Veterans Affairs Committee on April 29th, 2008

[The Chair, Conservative, Rob Anders]

I call the meeting to order.

We have yet another meeting of our Standing Committee on Veterans Affairs. I will just read it here: pursuant to Standing Order 108(2), this is a study of the comparison of veterans services offered by members of the Commonwealth and the G-8.

Today, we have as witnesses from the Department of Veterans Affairs, Darragh Mogan, director general of the program and service policy division, and Ken Miller, director of the program policy directorate.

I've seen you before, so this is all a good thing. Just to make sure nobody is left wondering how this process works, generally we allow ten or twenty minutes, and they've been told twenty. If you want to do ten minutes each or nineteen and one, as you see fit, or twenty and zero, that's fine. After that, we take a predetermined list of questions that we've all argy-bargied over. We do that until we're sore or our two hours are up, whichever.

Gentlemen, the floor is yours.

[Darragh Mogan, Director General, Program and Service Policy Division, Department of Veterans Affairs]

Thank you very much, Mr. Chair and members of the committee.

Ken Miller and I will divide this up. I'll do the easy part; he'll do the hard part.

This is meant to be sort of VAC 101, in aid of your comparative study of Commonwealth and G-8 services and benefits.

Before I begin the presentation--and it's been handed out to you--for what it's worth, I think this is a very important study or undertaking from the public service point of view. On the one hand, it's based on surmise, but based on experience on the other.

In 2001, Veterans Affairs started off its first of many meetings of what is called the Senior International Forum, comprised of senior executives who are concerned with veterans affairs issues from Canada, the U.K., the U.S., New Zealand, and Australia.

We've had six or seven such meetings. I never would have imagined, being involved in this from the beginning, that they would be such a productive enterprise, and I want to talk to you a little about that. It has graduated up to the political level, where there is now a ministers international forum ongoing in Washington, as we speak, for the ministries of veterans affairs from the five countries. The degree of sharing of experiences, best practices, research, and business innovation have been quite remarkable and have benefited the veterans and their families in all five countries, I am certain.

Some of the results of that sort of collaboration, and certainly when you expand the nature of your study to the G-8 you'll find even more, I'm sure.... I mentioned business innovation. The best practices in service to veterans, be it electronic or in the traditional sense, are a direct result, I think it's fair to say, of our discussion, particularly with Australia.

Each time we get together in the Senior International Forum we outline in considerable detail the issues that each country is facing, and it is remarkable how similar they are. A lot of the advances that all countries have made in the diagnosis, treatment, and recovery from operational stress injury is a direct result of the sharing of best practices amongst the five countries.

The operational stress support system we offer, the peer support system, is now being modelled in other countries. We used the British Ministry of Defence job placement program and mirrored it pretty well to fit the Canadian circumstance in the new veterans charter.

We used the New Zealand case management system, and we're meant to. We get all the value of the research that these people do and that we do for no cost to our individual taxpayers. It's quite remarkable, especially when you look at the size of the U.S. Department of Veterans Affairs' budget in research. It's enormous. It benefits our own veterans and we get that for no cost. So the value of collaboration, and therefore the value of the study that you're undertaking, cannot be overstated.

I won't take you through all the pages on the chart because we'll go beyond our 20 minutes. Some of the pages I think are self-explanatory, or you can ask questions about them during the round of questions.

What I would do is take you to page 7, if I may. Page 7 shows a graph. What you're seeing there is the changing proportion of our population over time, where survivors and Canadian Forces veterans begin to assume a larger and larger proportion of our workload, and therefore should also become a larger and larger part of our policy concern.

If you look at expenditures in the portfolio area, you'll see a very large proportion of disability awards and disability pensions. As you can see there, health care, made up of home care and other VIP services, treatment benefits, and long-term care, is about $900 million. So it's a fair amount of investment, and that investment is made in cooperation with provinces. We don't duplicate what provinces offer. We offer what provinces don't offer, and if they do offer it, we may be engaged in a case management way, but we're not engaged in a payment way.

The administrative costs for Veterans Affairs, I think we've calculated at about 9% of that overall $3.2 billion.

