Public Accounts Committee on Jan. 31st, 2008

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

On page 21, it says that “eight out of ten physician assistants who tried but did not pass the certification exam were providing direct patient care”. Is that still going on, and are they being compelled to comply now?

[BGen Hilary Jaeger]

The timing was a bit unfortunate. We had another rewrite of the certification exam very shortly after the report went to press, and I can't tell you that eight out of ten aren't practising, but I can tell you that anybody who is practising who has not passed the credentialing exam is practising under direct supervision. They are not independently ordering medications or tests.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Sweet.

Thank you, Brigadier General Jaeger.

Mr. Christopherson.

[David Christopherson, NDP, Hamilton Centre, ON]

Thank you, Chair. I appreciate that.

I am pleased to have here my colleague, the member for Sackville—Eastern Shore, the hard-working veteran affairs critic. He is going to provide the lead for us on this file, so I'm going to turn it over to Peter.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you, Mr. Chairman, and thank you, committee members, for the opportunity. And to the Auditor General, thank you, and to our distinguished guests, thank you very much for your service to your country as well.

I have the privilege and honour of representing the Shearwater air base. Twenty percent of my riding is either currently serving or retired military personnel along with their families, and I couldn't help but notice that in the brief you presented to us, sir, you didn't mention the word “families” in the first paragraph.

I don't know if you recall, but last year in The Globe and Mail there was an article of a soldier sitting in the background, and his kid was in the front, and the caption was “Dad, if you die in Afghanistan, I'll never forgive you as long as I live. Now go serve your country.”

There was an ombudsman report from André Marin, the former defence ombudsman, slamming both the Ontario and federal governments for ignoring the needs of children who have lost parents in Afghanistan. And I couldn't help but notice at exhibit 4.3 on page 14 of the Auditor General's report that although there's a moral obligation for the Government of Canada to provide treatment to family members or their loved ones who suffer from PTSD and other concerns, there's no legal requirement. It goes on to say that they're unable to extend member care to include family support because of resource shortages.

As everyone knows, when you're serving overseas for your country, or serving anywhere in the world, your thoughts are always back home with your family, and if the families aren't getting the care they need, then I don't think the soldier can perform up to speed as we would ask them to do.

Is the defence department improving family services, not just through MFRCs but through resource allocations and things?

My other question is about reservists. When reservists come back, they don't go to a base. They either go to universities or back to their jobs. And we found on the veterans affairs committee that the Government of Canada has a hard time tracking where the reservists are, to see how their mental or physical states are.

My question is for the Auditor General. Did you also include reservists' information when you were doing your data report?

And to the military, what are you doing to include reservists, to ensure that they're well cared for?

[MGen Walter Semianiw]

I'll begin first on the question about reserves, and then I'll move back to the family.

Firstly, we in the Canadian Forces would agree with everything you've said. Clearly with everything we've seen, we've known, we've practised, and that's in our culture, a strong family is the bedrock of operational effectiveness. I agree with you there.

On the reserve piece first, when we look at reservists, we have to understand there are different types of reservists. There are those who are doing it part-time, 30 days a year, called class A reservists, and those who actually help fill in full-time in the regular force and those who go on operations.

As you're probably all aware, the number of reservists going on the next deployment is almost 500, and it will continue to be that, so it's an issue that had to be addressed. As such, the department and the Canadian Forces have addressed this in the last year and will be addressing this in the next two months in four areas.

First, if I'm a reservist part-time, and I'm out there and I get injured getting ready and keeping fit on my own, who is going to look after me? Right now, when we take a look at the policy, it's not in place, but I know that we have a piece of policy that will hopefully be implemented in the next 30 days, which will state that if you are a class A or part-time reservist, and you get injured staying fit--and it's one component of the whole issue--you will be covered for pension purposes and with Veterans Affairs. That's the first piece.

The second question was, if I'm a reservist and I'm training for operations and something happens to me, who's going to look after me? This all comes back to the family. In September we put out a policy that stated that if you are a reservist and you are training back in Canada for an operation, you are covered for pension purposes and by Veterans Affairs if you are injured.

Next, two months ago we put out a new policy that states that if you are a reservist coming back from operations anywhere around the world, and you are injured and you're sick, you will stay on class C, that's full-time service, to receive the full suite of benefits that a regular force soldier would, until not only the medical system but your leadership says you're ready to transit back to be part-time, be it 30 days or a year.

