Public Accounts Committee on Jan. 31st, 2008

[BGen Hilary Jaeger]

Over the past eight years, the number of suicides in the Canadian Forces has remained relatively constant. The number varies between 10 and 13. However, I do not have statistics on the number of retired CF members who have committed suicide.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

So then, you know that between 10 and 13 returning CF members take their own life every year. In light of this fact, can you not design a specific program? There seems to be a pattern here. What is being done right now to avoid these tragedies? Have you developed a specific program to deal with this problem?

[MGen Walter Semianiw]

If I could interject for a moment, I think you're asking two questions. Firstly, are there programs in place at this point in time to help CF members? The answer is definitely yes. Secondly, is data on CF members readily available? That is a somewhat more difficult question to answer, but yes, that data can be found. As Brigadier General Jaeger said, all of this information is currently on paper. However, the situation may improve in a year or two, with IM/IT.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

The audit found that 75% of CF members who sought treatment for mental health problems were dissatisfied with the care they received. As for the suicide rate, members of the media looking into this problem wonder how such a thing is possible. According to sources close to CF members, the soldiers did not receive the help they needed to prevent these tragedies. The feeling is that they are not given the proper care or seen by the right people.

[BGen Hilary Jaeger]

I would like to clarify a few things for you. I will do my best to explain the finding of a 75% dissatisfaction rate among CF members. This figure comes from a survey conducted in 2002. In actual fact, 25% of the people who were interviewed said they were completely satisfied with the mental health care services received. Others—I cannot recall the exact percentage—maintained that they were somewhat satisfied. Still others were unaware that they needed mental health services. They exhibited symptoms, but did not realize that they had a problem that needed to be addressed. Still others—and again, I do not recall the exact percentage—who had received care said they were dissatisfied with the services. To say that 75% of the people were dissatisfied is not totally accurate. It is also extremely important to mention that this survey was conducted before we put in place our current system for delivering mental health care services.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

According to a press report dated October 31 last, in 2006, 20% of CF medical personnel were practising without a licence. Has this situation changed at all? Do medical professionals have the necessary qualifications to help people deal with mental health issues?

[BGen Hilary Jaeger]

Thank you for that very important question. Since the release of the AG's report, we have made the most progress in terms of carrying out this particular recommendation. The problem is this: at the time of the audit, we were unaware of the problem, since there was no system in place to verify licences. Upon conducting an internal audit, we determined that 100% of our physicians and dentists hold valid, current licences. This is true as well of 96% of our pharmacists and 80% of our nurses. As for the remaining 20%, we simply have not verified their status yet. We still have a bit of work to do in this area.

[Jean-Yves Laforest, Bloc, Saint-Maurice—Champlain, QC]

Thank you very much.

[The Chair, Liberal, Shawn Murphy]

Merci, Monsieur Laforest.

Mr. Sweet, eight minutes.

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

Thank you, Mr. Chair.

My first question is for the Auditor General. I just want to clarify something.

On page 7, paragraph 4.10, you had mentioned that the specific parameters of the terms of reference for your audit were around health care delivered to “Regular Force members in Canada”. Is that correct?

[Sheila Fraser]

That is correct.

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

The major-general mentioned in his opening remarks that operating a health care system with personnel all over the world, across national and international boundaries, affects the cost.

With your terms of reference, should there have been any reason why foreign deployments would affect the cost of health delivery in Canada?

[Sheila Fraser]

We didn't specifically look at that issue. We did raise a number of factors that affect health care costs in the military's health care system: the need to have health care available immediately to members, and a number of other factors as well, the major one being the availability of services. So there is an indication in the report, as mentioned, that we can't do a direct comparison with the health care costs in the public system, and one would expect it to be more expensive. The issue is, what is a reasonable cost? We would have expected National Defence to have determined some kind of benchmark and to be tracking the costs and to ask if they are reasonable or not.

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

Major General, are you working towards a process where you can benchmark?

I agree with you that it should be more expensive, and of course we want the absolute best quality for the people who serve and put themselves in harm's way. But it seems to me that given that you have some of the most healthy personnel in the nation, there would be some offset from that.

Could you tell me if you have a benchmark process you're going to go through?

[MGen Walter Semianiw]

Mr. Chair, I'll speak first to give you some information, then turn it over to General Jaeger, to give you a vantage point from a soldier, an infanteer, a soldier who has been on many operations, as I have. But I speak from that vantage point.