If we turn to page 10, the largest program is the disability pension, and we'll later on come to its new veterans charter equivalent, the disability awards program. That has been in existence since 1919. My sense is it is a very generous system. We have made comparisons to equivalent disability benefits in the other three Commonwealth countries and the U.S., and ours is as generous or more generous than any of the others.

I think we had about 30,000 applications last year for disability awards or disability benefits. So it's quite an active program. Since about half of those pension applications came from World War II and Korea veterans, it gives you an indication that the long-term effects of armed conflict are quite real, and they need to be borne in mind, I suppose.

The war veterans allowance is an income support program. It's not used much any more because it's been largely replaced by the Canada Pension Plan, OAS, and GIS, but there's a small top-up available.

On page 11 I talk about the health care program. The best-known one, and it's been around since 1981, is the veterans independence program. It is the only national home care program, other than the one in Australia, that any of the four countries we deal with have for veterans or their own citizenry, including Canada. It's an extremely effective program, in my view. It keeps many people at home, independent, and in their own communities. It's very popular, and everybody, as you probably know, seems to want to get access to it. That's quite understandable, and it's in many ways quite a good thing. It's certainly quite a strong endorsement of the policy framework for it.

CF veterans can get access to the veterans independence program when the need for it is related somehow to service. Although its utilization is primarily based on age, its eligibility is not. Any Canadian Forces veteran of any age can get the benefit if it is needed.

With regard to treatment benefits, to give you an indication of the scope, there are about 8.2 million transactions a year in the treatment benefit account, at an annual cost of about $260 million. About 110,000 people have the eligibility card. It's used for services from any authorized health supplier in the country. There are in the neighbourhood of 60,000 to 65,000 of them. You don't have to go into a VAC centre to get your health care. You can go next door to the pharmacy or across to whatever is there.

Long-term care is an important element of the service we provide. We can provide it in any number of locations. We have about 3,300 to 3,400 departmental contract beds reserved for veterans. They are in institutions we used to own that we transferred to provinces. The disadvantage is that they are located in about 14 sites, and not all of Canada's veterans are located near those 14 sites. So we also give them access to any community care bed that's available and licensed by the province. That accounts for the 7,400 veterans we have in community facilities. The disadvantage we used to have before VIP came along was that you had to go to one of those 14 sites. If you happened to live in a part of New Brunswick, you'd have to go to Saint John. If you happened to live in North Bay, you'd have to come to Sunnybrook, in Toronto. Now you can stay wherever there is a licensed community bed. It's very popular. Most veterans prefer to stay there.

We have a funeral and burial program in cooperation with the Last Post Fund. The slide speaks for itself. There is an interest in looking at the rates we pay. People are eligible if the death occurred as a result of war service or if the veteran of overseas service can't afford the funeral using his or her own resources.

These are the traditional programs we've had. They are primarily age-related programs. The slide earlier showed relatively rapid growth in the number of younger CF veterans and their survivors. So we had a look at this, along with the Canadian Forces Advisory Council, between 2003 and 2005. What we found was that these traditional programs were not aiding those younger veterans who were making the transition to civilian life. They were experiencing poor transition, fragmented services, certainly a very outdated approach, and many unmet needs. So it resulted—and I'm giving quite a short summary—in quite significant deliberations on the new veterans charter.

At this point, Ken, maybe I'll turn it over to you to take the committee through the new veterans charter.

[Ken Miller, Director, Program Policy Directorate, Department of Veterans Affairs]

Thank you, Darragh.

Good afternoon, Chairman and members of the committee.

I'd like to discuss at a fairly high level some of the key features of the programs comprising the new veterans charter. As I know you're aware, the charter and the new programs were first introduced in April of 2006, so we have just two years of experience with the programs at this point.

One of the key design features was to base the structure of the programs on modern principles of disability management, so it was very important to reflect in those programs things like early intervention, achieving the maximum functioning of individuals, and having very integrated case management. All of these things together help transition individuals back to civilian life.

