Veterans Affairs Committee on Feb. 11th, 2009

[Suzanne Tining]

Yes. For this fund there is no limit to the time in which you can access services, contrary to the case in other countries. I know for a fact that, for example, in the United States and the United Kingdom, you have a limited time in which to actually request the services of veterans affairs. We don't have a limit here.

The point is that before a serving Canadian Forces member leaves the forces on a voluntary release, our professionals will have a transition interview with this individual and with members of the family if they want to attend. They will have a conversation with this member about what he or she feels his or her needs are, and then we'll work with him or her on a transition plan well before the day that he or she walks out the door.

We also have outreach with our family coordinators across the country to make available to them the information on programs and services that could be available to their spouses, because you are quite right, often the individual himself or herself will not recognize that he or she is in need of help.

The more information we can have in the general public about programs and services available, the better the chance that we will be there for someone who needs us. We are working with all our partners in veterans organizations and elsewhere to make that information available.

[Judy Sgro, Liberal, York West, ON]

Thank you very much.

[The Chair, Conservative, David Sweet]

You have one more minute, Ms. Sgro.

[Judy Sgro, Liberal, York West, ON]

Thank you.

What are the qualifications of the people who sit on the mental health advisory committee?

[Suzanne Tining]

We have representatives from the six major veterans organizations, and we have specialists—I don't have the list with me—who have been recognized in a number of different areas of mental health.

[Judy Sgro, Liberal, York West, ON]

Thank you.

[The Chair, Conservative, David Sweet]

Thank you, Madam Sgro.

Monsieur André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Good afternoon, Madam. I'd like to thank you for having given us a really good snapshot of the array of services provided to veterans. It was a good basic summary, especially since I'm just getting up to speed on this file.

Yesterday, we discussed the budget with the minister, which totals about $3.4 billion; it has not gone up much. I read that that there was a call to reduce the budget forecast by $24 million, by way of rationalizing services. So there would be an attempt to provide more services with less money. Given that we are currently engaged in the conflict in Afghanistan, I imagine that the demand for health care services, whether it be for post-traumatic stress disorder or injuries, will actually increase. And yet, we're being asked to rationalize. I'd like to hear your thoughts on this.

I'm thinking most specifically about Sainte-Anne Hospital. The hospital is being asked to cut its spending by $2.3 million this year. How are these cutbacks going to affect the quality of care clients receive?

In Quebec, for example, there were 39 or 40 area counsellors covering Quebec City, Montreal, and most of the regions. I observed that the caseload, i.e. the number of clients per health care professional or case manager, was quite high. The caseload is also high when it comes to the traditional clientele, as you call them in your document.

The average case manager's caseload is around 600 traditional clients. I have some roots in that community because in a previous life, I was a social worker in a CLSC. I compared this caseload with the caseload I had back then, and I found it to be quite high.

Is the service delivery model working? Have services been streamlined? Are those working in the field and providing health care services happy, and by this I mean the case managers, nurses, and other professionals? Can cutbacks be made without there being a major impact on service delivery?

[Suzanne Tining]

Your question can be broken up into three sections. As to whether or not they are happy, I'll ask Mr. Hillier, who's responsible for service delivery, to respond.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Happy, well that's one way of putting it. Are they capable of carrying out their duties in a manner...?

[Suzanne Tining]

If I can just give you a succinct answer to your questions.

You talked about restructuring of services and the $24 million.

[Guy André, Bloc, Berthier—Maskinongé, QC]

That's right.

[Suzanne Tining]

Every four years, the Department of Veterans Affairs, just like all federal departments, has to review all its programs and services. It's called a strategic program review. The purpose of this exercise is to review all programs in order to determine which programs are the least in keeping with government priorities.

Government priorities can change and if the administrative apparatus isn't on top of these priorities, money may not go to the right place. Every federal department has to review its programs and identify the 5% of programs which are fully aligned with objectives or not as effective.

The Department of Veterans Affairs was subject to a strategic program review in 2008-2009, and the findings were published in the budget which was passed a couple of days ago.

In the case of the Department of Veterans Affairs, 5% of $3.4 billion actually totals far more than $24 million.

[Guy André, Bloc, Berthier—Maskinongé, QC]

The findings were published, but was the whole study published, and used to determine this outcome?

[Suzanne Tining]

No, it still hasn't been made public.

