Thank you, Mr. Chair.
We thank you for this opportunity to present the results of chapter 4 of our October 2007 report, “Military Health Care--National Defence”. As you mentioned, I am accompanied by Hugh McRoberts, assistant auditor general, and Wendy Loschiuk, principal responsible for our audits of the Department of National Defence.
At the time of our audit, National Defence and the Canadian Forces were providing medical and dental care to over 63,500 Canadian Forces personnel on 37 military installations across Canada and abroad. Members of the Canadian Forces are excluded from the Canada Health Act. The provision of their health care falls under the National Defence Act. If a military member needs medical services, it is the responsibility of National Defence to ensure that the services are provided. National Defence spent about $500 million on medical and dental care for its members last year, and costs have been rising.
In this audit we looked at how National Defence ensures that its military personnel in Canada receive quality health care. We did not look at medical care outside of Canada on deployments such as Afghanistan, nor did we do an assessment of medical treatment or practices.
We found that National Defence needs better information to manage its health care system and to help monitor whether it is delivering quality medical care to military personnel that is appropriate to needs. We also found that National Defence needs more information to better assess the performance and cost of the military health care system.
In this regard, our audit identified three main issues: first, the lack of health care information to monitor and measure performance; secondly, the need to better demonstrate the link between service delivery and the rising cost of military health care; and finally, the need for better governance and oversight.
First, I think it is important to note that military members themselves, when surveyed by the Department, said that overall they were satisfied that the military health care system responded to their needs. National Defence has been improving access to medical care and the continuity of care for its military personnel as part of its ongoing Rx2000 reforms.
On the issue of health care information, the Canadian Forces Spectrum of Care policy states that it is committed to providing Canadian Forces members with health care comparable to that which other Canadians receive. But we found that National Defence was unable to demonstrate how it assured itself that the care it was providing met its standards and expectations of quality health care practices.
We found that, with the exception of mental health standards, 35% of the Department's policies on standards of care were out of date. These policies are used to define the current and accepted practices that medical professionals are to follow when providing patient care, and they can help to ensure that members get appropriate care wherever they are posted.
We were concerned about the lack of information needed to ensure that only licensed and certified military medical professionals were treating patients. The Department has informed us that it is working on documenting the status of its health care professionals and developing a policy on mandatory maintenance of a provincial licence. Your committee may wish to ask the Department for an update on progress.
Furthermore, the military health care system expects its medical professionals to maintain their skills, and to support this, the Department has instituted the Maintenance of Clinical Skills program. Maintenance of skills is a requirement for the delivery of quality health care. Again, however, we found that the Department does not have the information it needs to monitor the success of this program—that is, to determine whether military medical staff are using the program to get exposure to a full scope of practice outside the military clinics. Because of this lack of information, we conducted a survey and found that few military medical professionals were completing the program. Your committee may wish to ask the Department about its progress on developing a tracking tool to monitor the maintenance of clinical skills,
The second main issue that we identified was the rising cost of the military health care system. Here we also found that National Defence lacks information to determine whether levels of service for its medical clinics are appropriate according to needs and to analyze whether the costs are reasonable.
For example, we found that in comparison with average provincial per-patient costs, National Defence costs are higher. The department has not developed a performance measurement system that would clearly measure what its health care system is achieving and at what cost. The department does have some indicators, but often information must be pulled together as needed, and it is still difficult to get an overall picture of the health of Canadian Forces members.
National Defence is working on an information system, and the committee may wish to be kept up to date on progress.
Third, we found that ten years after the department had identified a need to provide oversight of its health care system, there is still no mechanism that brings together all stakeholders to provide guidance and a basis for accountability. There is a need to bring together senior management responsible for providing health care, representatives for the military members using the services, and the senior military leaders who need to have healthy personnel to meet operational requirements.
Mr. Chair, National Defence has agreed with our recommendations and has developed an action plan to address the concerns raised in this report. I am pleased to see that the department has defined the outcomes it is working towards in the action plan and has set target completion dates. The committee may wish to have the department report on its progress and the results it is achieving.
This concludes my opening statement. We would be pleased, Mr. Chair, to answer any questions the committee members may have.
Thank you.