The approach, as you know, is a dual award approach. Simply put, it separates the economic and non-economic compensation; in other words, we have separate programs for earnings loss and separate programs for compensation for pain and suffering as a result of an injury. It's a needs-based approach to programming. What this means is that we have greater flexibility to respond within our authorities to the specific needs of individuals. It also means that those with greater levels of need get greater levels of support, and that's very important, we feel.

The approach also provides more authority and more programming for us to help families. It's very clear that families are directly impacted as a result of military service, so we try to assist in that way as well.

Moving to slide 15, the new veterans charter, in terms of eligibility, applies to Canadian Forces veterans who served after 1947, with the exception of those who served in the Korean War.

I'll just go through each of the program areas very quickly—there are five.

The first is the disability award. This, roughly, is the program that replaces the old disability pension under the Pension Act. As you know, it's a program that pays a lump sum payment in relation to the percentage or degree of disability the individual has. At the 100% level, the current payment is a little over $260,000, and that amount is indexed annually.

The next program area, and probably the cornerstone of our suite of wellness programs, as we like to refer to them, is the rehabilitation program. The intent of this program is to restore to the fullest extent possible the functioning and capability of an individual, recognizing that we cannot assist them in all cases to get fully back to where they were. Certainly, we want to assist them as far as we can, not just in terms of vocational ability but also in terms of social functioning and integration within their families and communities, and so on. The program does it by focusing on barriers and providing elements that assist in removing those barriers, which is really the key to success. It's a comprehensive program that provides medical, psycho-social, and vocational rehabilitation.

I'll turn next to slide 16 and the financial benefits program, which contains a number of different elements. This is the second part of what I referred to as the dual award approach. The first and perhaps most important element of this program is to compensate an individual when there has been a direct impact on their ability to earn a salary from employment. So we have an earnings loss program, which provides 75% of an individual's pre-release salary for as long as they are in the rehab program, or until age 65 if they're seriously and permanently disabled.

We also provide a supplementary retirement program, which provides 2% of all of the earnings loss they received up to the age of 65. That is paid as a lump sum at age 65.

Finally, we've also developed what's referred to as Canadian Forces income support, a program that provides a financial safety net, if you will, for those individuals who are capable of re-entering the workforce, but don't, for whatever reason. It provides a bridge for them to allow them some additional time to make that reintegration.

We also recognize within the financial benefits program that if somebody has sustained an injury and has a disability, particularly if it's a serious one, it can impact their potential career path or its enhancement for the rest of their life. So we provide something referred to as a permanent impairment allowance, paying a monthly amount for life to compensate for that—at least in part.

We also provide, under the new veterans charter, access to group health benefits. It's a gap-filling approach for those individuals who are not eligible to purchase coverage under the public service health care plan upon their release. They now have that open to them when the need is there.

Finally, we have a job placement program, which is all-important for those who can rehabilitate and do have the potential of re-entering the workforce. Getting a leg-up and some assistance in finding employment is very important.

Slide 19, the final slide I'll speak to, speaks to family support. I noted at the front end that this is an important area of our programming. The new veterans charter now gives us some ability to respond.

We do it by involving spouses, when we can, in rehabilitation planning. We provide rehab counselling that includes the family. We can provide case management services to family members. As I said, sometimes impacts come directly to the family member, and they may have some issues for which they would benefit directly. We can provide spousal access to the rehab program for themselves, when the veteran is sufficiently seriously disabled that they can't benefit. In other words, the family should benefit if the veteran can't; that was the logic. We provide child care assistance. If that is needed to facilitate participation in rehab, that's available. Of course, we have a range of survivor benefits, including, perhaps most importantly, the death benefit, which pays the same amount of $260,000 in the case of service-related death, together with the earnings-lost benefit that would have been paid to the veteran had they been injured but survived. There's a fairly comprehensive suite of benefits for family members.

With that I'll turn it back to you, Darragh.

[Darragh Mogan]

Mr. Chair, I'll finish up in about 90 seconds.

The glue that holds the programs together, be it the veterans independence program or the rehabilitation program in the new veterans charter, is a case management service, which Veterans Affairs has been offering since 1946 in one form or another. The version we now provide has been refined by our review of the New Zealand experience, where they don't have a lot of veterans programming, as you'll find out, but they have a first-rate case management service.

