National Defence Committee on June 2nd, 2023

[The Chair, Liberal, John McKay]

Thank you.

Mrs. Gallant, you have four minutes.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Mr. Chairman, this seamless medical care does not occur for families being posted, nor does it occur for families being transitioned. They can go through an entire eight-year posting at Petawawa and never get to the top of the doctors' waiting list. The same goes for when they're transferring out.

Is it time for Canada to consider having military families, the spouses, treated on the base by the doctors who are already there?

[Steven Harris]

Again, that's a question that my Canadian Armed Forces colleagues would have to answer. We are looking to support, as Ms. Ogilvie has referenced, a telemedicine pilot to help support veterans and their families and transitioning members to be able to get access to at least temporary medical assistance in health, in terms of having a family doctor from a call, while they're waiting to get access through these provincial systems.

We recognize that challenge. We're working to help support it from a veteran point of view.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Telemedicine doesn't work when a child has a specific medical condition for which they need a specialist. Again, going all the way from Petawawa to Fredericton or Halifax every time for a specialist is very taxing on a family. We're trying to rebuild the Canadian Armed Forces. These are exquisite times. Is it not time for a unique approach to taking care of the military families?

[Steven Harris]

I think that's actually the genesis of what Seamless Canada is really about. They're talking about it for certainly still-serving members, but the application for veterans and those transitioning out of the military is equally there. I participate as part of the Seamless Canada working group as well. I know that our provincial colleagues are recognizing the fact that they need to try to help address these situations. The member raised the situation of wait-lists for specialist appointments for families, for children and for others. This is a significant concern. It has impacts for, as we've discussed, recruitment, retention and other issues.

I'm not sure if Ms. Ogilvie wants to add to that.

[Laurie Ogilvie]

I also would have to defer to the Canadian Armed Forces. I will go back to my original point and say that there is the same lack of doctors within the Canadian Armed Forces as there is in the general Canadian population. It's a lack of doctors.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Yes. They're already there, though.

For transitioning from one province to the next, how long does it take for the spouse and children to obtain provincial health care? I understand that it's only in unique circumstances that they will be granted elimination of the three-month waiting period.

[Laurie Ogilvie]

That was one of the discussions we had at Seamless Canada last week. It was around families not having to be already physically relocated into the community before being able to apply for a health card. The conversation we had was around whether provinces and territories would be willing to provide that exception so that, for instance, families in February, knowing that they're going from Gagetown to Borden in June, could apply for their health cards.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

It's posting time now. People are getting their marching orders on where they have to move. This isn't in place yet, so it's going to be yet another year at least before these waiting periods can be waived for the families and children.

[Laurie Ogilvie]

It's not a decision of the Canadian Armed Forces. It's a decision of the provinces and territories to do that. The answer is yes. There still will be a wait to be able to get your health card until you can go and give them your address in that particular community.

[The Chair, Liberal, John McKay]

Thank you, Ms. Gallant.

Ms. Lambropoulos, you have four minutes, please.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you, Chair.

I'd like to begin by thanking our witnesses for being here with us to answer some more questions.

I'll apologize in advance if you guys have touched a bit on this already, but I would like to get a bit of a deeper understanding to see if you have any recommendations on this specific issue. We've heard in past committee meetings that one of the biggest issues is that a lot of veterans often don't necessarily have issues upon discharge. The issues come up later. PTSD often shows up and creeps in a few years later on. It may not appear when they're discharged, when they have that caseworker specifically working with them on the issues that they're currently dealing with, so they often report having more difficulty receiving the support they need.

I know that there is support offered to all veterans who ask for it. That's what we've heard, but it does appear that they don't always know that they can ask for this, or they don't always know who to reach out to and where to go to receive the support. Do you think there is anything we can recommend in a study that would help either continue that relationship with the veteran or make it so that there's an easier process in place for them to receive the help they need?

[Steven Harris]

Maybe I'll start, and then ask Ms. Hicks to join in to answer.

