Veterans Affairs Committee on April 29th, 2008

[Darragh Mogan]

I'm going to have trouble remembering what they all are.

The earlier one was about why a very wealthy person gets a hearing aid and another person is denied it just because of an income line. One of the problems of history is that it provides two gates into health care. One is a pension gate. If you're disabled as a result of military service, you'll get health care for that injury or ailment no matter what your income is. It's not a function of income; it's a function of compensation for an injury.

The other case is that of someone with a low income, when you served overseas and you have a low income. This is where the second individual probably falls. There are real disadvantages to that. We acknowledge that. We have been, as part of the health review, kind of looking at ways in which we might overcome that.

One thing we can say is that at least those to whom the greatest debt is owed--that is people who actually have war or military service injuries--and those who don't have the means at all to help themselves are covered.

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

But both of them are veterans. They both served in World War II, and a veteran is a veteran is a veteran the last time I checked.

[Darragh Mogan]

Yes, and I'm only explaining that, Mr. Stoffer; I'm not defending it.

What was the second question?

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

It was about disability for PTSD awarded as a lump-sum payment instead of a pension benefit.

[Darragh Mogan]

We heard a great deal about this before the new veterans charter was brought in. Politicians and others expressed concern, and we understood that. We will not provide lump-sum money to an individual. We will provide it to the public trustee when it is clear that that individual is going to do harm to themselves or others. But just like the disability pension itself, the old pension, which you can do harm with, too, most have the civil right to have that money paid to them.

We have extensive counselling from a private sector counselling service available for individuals who need to be counselled on how to deal with that kind of money, as I've said before, in terms of individuals who might do harm to themselves or others with that money. I don't know whether that harm rises to the extent of making an unwise purchase; if so, I think I'm in trouble myself.

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

But couldn't they have accounts?

[Darragh Mogan]

It could very well be that we could invest that money and have it paid out as an annuity. That's a possibility, too. There's nothing preventing that. I don't know of any circumstances in which that's been requested, and I don't know that we've made high enough disability awards for PTSD yet where that might have been a factor. I just don't know, but I can find out.

But it's a genuine concern, sir, and we're at least aware of it.

Now with regard to spouses being admitted to veterans priority access...that's an understandable concern. It pulls at the heartstrings of everybody, and for good reason. Why, in the last days of their mutual life, when they've been supporting each other for so long, should they be separated? That's why it's kind of heartening that so many veterans want to use community facilities where that's not a problem. That's how we solved the problem--when a veteran can stay closer to home, closer to his children, and closer to his spouse if he stays in the licensed nursing home next door rather than going 400 miles away. It's not the perfect solution, but it's the one we're working on and it's the one the minister is committed to.

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

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you, Mr. Stoffer.

Now we're going over to Mr. Shipley of the Conservative Party for seven minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you, Mr. Chair.

Thanks again, Mr. Miller and Mr. Mogan, for coming back. It's good to see you again.

I'm also interested in following up on the health care review. When we had the opportunity to visit some of the bases--and I know you don't deal with Canadian Forces or Defence--our objective was to try to learn how we're going to make that seamless transition from one ministry department to another one. Actually, we have heard that although it is not perfect, there have been incredible advances made. Certainly for the veterans who are in our care, that was great news.

You've said that part of the study is important to you. I'd like you to explain just why you think it is so important that we're doing it.

Secondly, you had mentioned that since 2001 there have been six or seven meetings with five countries. Actually, I think you said they're happening in Washington right now. I don't know if you mean they're actually happening right now or they have accelerated. Are we going to be able to get a follow-up from what has come out of those meetings?

Next, one of the things we've spent a lot of time on here is PTSD and operational stress. Clearly, if there's still a weak link in our health care system, it is likely how we are dealing with that. There's no doubt. Again, we've heard, particularly over the last couple of years or so, that there have been incredible advancements and acknowledgement made by the military to help break the silos down and start that transitional flow of information, so that when someone becomes a vet there is that.

I don't know if you have any comments to follow up regarding where you see it.

I'll just leave it at those three right now, and I don't care which one answers.

[Darragh Mogan]

I'll answer until I get into trouble and Ken kicks me under the table. I've been getting a lot of kicks in the last few minutes.

On one of the questions you asked, I alluded earlier to the senior international forum--which includes the likes of me, Ken, and the deputy minister--of five countries, including Canada, Australia, New Zealand, the U.K., and the U.S. We've been knocking ideas around like the ones you'll probably be discussing in this deliberation of the committee. It's very valuable. There's no reason why you cannot have the results of those discussions. I think the minister will probably want to give you those.

So there's the senior international forum of public servants and then there's the ministerial forum. That one is ongoing in Washington right now. It is the supervising committee to the senior international forum. It's had three meetings. The last two were in Paris, and then there's one in Washington. It talks about issues of political and policy concern to all the Commonwealth countries in there--not all the G-8, although there are two or three members of the G-8 in there. So it's very valuable. As I was saying at the beginning, your investigation into that area is bound to pay dividends in your work on veterans in Canada.

On PTSD and OSI, we have made great strides. We have some distance to travel. From my point of view, and I've been at this for a while—some would say since the War of the Roses—the focus should be on recovery. It's one thing to be able to identify a problem and intervene early, but the biggest hope for these individuals is to recover from it as much as possible--both the people who serve and the individuals who transfer to civilian life. So the transition to civilian life for someone with both a physical impairment and a psychological impairment—and they tend to come in twins by the way, one tends to lead to the other—is really very difficult. That's where we're increasingly focusing our energy, as is National Defence. Any advice and guidance you have in that area would be very welcome.

