Evidence of meeting #12 for Public Accounts in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was medical.
A recording is available from Parliament.
12:30 p.m.
Conservative
Ken Epp Conservative Edmonton—Sherwood Park, AB
Thank you, Mr. Chair.
I want to build a picture here. For many years I was the head of the math section at NAIT, where I worked as an instructor. I was the chief guy. I had an assistant, and then we had about 20 guys who were in the classroom. In that particular instance you would say that there were two administrators, even though both of us taught part-time, and we had 20 other guys who were actually full-time in the classroom.
When I see 40% of the military physicians not providing patient care, if I relate that to my situation, it would mean we would have had in our department eight administrators and 12 teaching in the classroom. That seems terribly disproportionate to me. I would like you to explain this.
If you were to ask me how many of our people were involved in administration, it would be 100%, because every instructor has to report marks, and so on. There was a certain amount of administration involved in the work, but as for administrators per se, really, I was the only one.
The question, when it was asked, was how many of you are involved in administration. I think every medical doctor is. There are forms to fill out and so on. But when I read that they are not providing patient care, that 40% are in administration, surely there is an error there. I would like an answer to that, first from the Office of the Auditor General.
12:30 p.m.
Auditor General of Canada, Office of the Auditor General of Canada
Mr. Chair, I'd like to ask Ms. Loschiuk to respond to that.
12:30 p.m.
Wendy Loschiuk Principal, Office of the Auditor General of Canada
Thank you very much for the question, Mr. Chair.
We went in to do some work to find out where all the doctors were and what they were doing, and we were able to get information from the department on what the different positions were, who the general duty medical officers were, and others, and where they were being posted. We are looking at military personnel here; we're not talking about civilian personnel.
It was a fairly easy thing to do, I think, to find out how many people they had, how many people they had practising in the clinics and doing direct patient care, and how many they had doing other work.
The question of the 40% was then calculated. The important message that came out for us was why is it 40%? Is that reasonable to expect, given the situation of the Canadian Forces, given how the Canadian Forces is organized and given what people are expected to do? As General Jaeger has pointed out, there are some positions that do require doctors; there is no question about it. But do all of them require doctors? We believed that as part of the administration, as part of looking at their Rx2000 and going through and reorganizing themselves, this was a cost driver the department should look at.
12:35 p.m.
Conservative
Ken Epp Conservative Edmonton—Sherwood Park, AB
Okay. Could I have a response from Brigadier General Jaeger?
12:35 p.m.
BGen Hilary Jaeger
I'll make a couple of observations.
I have a fairly long period of service in this organization, and I'd say that the process of scrubbing down the positions to remove as many physicians as possible from doing jobs that non-physicians could do was a major thrust between 1995 and the beginning of Rx2000. As an example, the commanding officer of a field medical unit, a “field ambulance”, as we call it—which has nothing to do with a vehicle with four wheels, but is just an historic term—always used to be a physician. I held that position some years ago. Now it's held by a health services operations officer, a health care administration officer with training. So there has already been a process to take physicians away from doing jobs that can be done by other people.
When you look at the number of positions that require medical training across the headquarters—and it's interesting you have the educational background you mentioned—part of what drives that 40% figure is that it's not like running a hospital or a big clinic. It's also like running a ministry of health at the same time. A little bit of Health Canada is in there for regulatory purposes. There is a research and development component in there. There is a medical education component in there. There is the public health system I spoke of, and the Public Health Agency of Canada is full of physicians, but none of them sees patients. So all of those things contribute to that ratio of brain power of people who don't actually speak to people one-on-one in an office.
12:35 p.m.
Conservative
Ken Epp Conservative Edmonton—Sherwood Park, AB
Thank you, Mr. Chair. I think my time is 20 seconds from being up.
12:35 p.m.
Liberal
12:35 p.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Thank you once again.
First, because we operate in NATO environment in many circles in the world, do we do any comparisons between our medical experiences within DND compared with how, say, Holland or Britain do it? That way you're not reinventing the wheel; you can take the best practices from others and combine them. Are those discussions taking place, and do you do studies to compare where savings can be met and where best practices can follow?
12:35 p.m.
BGen Hilary Jaeger
The short answer is yes.
There are two major fora for that. NATO has a committee on the use of medical services. All of the surgeons general of the NATO nations and the partnership for peace nations meet twice a year. They have an elaborate substructure of expert panels and working groups, which they can direct to examine specific issues to ensure commonality of approach. There is also cooperative research done at the NATO level via a smaller, more cohesive group. An analogue to that would be Australia, Britain, Canada, and the United States, the ABCA countries, which actually include New Zealand, although they don't get their initials on the title. So a group of very similar nations address how to approach medicine, and interoperability there has worked very well. Of course, our biggest one-on-one exchange is with the United States.