Finally, we are looking at the last piece, and that is the transition interview piece. This is connected to the Department of Veterans Affairs, so I'll speak about it briefly. You could address the question to them. This is to ensure that the part-time reservists--and that's the challenge, reservists who are working with us full-time on class B or class C--we do look after. You have a leadership chain. You have a structure. They're with us. They're close to us. But in the reserves, as you know, they're across the country.

What will happen is a class A reservist who has trained for operations and who has been in operations will receive a Veterans Affairs transition interview before they leave the military, and that will ensure that they get connected, Mr. Stoffer, to Veterans Affairs before they leave.

We think that with those four pieces there, those policy pieces, we're finally starting to address it.

Structurally, General Jaeger is about to put into place nurses into the reserve field ambulances across the country to help manage, to help coordinate, to help assist our reservists out there to work through this environment with Veterans Affairs and others so they get the best care and patient care that they can.

So that's the reserve case.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you.

[Sheila Fraser]

Mr. Chair, we did not include services provided to reserve force members within the scope of this audit.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

One gentleman and his wife in my riding went to an OSISS centre. They were told they could only get ten treatments and that's it.

Most psychologists indicate that treatment for an injury between the ears could last a lifetime. Why would there only be ten treatments, and not continuous treatment until they could be deemed mentally capable again?

[MGen Walter Semianiw]

It's not an issue that they are only going to get ten treatments. It's that we can give ten treatments and then the health care system of the province would continue that support.

There is a continuum of care. But you're right: all the soldiers, sailors, airmen, and airwomen I talk to want to stick with the mental health care provider they began with. That's what they're probably saying to you. It's something we have to look at.

On the family piece, if I may address that now, you're right, the bedrock of operational effectiveness, in large part, is the family. When a soldier is away on any mission, anywhere around the world, we want him to focus on that mission. The way to do that is to ensure he knows his family is being looked after while he is away.

We address that. A number of years ago the Canadian Forces and the department established the military family resource centres across the country to begin to address that need. We are very shortly going to establish a director of family services for the Canadian Forces. It will take place in about three months. That individual, on both policy and service, will start to bring in more coherence.

There's a lot more. I'd be more than happy to come back and talk to you on this at any point.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Stoffer.

Mr. Holland, please.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Thank you, Mr. Chair, and thank you to the witnesses for appearing today.

I want to come back to something that I think is the dominating issue here, which is mental health care services. I am going to summarize the concerns I have and ask some specific questions, because I really don't think we have some answers to this point.

We know from the questions and the report of the Auditor General that we don't have firm numbers on how many of those serving in our armed forces are receiving care for mental health disorders. Brigadier General Jaeger said that you may have the data in a couple of years' time. That concerns me, and I want to come back to that in a second.

We also know we can't meet the demand. When soldiers come back from theatres of operation to Canada, we simply can't meet all the demands for mental health care services.

If we flip the number you gave us before, instead of saying 75% are dissatisfied, we know that in 2002 only 25% were satisfied. That was some time ago. You say there are changes. There hasn't yet been a survey to assess the current status. The only answer to that was “maybe in a couple of years' time”.

We have a critical decision to make as to whether we will extend the mission in Afghanistan. The government wants to do that. Yet we were told that we have no firm grasp on the status of mental health care for our armed services in a theatre that is putting our soldiers in a very difficult and mentally stressful situation. This has generated a lot of questions for Canadians.

Let me come back to this. Instead of saying that maybe in a couple of years' time you'll have that data, specifically what are you doing to ensure that we will get that data, and what date will we have it by?

I am starting with the simplest question. How many of our armed forces are actually receiving care for mental health disorders today?

[MGen Walter Semianiw]

I`d like to first come back to the issue of time. And I think I made the comment, not General Jaeger.

I want to clarify something for the committee, because I think it's getting lost in some of the discussion. If you want the data, I'll give you the data, but it's going to take about a week and a half. It's not that I can't get you the data; I can. Getting the data quicker is the issue, and that's what the Canadian Forces health information system will get back in the future.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Could I ask a question of the Auditor General?

[The Chair, Liberal, Shawn Murphy]

Are you finished, sir?