There is no wrong time for a veteran to come forward to Veterans Affairs to seek benefits. We have programs that support people immediately upon their transition. We have programs that continue to support them through their progressive age and their changing needs, from rehabilitation or transition and supports in terms of education and career transition services, to supports in disability benefits, to supports in terms of income replacement, and on and on. There is no wrong time. We have people come to us at all ages, as you have noted, as the members noted, who may only discover they have a disability, or they may have a barrier as a result of their service later on in their life or their career. We need to do that.

From the point of view of the question of what else we can do, we need to continue to promote the benefits and services that Veterans Affairs has available at the time of transition, at the time of serving in the Canadian Armed Forces, through the rest of their lifetimes as well, to make sure that they're aware of those things. We certainly do that work now to try to make sure that people are aware of all the benefits and support services that are available, and we don't have a limitation. If people who have needs come to us, there is not a cap at a hundred veterans we can support at a time, or a thousand or ten thousand veterans. As many who need help and come forward can get the assistance they need, and we want to continue to promote that.

Maybe I could ask Ms. Hicks if she has some additional elements here.

[Jane Hicks]

There are just two points that I wanted to raise. Right now we are investing significant efforts in the transition process to make sure that all veterans are aware of the benefits and services when they release, and that they sign up for My VAC Account so we can push information out to them.

Also, we work with stakeholders and others to make sure that they are aware, so that if people come in touch with veterans who need assistance, they also know that they can refer them to us. We're really focusing on awareness and education at all levels—regional, local and national levels.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you so much.

I have one last question. We have felt and have heard that there are cultural changes taking place in National Defence through the Arbour report and just in general. There are lots of changes being made so that gender is taken more into account and so that women's needs are better met. I'm wondering if this has also transferred onto Veterans Affairs. Can you comment on whether or not there is gender-based analysis plus being put into the programs that are being offered, whether that analysis is being used in the programs that are being offered, and whether or not there is anything specific being done for the women who have retired from the armed forces?

[The Chair, Liberal, John McKay]

Ms. Lambropoulos has blown through her time, but having said that, maybe you could just briefly respond.

[Steven Harris]

The short answer is yes. There are a number of things that are being done within the department to help support women veterans. A number of years ago, we started the office of women veterans and 2SLGBTQI+ to help assist and recognize some of the challenges that may be faced by women veterans in the community in terms of approaching and getting benefits from Veterans Affairs. We've made changes to our benefits structure and made changes to things like our table of disabilities, when we look at adjudication, to make sure there is equity and fairness in terms of what we're doing on that front.

We've held a number of forums and do routine consultation with women veterans to make sure that we're hearing from them about the challenges they're facing in making adjustments on that front. Perhaps I'll leave it there.

[The Chair, Liberal, John McKay]

Thank you, Ms. Lambropoulos. That brings this first hour to a close. On behalf of the committee, I wanted to thank all of you for your patience earlier in the week and for returning here today. That is greatly appreciated.

With that, colleagues, we'll suspend and then empanel.

[The Chair, Liberal, John McKay]

We're back on.

We have with us today virtually Dr. Ayla Azad, chief executive officer, Canadian Chiropractic Association. Dr. Andrew Bennett from Cardus is joining us in the room, and Dr. Matthew McDaniel, clinical director of the Veterans Transition Network, is also joining us on video conference.

We are already seven or eight minutes past where we should have been. I'm going to ask you to be very tight on your five-minute opening statements.

Colleagues, we're already going to have to chop some time.

Go ahead.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

To that point, I don't want to waste more than about 15 seconds here. Doing witnesses in two panels like this contributes to our inability to get in rounds of questions. I would ask that, in the future, we run them together for two hours straight so we don't lose the transition time.

[The Chair, Liberal, John McKay]

Then we'd have to merge six people on the panel.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Exactly, yes.

[The Chair, Liberal, John McKay]

That creates its own problems.

