Veterans Affairs Committee on March 16th, 2010

[Bernard Butler]

A lot of work has actually been done over time in this respect. One of the major challenges we found in that program, previously pensions and now awards, was that injuries were often not adequately documented. Veterans Affairs has worked closely over time with the Canadian Forces to try to ensure that the so-called form CF 98 report on injuries is in fact completed when it should be and that it forms part of the member's record. A lot of work has been done with the Canadian Forces in terms of trying to improve the exchange of information and ensuring timely access to service records in order to expedite the disability claim process and to help those things move forward.

We're currently working with the Canadian Forces on how to leverage the work they have done on electronic health records, for example. They've moved more into the realm of electronically managing the medical information of members, which enables Veterans Affairs to access that type of data. Work is currently ongoing in that respect.

Those are some of the initiatives we've had with the forces in terms of managing that very type of information.

[Ben Lobb, Conservative, Huron—Bruce, ON]

It's good to hear.

Another topic was on early intervention. Of course, whether it's a veteran or someone who's lost a job, early intervention is always a key factor in getting back into the workforce. You've seen the suggestions from the advisory group. As you read the reports from this committee, or from the Senate, or from wherever you internally seek input, where do you see it changing or evolving from where it is today? Obviously, it's fairly rigorous today, but where do you see it moving forward?

[Brenda MacCormack]

That's a difficult one, I guess, in terms of predicting the future. The one thing I would say is that I think we will continue to see it improve. I think we see more and more focus, not only within the Canadian Forces or within VAC but within multiple jurisdictions, in terms of recognizing the impact of disability and recognizing the importance of early and active engagement with an injured or ill individual. I think you will see improvements across many organizations in that regard.

In particular, the Canadian Forces have made significant improvements already by recognizing, for them, that they are responsible for that first early intervention. They do a stellar job of that by investing more and more in return-to-work programs and trying to get injured soldiers back to some kind of job within the military, even while they're still recovering. Then, when it becomes clear that they will not be able to stay in the military, at that point it becomes a transition to VAC in terms of them starting to focus on vocational pursuits in the civilian arena.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay. Just building on that last point you made, for the committee's purposes, can you again explain where that decision is made in VAC when the veteran is evolving to the point where they can return to work? How does that work and where do the veterans have input on it themselves?

[Brenda MacCormack]

In terms of the interface with VAC, we do have transition services that are available to members while they are still in the military. VAC is notified six months prior to a member being medically released.

At that point, we can make a connection with the member if we don't already have a relationship. We can begin to explain the benefits and services that are available through Veterans Affairs, and we can begin the planning process, along with the Canadian Forces colleagues who are already involved in their planning, so they can think about where they would like to move to as they look at what kinds of skills and credentials they have from the military and how they might translate that to the civilian world.

That whole planning process and that whole engagement with the member begins prior to release. The goal is to have that smooth transition occur as they release out of the military, and then the plan continues, the plan that was put in place prior to release.

[The Chair, Conservative, David Sweet]

Thank you, Madam MacCormack and Mr. Lobb.

We'll now go on to Monsieur André, pour cinq minutes.

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

I will be sharing my time once again with Mr. Vincent.

I'd like to come back to the matter of the lump-sum awards and the allowances. Your explanations brought to light the fact that there were some problems with the lump-sum awards.

However, you stated that the awards had not necessarily resulted either in savings or in additional expenses. Are you saying that, in his current budget, the Minister of Veterans Affairs could review his policy respecting allowances to better meet the needs of veterans, to take into account certain shortcomings in the lump-sum awards paid to 22- or 23-year-olds—or in the monthly payments made to others—and come up with a more coherent one?

In your opinion, what type of coherent policy should be put in place to better meet the various needs identified here today?

[Bernard Butler]

Again, I think the lump sum award has to be viewed in the context of the entire package, the entire suite of programs. The lump sum award is not designed to provide an income support. It's designed basically as a form of compensation and a recognition of the contribution and the disability suffered by a member. It has to be viewed simply as one piece of the overall package, which includes, as we've discussed, the broad range of financial benefits that are payable.

We are hearing of these concerns, but again, they have to be viewed in the bigger picture, and we have to look at fundamental questions in terms of, I suppose, how the lump sum was set originally. Again, if you recall, that was based on previous discussions on this point and based on the comparators with civil awards in the court system and workers' compensation awards in provincial sectors, and it was considered very much in line with the types of payments being made in those contexts.

So again, from our point of view, the focus must always be in the context of the award as one component of the bigger picture of benefits available under the charter to individual members.

[Robert Vincent, Bloc, Shefford, QC]

I will put my questions to you in succession and I'd like you to answer each one as quickly as possible.

If a person has a leg injury, which doctor will be assigned to his case? Will it be a Canadian Forces doctor?

[Bernard Butler]

Acute medical care is the responsibility of the Canadian Forces for still-serving members, yes.

[Robert Vincent, Bloc, Shefford, QC]

Which doctor determines the soldier's release date? Is it the Canadian Forces doctor?

[Bernard Butler]

It would be in that context. Again, the Canadian Forces are responsible for their members until the time the member is actually released from the Canadian Forces.