I touched on it briefly. Right now the medical system is moving very quickly; it has already expended a lot of money to put in what is called the Canadian Forces health information system. In short, we're already into phase three. We're putting additional money into it, and it will be able to give us

the data, as I was saying earlier,

the facts that we need much more easily than we have had.

If I were to pose the question today—and General Jaeger and I speak about this—at any one point in time, across the Canadian Forces, how many people are in this state of sickness or need this type of support, we can get that information. I think it's something that has to be understood. We can get that information. But we feel, as did the Auditor General, that it takes too long, because you need that type of information, as the Auditor General said, to make informed decisions.

So when this project closes out, we'll be able to answer or address that specific issue and have that information quickly in a number of broad areas and be able to answer the questions posed, which are sound, tough, and I think great questions, such as how many individuals in the Canadian Forces today are suffering from mental health challenges. Tell us that; we need to know that. We're the first to tell you that until this project or program comes into full swing and is fully implemented in the next couple of years, we won't be able to do that quickly, but we think we should be able to.

[The Chair, Liberal, Shawn Murphy]

Mr. Sweet, before you go on, I believe the Auditor General has a comment.

[Sheila Fraser]

Mr. Chair, I just wanted to make one point of clarification. I was informed that the foreign medical costs are part of the support to deployed operations account. They're not in the medical costs here per se.

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

Okay, thank you. That was my concern, but I guess it's all dependent upon the collection of data.

One thing that is troubling around costs, which I think deserves a separate specific answer, is on page 16, where, under the contracting of physicians, the figures juxtaposed there for contracted physicians' costs look like they're out of control. Can you explain why there's such a disparity in the costs between the civilian positions and those contracted privately?

[BGen Hilary Jaeger]

The shortest answer I can give you to that question, sir, is that the costs you see are the costs we pay our third-party contractor, Calian Technology. They are not necessarily the costs they pay the service provider. There is a profit margin. They're a private company; they exist to make profits for their shareholders, so there is a margin between what they charge us and what they pay the provider. But the provider rates do vary, because we seek to entice providers into some parts of Canada where physicians are not easy to attract.

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

So maybe some brinkmanship and negotiating might be at hand for this, as far as getting costing....

[BGen Hilary Jaeger]

We try to hold the line as much as we can, but my bottom line is if I need a service provider somewhere to provide essential medical care to the members of the Canadian Forces, then if it's going to cost a little bit more, that's far preferable to not having the service provided or to having the member obliged to move somewhere else for the care.

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

Okay.

Page 22, paragraph 4.57 points to another big concern, because it almost looks as though there is a cultural issue developing. In paragraphs 4.55, 4.56, and 4.57, there is a discussion about the maintenance of the clinical skills program, and there is a statement here by the physicians, I guess, who were spoken to in the audit. They didn't take advantage of the program because they believed they could not spare the time. In other words, they refused to go away from their own duties in order to be more excellent caregivers later. Is that still going on?

[BGen Hilary Jaeger]

I believe the situation is improving with our uniformed physicians in particular. You have to understand I may not have been able to clearly explain to the Auditor General's staff the components and the differences between the maintenance and clinical skills program, which is military-driven with military requirements to keep the skills required to support deployed operations and the licensing bodies' and credentialing bodies' requirements for continuing medical education, which is a separate ongoing educational requirement.

Because we have had over the past several years--

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

I would just like to clarify something. I'm not talking about the licensing issue. I'm talking about this maintenance of clinical skills program in and of itself.

[BGen Hilary Jaeger]

Right. Yes.

The maintenance and clinical skills program is something we actually first came up with in the late 1990s when we realized that just working in your office didn't cut it to get you ready to go to Afghanistan and see the kinds of patients we're seeing there. We thought we needed to take military providers out of that kind of garrison-based very routine setting and challenge them more clinically. That's also a cost driver, by the way, because the goal is that roughly 20% of a unit's foreign physicians' time is spent doing that, so that makes them less available to provide direct patient care.

During the time since we conceived the program--and now on average we are about 35% short of military physicians across the board, so we don't have enough uniformed bodies to really make the program work the way it was intended to--we have focused on identifying those people who are coming to deployment in the next year or so and pulling out all the stops we can to make sure that they get brought up to speed in time for their deployment. That has resulted in relatively less effort for those who stay behind.

We are making headway with our uniformed medical officer recruiting. We expect to be up to full strength within about a year and a half, and after that I hope we can do much better at meeting the targets of the maintenance and clinical skills program.