For those individuals who will tell you as members of Parliament that they have an awful time navigating the system—it's the most frustrating part of dealing with a municipal, provincial, or federal system—this is a service for the most severely disabled and the ones who need it most. It does the navigating for them, and it makes all the difference in the world in terms of the outcome. We're developing this service, and it's a very important element that pulls the programs together.

The mental health strategy is a particular focus, as you will know, with the increasing incidence and attention being paid to PTSD. Veterans Affairs and National Defence have developed a joint mental health strategy. The number of individuals we now have pensioned for psychiatric disabilities is about 11,000, of which 7,200 have post-traumatic stress disorder. That's a remarkable increase in 10 years.

We've responded with a comprehensive continuum of health services, building capacity leadership in collaborative partnerships. The net effect of those words is that we have OSI--operational stress injury--clinics now open in nine cities in Canada. National Defence has five operational trauma support service clinics. We are expanding our services to help family physicians. They are the primary caregivers to deal with individuals. We're now offering services through these clinics to around 2,000 individuals to whom we were not offering any services at all four years ago. We have some distance to go, and I'm sure in your discussions with the G-8 and the Commonwealth, you'll learn lots of ways in which we can improve. And I know you won't be shy in telling us.

The last one is the remembrance programming. It's very important. It's often referred to as the third leg in our stool--the first being the disability awards, the second being health care, and the third being remembrance.

One of the things CF veterans will tell you, if they haven't already, is that they want to be recognized as World War II veterans are. We want them to feel recognized and remembered like the World War II veterans. That's at the heart of our remembrance programming. It involves community engagement in Canada, maintaining international and national monuments, and certainly public information and research. The priorities, as it says on the last slide, are youth learning and engagement, better remembrance and recognition of Canadian Forces veterans, and engaging community and organizations to carry this legacy forward.

Mr. Chair, committee members, that's our presentation. We were 30 seconds under time.

[The Chair, Conservative, Rob Anders]

Well done.

Now we will go over to the Hon. Ms. Guarnieri, with the Liberal Party, for seven minutes.

[Albina Guarnieri, Liberal, Mississauga East—Cooksville, ON]

Thank you, Mr. Chair.

Let me begin by thanking both our guests for being dedicated civil servants who really do deliver for our veterans. When I was Minister of Veterans Affairs I was fortunate to rely on many individuals like you who were committed to the progress of the department's programs.

You have offered the committee a brief assessment of the relative merits of our benefit program relative to other jurisdictions. I was wondering if you could comment on whether there have been continuing efforts to study systems in allied countries to further enhance services for Canadian veterans. In particular, you mentioned earlier study case management and service delivery standards in New Zealand, for instance. Be free to talk about other countries also. Can we say that we've adopted the leading edge in the treatment of post-traumatic stress disorder?

I have one other question I'd like to give you and then allow you the latitude to answer at your leisure. The second question I have pertains to the health care review going on in the department. I wonder if you could confirm for the committee the history of that review specifically. When was it initiated, what were the initial terms of reference, and were the terms of reference changed? And when might we anticipate that this work will actually be completed?

[Darragh Mogan]

Thank you, Madam, and thank you for your kind words. They are very well appreciated.

[Albina Guarnieri, Liberal, Mississauga East—Cooksville, ON]

They are very well deserved.

[Darragh Mogan]

As I mentioned in the opening comments, I think you'll find a very rich ground for comparison by looking at the G-8 benefits and those of the Commonwealth. I'd like to think we've borrowed the best from at least the Commonwealth countries we've talked to, and they from us. One example I gave is the case management system, which is New Zealand. They have a good one because they don't really have any other, other than their pension benefits, so they have to use the community benefits in the North Island and the South Island. Their veterans are not few, but they are far between, and they do a remarkable job. So we've refined our case management system based on theirs, and they were quite fine with that.

We use the job placement program that the Ministry of Defence in the U.K. has used as part of our new veterans charter. It's very, very successful there. The U.S. is looking at our OSIs, our operational stress peer support system...to model it in there. So there are several examples of where this collaboration has made a lot of sense for all the parties. I'd like to think we are in the position of having the best of all four worlds, or all five worlds, and from your review, you'd be able to tell us whether that's an accurate assessment. I think it's been very good.