[Mark Holland, Liberal, Ajax—Pickering, ON]

If I could, Chair, I want to go to the Auditor General.

Why would we say that we don't have the information in the report if it could be produced in a week and a half?

[Sheila Fraser]

Chair, I'd just like to clarify.

What we are talking about in the report is ongoing monitoring and the systems that would be able to provide that information quickly, and that there be continual monitoring of this, be it for mental health or any other injury, to see tendencies, trends. The kind of information that can be obtained now is by going through files on an ad hoc basis, a one-time request. To do it every month means you'd have to spend a week every month to get this information. Our main concern is that there is no information system supporting this program.

Certainly at the time of our audit—and DND officials might want to clarify if anything has changed—we note in 4.29 that there was a health information system that was begun in 2000. The targeted completion is 2011. There was a large component of that.... The funding was cut in 2006, so it's delayed even further. We do express concern in the report that this seems to us to be taking a very long time and that there's a certain amount of uncertainty about actually getting the kind of information you would expect to be able to manage this health care system.

[Mark Holland, Liberal, Ajax—Pickering, ON]

The question, then, to the major-general would be, okay, when? When are we going to be to the point where we can get that information in a timely fashion and can use it in a meaningful way?

[BGen Hilary Jaeger]

Thanks.

It's not that we have absolutely no information now. I can tell you that we know that six months after a mounting base gets people back, their mental health clinic experiences a doubling over baseline of their mental health workload. From base to base we can track that.

When will the automated system be in place so that we don't have to rely on that base-by-base, case-by-case reporting? Well, that depends on Treasury Board approval of increased third phase funding for the Canadian Forces health information system. We are supposed to, if all goes well, begin implementation in May of this year. It will be substantively complete by 2010, and we'll have the dotting of the i's and the crossing of the t's on the project done by 2011.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Okay. Well, certainly we'll be looking to ensure that the government is supporting the troops on that end and that the money is in fact put in place.

I want to come to my point about the survey and the fact that we keep talking about the data being so old. We don't have a handle on people's current feelings about the quality of health care that they're receiving. There was a comment made, I can't remember by which of you, that maybe that was something you'd do in the future.

I think this is obviously a very big concern. We do have a difficult decision to make. I think Parliament would want to have that kind of information before making a decision on extending the mission.

When are you planning to get a current and accurate read on the quality of health care that our Canadian Forces personnel are receiving so that we can have that information available?

[BGen Hilary Jaeger]

Each clinic at the moment, as part of their routine activity, does conduct customer satisfaction surveys, for lack of a better term. What we don't do is roll those out nationally. And we don't impose on clinics a strict schedule for doing those surveys, nor do we mandate, necessarily, that they focus particularly on the mental health part of their clinic, or, frankly, on the general practice part of their clinic.

[Mark Holland, Liberal, Ajax—Pickering, ON]

But you can understand the concern here. As the questioning proceeds, you keep saying, “Well, this data's old. We're sure it's better, but we have no empirical evidence of that.” So what we're left with is that the only way we have national numbers is by going back to 2002.

So the question is when are we going to have rolled-out national numbers so that we can actually have a current snapshot of what we're dealing with?

[BGen Hilary Jaeger]

Depending on the wishes of my superiors, I can put in place a focused satisfaction survey that will get useful information back within six months, but it will be a self-reported, paper-based satisfaction survey on a random sampling of people going through a clinic.

That can be done.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Can you undertake to ask your superiors and come back to the committee to say if that could be undertaken? Again, I'd feel much better about getting a firm date and a commitment that it's going to happen, instead of saying, you know, maybe you're going to have this data at some time. It's very hard for the committee to debate this issue when we don't have current information.

[MGen Walter Semianiw]

That's a fair question. That's something we're going to do, and I commit to that.

Right now our focus is on getting what we've got right and getting it better. For example, next week, February 5 and 6, we have 450 soldiers, sailors, airmen, airwomen, all different ranks, coming here to Ottawa. We're conducting a lessons-learned symposium on care of the injured in the Canadian Forces—what have we done the last year and a half, two years, what do we need to do better to listen to them, aside from doing a survey, to identify those areas in which we need perhaps improved policy, process, machinery. That's happening next week for two days, a very internal kind of activity. And from that we'll develop and take away an action plan.