Anyway, we're back to asking Dr. Ayla Azad for an opening five-minute statement. We'll go from there.

Thank you very much.

[Dr. Ayla Azad, Chief Executive Officer, Canadian Chiropractic Association]

Thank you, Mr. Chair.

I would like to begin by thanking the members of the Standing Committee on National Defence for inviting me on behalf of the Canadian Chiropractic Association and the 9,000 doctors of chiropractic across Canada we represent.

I'm sorry I missed you in person on Tuesday, but I'm happy to join you virtually this morning.

I want to acknowledge that I'm joining you from the traditional lands of the Haudenosaunee, Huron-Wendat and Anishinabe nations, and it is my honour and privilege to be here.

It's takes eight years of education and 4,500 hours of clinical training to become a doctor of chiropractic. Chiropractors are trained to be primary care contact professionals with the ability to assess, diagnose and treat spinal, muscle, nerve and joint conditions, also known as musculoskeletal, or MSK, conditions. These conditions such as back pain, headaches and neck pain have a devastating impact on Canadians' health, quality of life, workforce participation and the economy. According to the World Health Organization, MSK conditions, specifically low back pain, are the leading causes of disability around the globe, and more than a 11 million Canadians suffer from musculoskeletal conditions every year.

Due to the physical demands put on active military personnel, MSK conditions like back and neck pain are double that of the general population. MSK injuries are also a major occupational risk for a military career and are responsible for 42% of medical releases. These conditions are a key issue for transition services, as 59% of Canadian Armed Forces veterans who report difficult adjustment to civilian life had chronic pain.

We are all here today because we want to help our women and men in uniform stay healthy and pain free. We feel chiropractors are part of the solution, but there are two barriers we want to bring to your attention, barriers to access to care and inadequate benefits coverage.

Yes, armed forces members do have access to some chiropractic care, but in order to receive treatment, they first need to get a referral from the on-base clinician. Most Canadians can simply walk into a chiropractor's office to get care. The requirement of a referral before accessing chiropractic care is not required in any provincial or national health regulation and is not best practice in the health insurance industry. Veterans in the RCMP can seek care when they are in pain without this requirement.

There's well-documented research that patient-centred care includes choice of provider. This results in improved outcomes. Some people respond well to physiotherapy. Some people respond well to chiropractic. Some may need both. It seems disrespectful that our brave Canadian Armed Forces members don't have the same choice and require a referral.

This requirement also takes time. It takes time to see a physician. They take a history. They have to perform their own assessment, and then usually the patient is required to first try a course of treatment with on-base staff. Then, when that doesn't work, they might get a referral to book an appointment with a chiropractor, who then has to go through their own processes. This causes significant delay in accessing care.

As a clinician and a chiropractor, I know the sooner I can see the patient, the shorter the recovery period and the better the outcomes. When care is delayed, acute cases become more complex and potentially chronic. We hear stories of Canadian Armed Forces members waiting weeks to get their required referral. Many are paying out of pocket so they don't need to jump through these hoops. At a time when health care human resources are spread thin in the armed forces and across Canada, we need to streamline and reduce duplication.

Secondly, the benefits offered through Medavie Blue Cross only cover 10 visits. This might be enough to cover an acute case of injury, but we know that MSK conditions like low back pain can reoccur, and there is a chronicity to them. Veterans, for example, get access to 20 visits.

Our chiropractors are ready and willing to follow the protocols and reporting requirements that are necessary to interface with the armed forces. We already have the training to do so. Culture change is hard and takes time, but we are asking this committee to encourage the removal of the barriers that are preventing Canadian Armed Forces members from getting the care they need. The prevalence of MSK conditions among active service members means chiropractic can play a role in improving health outcomes and quality of life.

We feel that the brave women and men of our armed forces deserve choice and the very best in health care.

Thank you again for inviting me to appear before the committee.

[The Chair, Liberal, John McKay]

Thank you.

Dr. Bennett, you have five minutes, please.