Certainly all four countries, including us, are very much focused on operational stress and what the effect of that is. We could call it battle fatigue, or whatever it was years ago, but now it's become apparent that it's a very dangerous thing for the military culture just to assume that it's safe and wise for soldiers just to, as it were, suck it up rather than deal with it. We realize the consequences of that attitude of just sucking it up, of how difficult it can be both in doing one's military duties and in transition to civilian life. Focus a lot of attention on there. You'll hear about that in your deliberations, and I think it's having a lot of payoff.

With regard to the health care review--and Ken can elaborate on this--this was announced by the minister, I think, probably in October 2006. There had been some reviews going on through the Gerontological Advisory Council before then, but it had a very intense political focus at that time. The Gerontological Advisory Council and the six veterans organizations released a report that called for a comprehensive review. They had the features of removing all the complex eligibility rules that had built up since 1946. They are very complex and they're very hard to navigate, and the cost of navigating that system...they are resources that could be directed towards care itself. Some of the health outcomes are impeded by that. There are a number of veterans who are not eligible for benefits right now, and there are a large number of veterans who are only eligible for the most expensive benefit, when maybe what they want is a less expensive one closer to home.

So that review has been examining that, and I don't think it's complete yet. I think it's still being reviewed at the political level and the administrative level. I think the standing committee's report on that subject would be very timely if it were to come relatively soon.

I don't know if I've covered all the subjects you wanted me to cover, Madam.

[Albina Guarnieri, Liberal, Mississauga East—Cooksville, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Mr. Gaudet from the Bloc Québécois, for seven minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chairman.

Good day, gentlemen.

Before I go any further, I would just like to explain why my head is shaved. I did it to support Leucan and the fight against cancer. Four or five us had our heads shaved and in the process, we raised $13,000. That's why I look like this. I am not sick. In fact, I'm quite healthy. We did this for the children.

I have a question and I do not know which one of you will be able to give me an answer. Consider the case of someone who lives in a rural area and decides to move to the city to get more services. While living in the country, this person benefited from housekeeping, lawn mowing and snow removal services. If he moves to a condo in town to be closer to people, will he still be entitled to the same services? Will someone still mow his lawn or clear his sidewalk?

[Darragh Mogan]

I'll attempt to reply in English, if that's all right, si' c'est acceptable.

Living in condominiums has been an issue because the groundskeeping fees are included in the condominium fees. We are reviewing our policy to ensure there is no unfairness to someone, where they're having to pay for groundskeeping but they're not having to pay for it directly; it's in the condo fees. That's being looked at, sir.

[Roger Gaudet, Bloc, Montcalm, QC]

I am asking because there is someone in my riding who lives in a rural area and who is planning to move into the city. Truthfully, I was checking to see if he qualified for the same amount that he received while he lived in the country, namely $1,000 for lawn mowing and snow removal services.That is the question I would like answered.

[Darragh Mogan]

I don't know that it would be the same amount, but it very well could be. What the fees would be depend on if they're going into a condominium. Veterans Affairs, under the veterans independence program, would pay whatever the costs are to the individual. In places where it's included in the cost of the overall logement, it's going to be a little difficult to determine. We hope to have a policy in place that allows us to do that, sir.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you.

Do you not seem to have a lot to say about one of your programs for PTSD sufferers. About two weeks ago, we went to Petawawa and heard how there was a serious shortage of psychiatrists and psychologists. What are you doing to provide services to veterans? They are being referred to psychologist and psychiatrists who are not employed by the Canadian Forces and when they come back with their findings, DND refuses to examine them.

[Darragh Mogan]

I don't know.

I can't comment on what National Defence does or does not do. They'll have to speak for themselves.

[Roger Gaudet, Bloc, Montcalm, QC]

I agree with you. I am not asking you to comment on what DND does. I am merely saying that veterans, especially those suffering from PTSD, are having a difficult time of it because in Petawawa, there is only one psychiatrist for 7,000 soldiers. Clearly, there's a problem. When a soldier has left the forces, he is referred by Veterans Affairs to a psychiatrist. Subsequently, DND does not accept the assessment.

