Good morning, honourable members and colleagues.
Thank you for your invitation to appear today as part of your study on the military health system and the provision of health and transition services under the Canadian Forces Health Services Group. I didn't add veterans there as I kept serving.
As the chair mentioned, I am a senator but I'm also a veteran, having just recently retired from the Canadian Armed Forces as a rear-admiral. I'm a service spouse. I'm a mother of two. I'm also a military mom, because my son is a reserve force member.
I enrolled in the Canadian Armed Forces in 1989 as a nursing officer. During my 34 years with the military, I've been posted across Canada and deployed overseas to Saudi Arabia, Somalia and Afghanistan. I've served as commander of 1 Health Services Group in Edmonton, covering the west and north of Canada from a health perspective. I was the deputy commanding officer of the Canadian Forces Health Services Group and ultimately the commander—or, in effect, the CEO and COO—of health services within the Canadian Armed Forces.
I continue be a member of the College of Nurses of Ontario, the Canadian College of Health Leaders and the Royal Canadian Medical Service Association. Suffice to say, I have quite a bit of experience in the domain we are about to discuss today.
The military health care system is not like the sort most Canadians are familiar with. Unlike provincial and territorial health care systems, the military system provides a spectrum of occupational health services in Canada. This includes medical, dental, pharma, mental and physical health across Canada and around the world. However, it is also responsible for medical and dental procurement of material and equipment, research and development, logistics and recruitment, retention and the training of military health human resources.
International operational health services support involves a high degree of interoperability with our allies and within multinational alliances like NATO and ABCA. The Canadian Forces Health Services Group is, in essence, Canada's 14th health jurisdiction, because serving members of the Canadian Armed Forces are excluded under the Canada Health Act. Despite paying provincial taxes like any other resident, CAF members are not issued provincial health cards and cannot access health care delivery via their respective provincial health care systems. Instead, CAF members receive health services through military health care facilities and not via a local provider in their community.
Health services that are not provided by the military are sourced through the provincial health care system, or through private medical and dental facilities. The CAF must purchase those health services for its members from providers, often at exaggerated rates, just like non-Canadians.
Despite what you've heard, funding for the health care system, which includes everything I've previously mentioned, is a concern. As recently as 2018, an internal evaluation of military health care found that in the period between 2010-11 and 2016-17, so pre-COVID, health care spending in Canada generally rose at a rate of 3.3% per year. In other words, it was greater than the national inflation rate, whereas within the Canadian Forces, it was only funded at 0.7%. This demonstrates the diminished buying power within the CAF relative to the health care it is expected to provide.
As I've mentioned, the CAF often purchases services for its members at higher rates despite having less to spend on health care. This is where the Minister of National Defence, with her respective colleagues in health and intergovernmental affairs, can emerge as a champion for CAF members by working with provincial governments to negotiate better rates more closely aligned with those charged within the provincial health care systems, if not the same rate.
However, colleagues—and I use the term “colleagues” because we are fellow parliamentarians—funding isn't the only issue. There are structural issues related to service delivery and to the human resource side of health care provisions in the military. Health service personnel in the CAF are fully trained sailors, soldiers and aviators in addition to being health care providers. You can appreciate there is no other career quite like it.
You've talked about retention. Salary and quality of life are often higher outside the military for health care providers. We're posted all over the world on a regular basis, and it's extremely hard to maintain required clinical competencies. There is also a mental and physical toll. While the CAF is not a licensor or regulator of health professionals, there is an opportunity for the CAF to lead on either a federal regulatory approval system or greater interprovincial recognition of licensing, in other words, portability.
As I mentioned, military health care is unlike the provincial medical or dental care systems. Given resource challenges within CFHS, both human and financial, coupled with the urgent need to recruit new and more diverse CAF members in general and policy changes that have led to the retention of members for longer and with more complex health requirements, it is critical that we rethink health care in the Canadian Armed Forces.
Thank you. I welcome your questions.