It may interest the committee to know that in fact the facility that is Canadian-led in Kandahar also has contributions from the Netherlands, Denmark, Australia, New Zealand, the United States, and the United Kingdom, all working together to make that one facility work.
12:35 p.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Thank you.
It has been noted and been said, and it's also in the Auditor General's report, that when you sign up you have the unlimited liability, which basically means that I can have a good night's sleep because of the uniform you wear. So I've always thought that we in government or in opposition have what I call the ultimate responsibility, although you never see that written anywhere, to care for you right to your headstone, including that of your family. And in many cases you'll hear the slogan “support the troops”, but when you stand in a crowd and say don't forget to support them when the uniform comes off, you get a blank stare that says, what's he talking about?
Some of the biggest problems I have on the veterans committee are about watching the baton being passed from DND to DVA. It drops a lot. It takes months sometimes for medical files to go from National Defence to DVA for people to apply for pension and compensation benefits. And in fact I hope you never have to fill out the forms for PTSD, because that alone can give you PTSD, in our testimony.
Having said that, and I know my Conservative colleagues are always worried about 40% of doctors filling out forms and things, and they should always talk to their defence minister to fix that up. I don't think necessarily it would be you. But don't you think that in your experiences and in terms of some of the advice that you can give to General Hillier down the road and to the bureaucrats and to the government and to opposition that when it comes to signing up for the unlimited liability we have the ultimate responsibility and that costs should not be a concern? We shouldn't be nickel and diming our troops and their families when it comes down at the end.
I know you have challenges in terms of the number of personnel, but when somebody calls up looking for help we shouldn't put them through the wringer. The only thing we should ask them is if you've served, how can we help you? It would be utopia for me to see that happen.
What would it take to make that happen, besides more money?
12:40 p.m.
MGen Walter Semianiw
Aside from the money piece, to come back to the discussion in front of us, I would agree with you. First, if we look at the soldiers who have fallen, is there a price the nation can put on any soldier who fell? I would submit you cannot.
12:40 p.m.
MGen Walter Semianiw
That then segues for me into a very critical question of can you then perhaps sit back and say that a health care system that's providing health care to those in uniform who have an unlimited liability contract with not only society but this nation somehow should be constrained by dollars and cents? My short answer is no. However, I also agree it needs to be done efficiently and effectively--
12:40 p.m.
MGen Walter Semianiw
--because there is a responsibility that we need to do that.
I could sit here and tell you that we have, over the last number of years, moved very quickly to establish a stronger link between us and the Department of Veterans Affairs, but to segue it back into an issue here it would be can the two departments have information management systems that could talk to each other. Fair question. That is something we're moving towards. Our officials are now working together to ensure that we can pass that information, because right now it's in paper form and it needs to get downloaded. And remember, this has been going on for 30 years; it's not just since the last three years, it's been going on for many years. But officials are now meeting, with full support from the department and the government, to be able to bring that piece together so that information can be patched seamlessly between the two organizations so that there is, as was mentioned here, a seamless transition.
So we are moving towards what you would call utopia or nirvana.
12:40 p.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
I have a point of clarification, Mr. Chairman.
Is it not true, sir, that a mission doesn't end until the last person who serves that mission dies?
12:40 p.m.
MGen Walter Semianiw
Whose policy is that? The Department of Veterans Affairs?
12:40 p.m.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
No. Jack Ford, an 89-year-old veteran, told me that. He said the mission doesn't end until the last person who serves that mission passes away.
12:40 p.m.
MGen Walter Semianiw
I would submit to you that I don't think a mission ever ends. It will never end in the history of a nation. If you take a look at it from the point of view of honouring our veterans, we continue to honour them every day. If you look at how we portray that information, we still recognize them.
World War I hasn't ended. It won't end when the last great vet passes away. We'll continue to celebrate. We'll continue to honour the sacrifices they have made. So I look at it a little bit differently. I don't think a mission ends when the last veteran has died.
However, the nation views it from a pension and benefits point of view. And clearly from our point of view a mission continues, I would say, in the name of its nation forever, in perpetuity. It helps build this nation, as we do in uniform.
12:40 p.m.
Liberal
12:40 p.m.
Liberal
Borys Wrzesnewskyj Liberal Etobicoke Centre, ON
Major General, previously you had stated that it would take you about a week and a half to produce the numbers, the number of soldiers undergoing mental health care at this point in time. Can you commit to providing that to our committee within the next two weeks?
12:40 p.m.
MGen Walter Semianiw
I would say yes, but you have to know how simple and how challenging it is. As General Jaeger alluded to, much of this, if not all of it, is decentralized.
12:45 p.m.
MGen Walter Semianiw
Just to be clear, if we were to bring a base wing surgeon in who has a geographic catch basin, he'd probably give you a pretty clear assessment of the state of that area. So it's rolling it up together, and we could do that. But again, I come back to this committee, why we're here. Once we have that information system in place, we'll be able to do it quicker.
The short answer is yes, we can.