[Guy André, Bloc, Berthier—Maskinongé, QC]

So it still hasn't been published. Will the committee be able to get access to this document?

[Suzanne Tining]

I'm waiting to hear back from the Treasury Board Secretariat as to the ministers' decisions on the strategic review.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Will it be made accessible soon?

[Suzanne Tining]

I hope so, because if we want to implement this, I'll need the report on the Treasury ministers' decisions.

[Guy André, Bloc, Berthier—Maskinongé, QC]

I imagine the committee will have access to that document.

[Suzanne Tining]

If it's made public, yes.

So that's the strategic review and service rationalization piece, in a nutshell.

The second part of your question was with respect to Sainte-Anne Hospital. You mentioned cutbacks to the tune of $2 million. I just want to clarify something.

[Guy André, Bloc, Berthier—Maskinongé, QC]

$2.4 million.

[Suzanne Tining]

Yes, that's right. I just want to point out to all committee members that every department manager, as well as all public federal public service managers, must constantly review the way they administer public funds. So in this particular case, the director general of Sainte-Anne Hospital must, just like every manager, review the entire budget and figure out how to provide the best services given the money available in the budget.

This year, Sainte-Anne Hospital held consultations between the union and labour to review just how the hospital will be able to stick to its budget next year, in fiscal 2009-2010. However, no staff cutbacks have been planned to date, and no reduction in terms of client services.

An attempt is always made to maintain services and benefits at the current level. And when hospitals are concerned, they try to ensure that there's no reduction in patient services. As part of this process, decisions are made as to spending and managing the budget in order to come up with the amount in question.

As far as your 39 or 40 counsellors and their caseloads are concerned, those numbers are only a piece of the puzzle. For example, when it comes to our traditional veterans, in many ways you may say that it's easier for a case manager to process the case of a member of the armed forces who comes back from Afghanistan with complex psychiatric or psychological problems. Keith and his team have a well-oiled network to determine acceptable caseloads.

Over the course of the past three years, the department has had to deal with major changes which have affected our front line service providers. They've had to adapt to serving both the traditional geriatric clientele—seniors—and the new generation of 20 or 30-year-olds who have major mental health needs.

I hope I've answered your question.

Do you want to add anything, Keith?

[Keith Hillier]

I can add to the deputy's comments, particularly with respect to the Quebec region. I spent two days last week at Valcartier. I had the opportunity to meet with the VAC-DND team that's actually located on the base. I also had the opportunity to meet with the director and the client service team manager from the office in Sainte-Foy.

I think there are a couple of things to bear in mind. First of all, with regard to some of our modern-day veterans, particularly those who are going through the various types of rehab, whether it be vocational or psychosocial, the caseload is much more demanding. It's for this reason we recognize that in some cases, particularly where we're very close to Canadian Forces bases, we need a different mix.

As the deputy had noted, 600 is a number, but some of these people in the case mix of 600 receive a cheque via direct deposit into their bank account each month, so the actual level of intervention is very, very low.

However, for the most serious cases, we're looking at a different model. We're actually going to be testing some models in Sainte-Foy, at Valcartier, and in three other locations across Canada to see what would be a more manageable workload. Also, in those cases where the caseworker identifies that a veteran or a veteran's family member has a specific need, by giving increased delegation authority we can expedite that need through the system much more quickly. We can do that by giving more delegated authority to those who are there with the veteran. We're very sensitive to that.

As a matter of fact, in Valcartier we actually have 15 Veterans Affairs employees who are working full time. They go to work every day at Base Valcartier.

In terms of the numbers of area counsellors, we've actually increased the numbers in Quebec slightly over the last number of years. In fact, we're doing work around Saint-Jean and Bagotville as well. On April 1 we'll be opening a new note on our call centre in Montreal, so that our clients who prefer to have

for French services we'll have a single number to call. The call centre will be located in Montreal for our francophone clients. There has been a lot of pressure, and there is a lot of work to do. However, I think that now,

we're actually trying to do that balance. Part of it is that my management team and I are actually having our management meetings on Canadian Forces bases, where we're having an opportunity to interact with the men and women and to hear first-hand what some of their issues and needs are.

[The Chair, Conservative, David Sweet]

Merci beaucoup, Monsieur André.

Mr. Stoffer, who was the star of Power Play on CTV last night, cinq minutes, Monsieur.