[Robert Vincent, Bloc, Shefford, QC]

Correct me if I'm wrong, but the Canadian Forces are both judge and jury. The Canadian Forces doctor manages the injured CF member's file, but I don't believe any other doctor could say that the CF member should not be released because he still has treatment to undergo. The Canadian Forces doctor alone decides when that CF member will be released and what his level of disability, if any, will be. Can the CF member request an outside expert opinion?

[Brenda MacCormack]

I think it is probably not fair for us to comment on the responsibilities of the Canadian Forces Health Services. Probably that would be inappropriate.

[Robert Vincent, Bloc, Shefford, QC]

I understand, Ms. MacCormack. You are responsible for allowances. Rehabilitation and disability awards go hand in hand. If we look at one of your files, we see that mention is made of rehabilitation.

How is it decided that a person is entitled to a particular kind of rehabilitation? How long does this person continue to receive such services and what kind of lump-sum award is that person subsequently entitled to receive? How long does that person have to look for a job?

You didn't answer my question about seeking a medical opinion from someone not connected with the Canadian Forces.

[Bernard Butler]

Perhaps I can respond to that. Again, as it relates to programming provided by Veterans Affairs Canada, and whether that has to do with determinations on lump sum awards or whether it has to do with access to our rehabilitation programs, those are decisions that are made by Veterans Affairs Canada based on all of the medical evidence that is available to them. But again, that is applicable to members who are entering the release phase and are released. All other activities and services that are provided through the Canadian Forces rest with the responsibility of the Canadian Forces medical establishment.

[Robert Vincent, Bloc, Shefford, QC]

Thank you, but that doesn't answer my questions. I'm talking about awards and about the decision-making authority of the Canadian Forces. I think you know how this process works. I'm curious to find out how it works. You are a clear expert in rehabilitation services. I'm sure we'll have the chance to meet again and to hear from you.

[The Chair, Conservative, David Sweet]

We're way over, Mr. Vincent.

Now we will go to the Conservative Party, for five minutes, Mr. Mayes.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you, Mr. Chair.

Thank you to the witnesses for being here today.

I must say that in my constituency, as I talk to veterans, they are very appreciative of the Veterans Charter and are appreciative of the benefits they receive. But there are a few problems with it, some holes in the program, and we're seeking to better the charter.

Concerning the front-line people delivering those services to the veterans, do you have something in place where you track those problems with the benefit delivery and bringing forward recommendations? There is some strategy in here, as you called it. I just want to know a little bit about how you track some of the information you are getting directly from the veterans on some of those holes.

[Bernard Butler]

In our service delivery framework, as you probably are aware, we have front-line staff, case managers, and client service agents who deal directly with the veteran on a day-to-day basis. They are the ones who develop case plans. They're the ones who work hand in hand with the veteran in terms of progressing through the programs. We have other folks who work directly with the veteran, in terms of pension officers who help them prepare applications for disability benefits and so on.

All of those interactions certainly form part of discussions with their client service teams. All of these backstops work together in that respect. Those are subject to the general types of monitoring of activities within district offices, and form part of the overall strategy in terms of looking at service delivery improvements.

Veterans Affairs is in a process right now of a major rethinking of how benefits are delivered and looking at major strategies to improve service delivery. Much of that is coming to us directly from the clients.

We have a national client call centre network where veterans call in for information. They too track concerns and they track information. That all forms part of our overall assessment of how things are working and what is not working.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

I think you missed the question just a little bit, because I wanted to know how the department was moving those concerns through, not the veteran himself.

They are dealing with a number of veterans, so if a specific issue comes up and it is repeated and repeated, do they have a way to send that information along and say they've got a bit of a problem and this is just a heads up? There should be recommendations on how things should be changed. Do you get that sort of feedback from your front-line people?

[Brenda MacCormack]

Obviously, yes. There are multiple forms that we can use on the service delivery side in terms of understanding what's happening at the front line.

As Bernard mentioned, there are performance reporting pieces that we look at in terms of are we meeting turnaround times, are we doing assessments, are we meeting in a timely manner and delivering benefits and services in a timely manner? So yes, we do that.

As well, there are multiple forms between head office, regional offices, and districts that talk about different disciplines in the different programs being delivered, that look at what the challenges and issues are, and what some of the solutions might be. At a working level that absolutely would be happening, from the employee level and not just the veterans level.

Then from an overall system perspective, we do look at outcomes. We look at outputs. We look at what kind of performance we are seeing from the programs, in particular, new Veterans Charter programs, and what we are achieving.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

Thank you for that.

As an elected representative, grassroots is important to me, and that's why that question was asked.

[Brenda MacCormack]

Absolutely.

[Colin Mayes, Conservative, Okanagan—Shuswap, BC]

The other issue is this. Our government has put forward an increase in investment to implement these programs. You mentioned $740 million over five years. That started in 2006, as I understand it.

How did you arrive at that figure to say we've got that much extra money, let's throw it at veterans? Was there some work done previously to look at the big picture and say that we need a greater investment? I mean, you cannot perfect the cost because it is an unknown, but the fact is somebody must have put something together to come up with that figure.