

Thank you very much.

I'd like to pursue the same line of questioning.

There seem to be two problems with the transfer of medical records to the provinces. The first is that the first two years are the most critical part of any transition, but the provinces are short on doctors and it isn't unusual for new veterans to not be able to find one. The second issue is that, even when they have access to the medical records, some doctors believe that their code of ethics requires them to start the process over from the beginning.

Are there any initiatives that would allow new veterans to keep having access to Canadian Forces health services for a year or two to ease the transition? Are such avenues being considered?

Is it a human resources issue or more of a financial issue?

Some people have explained to us that they have expertise as physician assistants in the armed forces but can't work as civilians because their credentials aren't recognized. And yet, they could work for the federal government and help our troops in their transition.

I'd like to hear your opinion on this. Are these realistic solutions?

[MGen Marc Bilodeau]

Thank you, Mr. Chair.

Thank you for the question, Ms. Normandin.

It's true that the transfer of care during the transition to civilian life can be problematic due to the issues with the civilian health care system. As you're no doubt aware, the system is unable to meet current needs.

We've implemented a process by which our members can stay in uniform longer to ensure a safe transition. This is something that we manage in partnership with the transition group. We're ensuring that our members have access to all of the health care and support they need. That allows us to bridge the gap, so to speak, in light of the resource availability issues on the outside.

We're looking at a number of initiatives with Veterans Affairs Canada with the goal of improving access to family physicians when our members leave the Canadian Forces. For instance, in partnership with the College of Family Physicians of Canada, we've put together a document to help family physicians understand what life is like for veterans and to encourage them to take patients that were released from the armed forces into their care.

We're obviously looking into the options you mentioned, like utilizing professionals with varying backgrounds. Physician assistants are increasingly popular in Canada. The majority of provinces agree on the issue of allowing physician assistants to practise. Those that haven't quite come around yet are getting in touch with us to get the benefit of our experience in the matter. The Canadian Forces have been employing physician assistants for 50 years now. It's a profession we understand well, and we know that physician assistants can help improve access to primary health care and reduce the backlog in the health care system.

[LGen Lise Bourgon]

I'd like to add something about the transition group.

Before members are released from the Canadian Forces for medical reasons, there's an assessment to ensure that it will be possible to transfer their medical records to the civilian system. Those who are released from the forces aren't left to fend for themselves in the jungle; they have support. We ensure that they're ready to be released from the forces. The beauty of the transition group is that files are managed on a case-by-case basis, and members' personalities are taken into consideration.

There's also the Maple service, which offers transition services to members released from the forces who don't yet have access to health care in their province. It's a telemedicine network that they can access—

[The Chair, Liberal, John McKay]

Unfortunately, again we'll have to leave it there.

So that I don't continue to cut off a bunch of generals, just look up here every once in a while. I'll try to indicate where the time is at. That way I won't feel like I'm interrupting important answers to important questions.

Ms. Mathyssen, it's your important question, please. You have six minutes.