Veterans Affairs Committee on Oct. 24th, 2012

[Sean Casey, Liberal, Charlottetown, PE]

You would undoubtedly be aware that the Auditor General wasn't overly impressed with the delivery of case management. In paragraph 4.45 he referred to the fact that consultations between the case manager and other experts are required when a veteran has health needs that are not being met. He found there was no documentation of any consultation in 40% of the cases. He found in 68% of the cases he reviewed that the department didn't meet the applicable service standards for making a decision on the complete rehabilitation application.

Mr. Hillier, there must be some reason for these gaps. What is it?

[Keith Hillier]

Mr. Casey, I'd like to respond two ways.

First of all, Mr. Chair, as the minister has said, there is an action plan that will be coming forward. Second, with regard to the clarification, as is noted in our reply to the Auditor General in January 2012, steps were put in place to clarify when these referrals need to be made and the level of documentation that's required.

[Sean Casey, Liberal, Charlottetown, PE]

One of the other things that you said in your responses to the Auditor General was that processes and standards are in place to give all case-managed veterans more access to their case manager. You also referred to it in your remarks today when you said you're updating the VAC offices.

We talk about processes and standards to give all case-managed veterans more access. Charlotte Stewart, from your department, testified here that the district office in Prince Edward Island would be closing, leaving it as the only province in Canada without a district office, and she could offer no assurance that there would be any case managers in Prince Edward Island.

Can you square her evidence with your comments to the Auditor General that processes and standards are in place to give all case-managed veterans more access to the case manager? How do you get more access when you're moving the case manager out of province?

[Keith Hillier]

Mr. Chair, I'd like to respond to that by saying that first of all, part of access to the case manager is easier access to a more modern telephone system to facilitate that.

Second, I just want to make some clarifications with regard to case management and with regard to Prince Edward Island.

Yes, the Government of Canada announced that the Charlottetown office would be one of eight offices closed. I want to share a clarification, Mr. Chair, if I may. What I say for Charlottetown relates to all eight offices. Veterans will still have access to the department through our call centres, My VAC Account, Service Canada locations, and the 24-hour crisis line. The local peer support coordinators will be there. Veterans will continue to have access to their case managers by phone or by home visit. If a veteran wishes to meet with a case manager, whether it be in an office, at the veteran's home, or at the local Tim Hortons, the case manager will go there.

We will continue to provide nursing visits and occupational therapy visits. We will continue to provide treatment authorization, and the veterans will still have access to the operational stress injury clinic that serves their area.

As I've testified before this committee before, the changing demographics of veterans require that in some offices we add individuals. Other offices will remain relatively stable over the next four to five years, some will get smaller, and some will close, but even in the areas where we're closing the bricks and mortar, the services to the veterans, including home visits by case managers, will continue.

[The Chair, Conservative, Greg Kerr]

Thank you, Mr. Hillier.

We're quite a bit over time, but I wanted to make sure that you gave Mr. Casey a full answer, so thank you for that.

I'm going to pass by Mr. Harris for a moment and go directly to Mr. Hayes, if I may.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you, Mr. Chair.

Admiral Smith, in your report you spoke a lot about terms of reference. I notice that in 2010 there were some new terms of reference. In 2011, it looks as if there was a shift, and in 2012, I think, there is another potential look at terms of reference. I'm trying to get an understanding of the terms of reference as they originally were, why they have changed, and what the new terms of reference might be.

I think it's important that you're doing that. I think it's very important, because obviously there is probably a shift in the nature of the types of things that are done. I just want to get a better understanding of the committee's terms of reference.

[RAdm Andrew Smith]

Certainly. Thank you for the question.

I've been here for four and a half years. The committee has been around much longer than that. My view is that in the embryonic stages of the committee, they were very much finding their way, as I mentioned in my remarks, trying to make sure that there was greater collaboration and communication between the two departments. It may be surprising, but when you go back and read the history of the committee, the two departments were not always as closely linked as they are today.

As time has gone on, the two organizations have become much better at understanding each other and the respective cultures of each organization. They have better understood the needs of veterans. The terms of reference of the committee have changed to reflect that better understanding.

Even in the four and a half years I've been sitting on the committee, there has been a real shift as the Department of Veterans Affairs has come to, I would submit, better appreciate the needs of the modern-day veteran. Some don't like that term, but we now have a much more computer-literate, social media-literate organization. Veterans Affairs has taken great steps to address that. The terms of reference for the committee have been in line as we have tried to make sure that we've stayed abreast of the changing demographics and the needs of veterans.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Mr. Hillier, do you care to comment as well?

[Keith Hillier]

The world is changing quickly. We need to evolve as a committee. We need to look at what the current pressures are and at the environment in which we operate.