What kind of services will you be providing to them? That is where I have a problem. You note on page 16 that this is part of the services provided, but you do not say a lot about these services.

[Darragh Mogan]

If there is a specific or a general problem with the acceptance of professional advice and guidance, there's no reason that I know of why that should be, sir. If it's on an individual case basis, we'll have to deal with that.

[Roger Gaudet, Bloc, Montcalm, QC]

Perhaps I'm not making myself clear. Veterans are not receiving any services. There is a shortage of psychologists and psychiatrists. What services are you talking about? You state in your presentation that you have a program and services policy in place as well as a program policy directorate.

What is it that you do for these veterans?

[Ken Miller]

I would like to say something, sir.

It's the question of the availability of professional services that I think you're referring to. That's a reality that's faced across the country. Particularly in areas that are somewhat more remote, access to psychiatrists and psychologists can be a problem.

Our responsibility picks up when somebody releases from the forces. The forces provide access to professional therapy to those in uniform. You're quite right, there can be a problem, depending on where they're located when they release. We try to access professionals who are reasonably close to where our clients are. It's not always possible. We can and do provide access at more distant locations, if it's appropriate and necessary. It's very difficult for us to create capacity in an area where it doesn't exist. But where capacity exists, we can facilitate access to it. We can help the veteran to go where the service is available.

[Darragh Mogan]

I'm sorry, I did not understand your question at first. It's a very good one.

One part of the mental health strategy, which we're now working on, is for these OSI clinics to be able to provide a service to family physicians. It requires an individual to have a family physician or access to a clinic. The family physician is not going to be an expert in treating OSI, but he or she will be able to serve as a contact point for someone who is. They will be able to determine the level of illness so that necessary action can be taken, within the capacity of services available in a remote area. They will also be able to determine whether the individual needs to seek treatment in a central area. We're working on this as part of the mental health strategy.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you.

[The Chair, Conservative, Rob Anders]

Mr. Stoffer.

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

Thank you, Mr. Chairman.

Thank you both for your service. My thanks also to the front-line staff across the country. They do a great job, within the legislation, helping many veterans and their families.

It's rather sad when the director general of the program and service policy division has to say that some veterans don't apply for benefits.

I have a case in point. Mr. Dan Brownlow, a fairly wealthy individual, undertook a court case last year. Before the court case he was denied hearing aids. He just received his hearing aids the other day from VAC. He is quite a wealthy fellow, and he greatly appreciated it. But Captain Earl Wagner applied for the VIP program after his wife died, because he physically can't do the work any more. He was denied VIP because he makes too much money. You're going to have to explain why one person who is extremely well off gets hearing aid assistance from VAC while another person just barely over the limit is denied VIP.

You're right, the VIP program is a fantastic program for those who get it. But many people I deal with, including widows of veterans, are denied this service. That's a matter I'd like you to explain.

Another concern is coming up, and this is something that no one is responsible for because all parties supported the veterans charter. We heard from the previous government, and the current government, that it is a living document. If changes need to happen, they can be discussed and put in place. One of the big concerns is giving someone who is suffering from PTSD a payment in one lump sum. We're hearing stories from across the country about this money disappearing in a year, and there's no other program to help them. Are there discussions within your level about whether these lump-sum awards are advisable? Perhaps they should get a pension benefit instead, so that they can have something for the rest of their natural lives. Emotionally and mentally, many of them simply can't handle $100,000 all at once.

Here's another concern we're getting in Nova Scotia. When a veteran goes into Camp Hill hospital, the spouse is left all alone, and the spouse is not allowed in the Camp Hill hospital because DVA will cover only the costs of the veteran. So in the final months of these people's lives, they find themselves separated from their spouses. The minister told us they're working with the province to find provincial facilities where spouses can be together, which I think is a good idea. Can you tell me how this is working across the country? Is it part of your health care review? In the final stages of their lives, these spouses, especially the elderly ones in their nineties, should have an opportunity to remain together.

I have more questions, but I'll come back to you.