Public Accounts Committee on Feb. 25th, 2015

[Frank Valeriote, Liberal, Guelph, ON]

Can you tell me of any of the veterans who died by suicide, had they applied for and were denied? You don't keep track. Okay.

Then can you answer my second question?

[Michel D. Doiron]

Absolutely, sir.

We have taken a lot of steps to improve, following and at the same as the Auditor General was in with us reviewing it.

As an example, we have simplified the application process for mental health but also for all our application processes for disability. We went from an 18-page form—and I know 18 pages is incredible. I've only been here a year and I'm reviewing all forms, and our forms are complex. We're down to 11, and you say that's not much better but the form itself is four pages and it includes a quality of life. The other part of the package is information. That was implemented in October. It has been done. We're now doing a secondary review to see if we can simplify that even further.

On mental health, we've implemented an accelerated, evidence-based process for PTSD or for mental health. Now, when we speak of mental health, 72% of our cases are PTSD. But it's not only PTSD. We have various cases.

We've had about 250-odd applications to date under this new model. It is done at a lower level closer to the veteran. It is much quicker. It is an accelerated process so we get that answer quicker to the veterans so we can get them into care much faster.

[Frank Valeriote, Liberal, Guelph, ON]

Can I ask you another quick question?

We lost the equivalent of 949 front-line workers. We know that the caseload is about 40:1 for the case workers. That's increasing in certain areas where back offices have been closed. For instance, in Sydney, they now have to go to Halifax.

You talk in your report here about a number of people who will be hired. Can you tell me specifically what financial resources you've been given to hire more people, the exact number you are hiring, and where they're each going to be deployed?

[Michel D. Doiron]

I cannot give you that number.

We have hired five to date, five additional case managers. The additional are not all in the areas where the offices were closed. We have to be very careful. Ottawa is a high-volume area for obvious reasons. There are a lot of military in the greater Ottawa area.

We are adding resources. I've been instructed by my minister and by my deputy minister to go ahead and risk-manage those resources and add the resources I think we need in the areas where we need them. We are doing that presently. There was a public selection process about a month ago. We have 600 applications for case managers and 600 applications for client service agents. We are now going through the phase of evaluating them.

I want to be clear. When you said 40:1, you are correct. In some areas it is higher than that. You are totally correct.

[Frank Valeriote, Liberal, Guelph, ON]

The average is 40:1.

[Michel D. Doiron]

That is average. The actual average in the country is about 34:1. Our target is 40:1. Our office is very much on the average.

It fluctuates. As the Brigadier-General also mentioned, our volume will fluctuate from month to month or from year to year. Unfortunately, we have case managers who are carrying more than 40:1. That is a fact, and we are tracking that closely.

[The Chair, NDP, David Christopherson]

Thank you.

Moving along, we'll go to Vice-Chair Carmichael. You have the floor, sir.

[John Carmichael, Conservative, Don Valley West, ON]

Thank you, Mr. Chair.

Welcome to our witnesses today. Thank you for joining us.

I'd like to shift the focus a little bit to information flow and talk about some of the causes of the delays that are inherent in the process. I'll start with Mr. Berthelette, and then, Mr. Doiron, perhaps you could offer a few thoughts of your own.

Mr. Berthelette, you identified in the audit report delays in the disability program. I wonder if you would be able to confirm whether the primary cause of that delay is the transfer of records from National Defence and CAF to Archives Canada and Veterans Affairs. It is my understanding that this process could take up to nine weeks. I understand privacy and the Privacy Act, etc., but I wonder if you could talk about some of those delays and how they impact the process.

[Jerome Berthelette]

I would make reference to paragraph 3.35 of the audit, in particular the last sentence. It says, “Officials advised us that the time frame for transferring records has improved from 18 months to approximately 16 weeks.” The transfer of records can add up to 16 weeks, approximately, to the time it takes for a file to be complete.

[John Carmichael, Conservative, Don Valley West, ON]

Mr. Doiron, if....

[Michel D. Doiron]

The transfer of the records was at around nine weeks for us to get them from the Canadian Armed Forces. It's not all because of privacy. I want to be clear. They do have to cull the information. They do have to make sure that there is no third party information and that we comply with the Privacy Act. That's very important to all of us.

Some of the files, and the Brigadier can explain that much better than I can, are held on bases across Canada, and the veterans will have both an electronic file and a paper file, depending on how long they've served and where they've been. Those files have to be taken from the bases, sent to our central area in Ottawa, where we work together—we have people from both departments working in that area—and then transferred to the disability area.

It was taking about nine weeks. They've added resources and that has come down. I don't have the latest number.

[BGen Jean-Robert Bernier]

The news today is five weeks.

[Michel D. Doiron]

I knew it had come down.

[John Carmichael, Conservative, Don Valley West, ON]

That's certainly an improvement and shows good signs of meeting the objective of process improvement.

Mr. Berthelette, in paragraphs 3.65 and 3.66 of the audit, you talk about the client-reported outcome monitoring information system, CROMIS, and its development. I wonder if you could speak about what we are going to see in terms of improvement and treatment of our veterans by the application of this particular system.

[Dawn Campbell]

Thank you. I think I'll ask Michel to follow up on my response because I think he has more of the details.

CROMIS is being piloted and it's going to be rolled out to a broader audience. It was our perspective that this was a good initiative and it holds promise.

[Michel D. Doiron]

I'll start and I will pass it over to my doctor expert beside me.