[Ken Miller]

I think a lot of your questions focused on the importance of transitioning and what happens at that time. For us that's a very key thing, and it's one of the fundamental reasons we work as closely as we do with our colleagues in the Canadian Forces. It's not just a matter of somebody taking off the uniform and us picking them up. For that transition to work effectively, we really have to overlap in the way we support clients, so that the support begins while they're still in uniform, and we assist them, working with CF. When they actually take the uniform off, we're well positioned to support them with a continuation. The continuity of treatment is very important, and the early onset of treatment is very important.

So I think we have made huge strides in improving those things in recent years, but it's something you always try to do better. Through our collaborative efforts with CF colleagues, I think we're certainly doing that.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

On the continuity of systems, one of the things we heard is that the systems for transferring information--whether it's health records or whatever--from one department to the other are not always concurrent or not always the same. As a result--whether it's right or not--that information doesn't travel sometimes; it gets lost or waylaid, and it doesn't get from Defence to Veterans.

Is there an effort to bring those systems together, likely by going from hard paper to digital?

[Darragh Mogan]

The short answer is yes. When you do your review of the U.S. DVA, you'll find they have an electronic health record that is remarkable. They'll give you a briefing on that. It's quite a step forward. We're certainly looking pretty hard at that to overcome some of the stovepiping that can go on.

On continuity, we are trying to make sure that an individual who leaves the Canadian Forces doesn't get a different kind of benefit for the same condition as when they were in there. So that continuity of care is a very important initiative as well. You might want to have a look at that in your deliberations and see if that's working particularly well.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Indeed, it did run to seven and a half minutes, Mr. Shipley. I apologize tremendously. I jumped the gun at five minutes rather than allowing you the full seven minutes there. Hopefully that half minute counted toward that.

We're now into a regular round of five minutes. I was mentally ahead of myself there. I know it doesn't happen all the time; that's exactly right.

Mr. Valley from the Liberal Party is next for five minutes.

[Roger Valley, Liberal, Kenora, ON]

Thank you, Mr. Chairman.

I've been trying to figure out when you two gentlemen came before us, but you kept tricking me. You are with Brian Ferguson, individually, so I don't know if you've been here

Mr. Miller, you were here in September. I don't know if you said this, but I'm going to read it: “There is a lot of information about a lot of services to serve a lot of people who need a lot of help.” Not much has changed from that. The people need help, but I'm glad to hear that services are improving and you're moving the issues forward. We are grateful for that.

Mr. Mogan, you visited us in May, if not many other times. We talked about how to reach out on your health care review that is going on in your department. How do we do it? We talked about whether we've tried to contact the veteran who is not accessing these services. Whether it was one of us who said it, or maybe it was you, one of the issues we talked about that day was that we thought we could advertise in the papers. Somehow we could try to reach the veteran on the street who is not doing that, because, as you know, we have difficulty with that. Was that ever considered, or was it done in different venues I am not aware of? This was quite a while ago.

[Darragh Mogan]

It's a good question. On the direct surveying of people who are not our clients or aren't eligible, I guess we did it by proxy. We were a little concerned about building up expectations, especially among people whose average age is 84, and then, as they often do, political trade-offs have to be made, and we might have encouraged somebody and not done something for them. That was a bit of a concern, but in terms of all the research through the Gerontological Advisory Council and their report Keeping the Promise, we were pretty sure we had the problem definition right, and the direction in which to move, which was proposed to us through the Gerontological Advisory Council, was going to overcome some of the problems Mr. Stoffer referred to earlier. This is a very complex, multi-varied eligibility that is very hard to explain and even harder to administer.

To answer your question, we didn't do direct surveys of individuals of that age. I don't think we thought it was going to work out quite that well.

[Roger Valley, Liberal, Kenora, ON]

In the future we will be serving much younger veterans, so that may be an option for us.

[Darragh Mogan]

Yes, and in terms of the younger veteran--and maybe we should have done the survey. I'm just giving you an indication of what the thinking was with the older veterans. We are doing focus groups with the younger ones. We did at the time of the new veterans charter. In any changes we're proposing--and it has been raised that there was a commitment that there would be changes when we got some experience with the new veterans charter--we will be engaging the younger veterans in testing some of the gaps that we think are there.

As I'm speaking, we have an advisory group, the new veterans charter advisory group, made up of the best and brightest in the country and all the veterans organizations and psychological and physical medical practitioners. They are meeting today; they are meeting here, and they're giving us a lot of advice and guidance on what changes there should be to the new veterans charter, and that includes representatives of younger veterans.

[Roger Valley, Liberal, Kenora, ON]

Good.

On page 12 of your slides, I have a couple of very specific questions. There is $261.8 million in traditional programs, plus the 8,189,893 you serve. Is that number going up or down? Talking about traditional veterans, I assume that number--

[Darragh Mogan]

What page is that, sir?

[Roger Valley, Liberal, Kenora, ON]

It's on page 12 of your slides. The figures at the bottom of the page--8,189,893 transactions, $261 million. Is that number going down considering the challenges many of those traditional veterans are under, such as age?

[Darragh Mogan]

The number is going up.

[Roger Valley, Liberal, Kenora, ON]

Both numbers will be going up every year?