CROMIS is an outcome-based system that tracks not the name of the individual but what type of care we're giving them and what the outcomes are. CROMIS is recognized internationally and the doctor who works for us, who works for Dr. Courchesne is speaking about it internationally because not many other organizations are doing what we're doing with CROMIS and saying, “Did this treatment work for this area?”

We are expanding it to all our clinics. We did have a bit of a push-back initially in the Quebec region from some psychiatrists who weren't very comfortable. We're okay now. That's okay; it's done. Our colleagues at CAF are now implementing or have implemented the same tools.

Doctor, do you want to add something to that?

[Dr. Cyd Courchesne]

CROMIS has been implemented and rolled out in all of our OSI clinics right now. We're expecting first reporting results in the first quarter of the next fiscal year.

What CROMIS does, if I can simplify it, is a little bit like monitoring your blood sugar. It's monitoring the vital signs of mental health. With this system we can demonstrate that there are improved cure rates, less time in the system, and fewer people who relapse.

We're very excited about the rollout of the system, what we'll be able to learn from that to be able to improve our treatment programs, and sharing that information with our colleagues at the Canadian Armed Forces because we'll be using similar systems to compare.

[The Chair, NDP, David Christopherson]

Very good. Thank you. Time has expired.

Back over to Mr. Allen. You have the floor again, sir.

[Malcolm Allen, NDP, Welland, ON]

Thank you, Chair.

Mr. Berthelette, in looking through your chapter that the Auditor General's responsible for, I found the conclusion. This clearly wasn't a snapshot of 10 years ago. This is more recent in a sense. It took a period of time, for sure. You looked at a large period of time but it also includes very recent data.

One of the recommendations is what has given us CROMIS, quite frankly. Prior to that, according to the Auditor General's report, you had a mechanism for looking at things but not measuring them. So you didn't actually measure outcomes, you just had outcomes. We now see...which is a good thing. It will now measure outcomes.

We're now going to see them next year, I believe, Dr. Courchesne. Is that what we're looking at, the first quarter of next year when we actually get those metrics of that kind of measurement?

[Dr. Cyd Courchesne]

By July 2015.

[Malcolm Allen, NDP, Welland, ON]

Okay.

In 3.68, Mr. Berthelette, your conclusion—let me just read it—says:

We concluded that Veterans Affairs Canada is facilitating timely access for veterans to the Rehabilitation Program.

Kudos, Mr. Doiron. We should point that out.

But unfortunately that's the smallest component of your overall program. It runs to about a total of 18%. Therefore, 82% is in the other part of that statement, which says:

Access to the Disability Benefits Program, through which the majority of veterans receive long-term mental health support, is not timely.

That's a bit of a failing grade, unfortunately

But I want to turn specifically, Mr. Berthelette, to the issue of folks who actually went into the appeal process. My colleague has already pointed out the fact that a number of folks decided not to, for whatever reason. Either they were fed up with the system or they just felt, “Well, perhaps I don't need the services so I'm not going to bother.” We don't know. I don't think the department knows. I don't think you probably track those. I see Mr. Doiron saying no. I'm not asking you to track them, by the way. If folks don't do things, they don't do things.

What's interesting in this is the length of time that a denied veteran ended up having to wait to get service unless, of course, they went and got private service. Now, they may have done that. I'm not suggesting that may not have happened. In some cases they may have gone into the public system and said, “I need some help,” or they went and paid for it, or did whatever. They may have done that.

But the dilemma here is that the Auditor General's report talked about the fact that the wait times exceeded your benchmark, and for those who were successful, the length of time it took at the outside was up to seven years. That appeal was successful. That is a catastrophic amount of time to wait to be told, “You're successful.” How does that happen, Mr. Doiron? How does it happen that we end up with a system that takes seven years potentially for a veteran to actually get through the appeals process to get what turns out to be a “yes”?

[Michel D. Doiron]

I don't want to talk about the case in particular because—

[Malcolm Allen, NDP, Welland, ON]

No, of course not. I would never ask you to do that, sir.

[Michel D. Doiron]

Veterans Affairs offers multiple levels of appeal rights to an individual. You can appeal at the first level. At the second appeal, you go to the veterans review board. You can actually go to the Federal Court. In all my 25 years in the public service, I don't think I've seen any other organization that not only offers so many levels of appeals, but where we actually pay the lawyer to represent the individual—

[Malcolm Allen, NDP, Welland, ON]

Sir, listen, I don't get very much time. I appreciate multiple levels of appeal. Whoever this particular case was, it was ultimately a yes, that you should provide the service. What I'm saying to you, sir, is that even though there are multiple levels of appeal, and you pay for this and you pay for that and it's all wonderful, the bottom line is that whoever that serving member was didn't get service. Basically, if they had gotten the benchmark of your 16 weeks, which really is 32...but it was seven years. Let's do the math: seven times 52. It's a lot of weeks. It's way past your benchmark.

How is it that a system that eventually says “yes” would have taken seven years to get to a yes? What was systematically missing in your system? Because ultimately, it's about medical information. That's what we're looking at, mental conditions and a mental health issue that is actually and literally an illness.

We're looking at how you prove you have an illness and how you prove that you actually got it when you were serving, right? There are two components. I used to do WSIB cases. There are two components in all of this. First, did you get hurt at work? That's where you are serving. That's your workplace. Second, do you actually have that particular illness? That's what you have to prove to get service.

It took seven years, sir, for this serving member who's a veteran in this country to get a yes. How did the system fail—in my view—that veteran? Have we seen the weaknesses in it to make sure that it doesn't happen again?