When the committee started off back in 1999, it was fairly rudimentary. I would like to think that we've learned some things over the years. We try to keep our mandate and our terms of reference alive, I would say, to meet the ongoing challenges that are with us today and some that we think will be around the corner.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

That's a good segue, because there's a document that stated that new terms of reference will be completed, approved, and signed for the next steering committee meeting in December of 2012.

What's the process that's going to happen between now and December, 2012, in terms of discussing those terms of reference and reaching agreement on those new terms of reference? Do you have a sense of what some of those new terms of reference might entail?

[Keith Hillier]

I'll start, and Admiral Smith can jump in.

In terms of the process itself, it's an iterative approach. It's an approach that's built on each side providing input, based on what we see the needs are.

I want to be very clear that while we have our steering committee twice a year, as prescribed, the reality is that Admiral Smith and I talk many more times than twice a year when we sit down across the table, as do our directors general on both sides, as do our directors, so this is a document that we build together. By the time we get to our steering committee, to the formality of signing it, we've had our discussions and our debates, and we bring it forward. Then it's really for ratification, to make sure everyone's comfortable and everybody understands what we're signing on to.

[RAdm Andrew Smith]

I would only add that we have had very fruitful discussions throughout the study period of the Auditor General's report. There are some observations that you will have undoubtedly read related to governance. Those have been helpful in continuing to shape the direction of the steering committee.

I would further add that over time I have witnessed a change as the committee has evolved, becoming a more strategic committee as opposed to a tactical, details-oriented committee. I don't think that's really the nature of the committee and what we want the committee to do, so we have changed the scope and composition of the committee to reflect a more strategic decision-making nature that is beneficial to veterans.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Hayes. I know, it passes quickly, doesn't it?

We now go to Mr. Chicoine for five minutes, please.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

Thank you, Mr. Chair.

I want to thank our two witnesses for coming to testify before the committee.

I would like you to explain to us the motives behind the decisions regarding the accountability involved in the Canadian Forces members' transition to civilian life, which is now a responsibility of the Department of National Defence.

Could you tell us whether the two departments have worked together on that transition? In your answers, I would like you to respond to one of the observations of the Auditor General, who said that your committee does not have to consult other departments and that information on policies is unfortunately not always shared properly.

[Keith Hillier]

First of all, as I noted, the minister will be coming forward with an action plan that will go beyond what the Auditor General has suggested.

With regard to the transition, I'd like to point out that with regard to the work of the Auditor General and all the recommendations, which we accept, there has been a certain maturity over this period of time. You will note that the period covered in this report goes back to 2006-2007, and I would like to believe we've made some progress in that area, specifically with regard to how it works.

I'll talk about individuals who are being medically released from the Canadian Forces, which is a small percentage. As was noted in the Auditor General's report, it's a very small number.

We offer a transition interview to those members of the Canadian Forces before they leave, and generally within 60 days of somebody leaving the Canadian Forces, our case manager joins in, so there's a period of time of co-case management so that when the person decides that they are no longer wearing a uniform, they don't have to start all over again with Veterans Affairs Canada. In fact, they can start their rehabilitation program with Veterans Affairs Canada, if that's what's necessary. We can ensure that medical and treatment authorizations are in place.

There's actually a degree of familiarization, so before the Canadian Forces case manager says goodbye and reminds you that you're now moving out to civilian life, they get to know their VAC case manager for a period of time and, hopefully, garner a level of trust with that case manager.

[RAdm Andrew Smith]

I would add that the committee operates at a strategic level, while the two departments work closely at a tactical level within the JPSU—the Joint Personnel Support Unit, which has 24 offices or integrated personnel support centres, IPSCs, in Canada. The system works very well. The integration is done so well that, if you were to come into an IPSC, you would have a hard time distinguishing between the employees of Veterans Affairs Canada and those of the Canadian Forces.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

I am afraid that soldiers will fall through the cracks of the system, if the transition happens not to go as expected. If soldiers had no access to the Canadian Forces services because they have fallen through the cracks of the system, that would mean Veterans Affairs Canada would have the responsibility of providing them with transition services because those soldiers would become their clients.

How will you guarantee that the transition program will continue to provide consistent and timely services?

[RAdm Andrew Smith]

Mr. Hillier did say that each member of the Canadian Forces who is released—regardless of whether we are talking about a medical release or not—will have a transition interview. All of them go through that interview. About 4,000 people are released from the Canadian Forces annually. They will all go through an interview with Veterans Affairs Canada before leaving.

In addition, we have certain online initiatives for people whose file has been lost. I would not use the expression “fall through the cracks”. Mr. Hillier launched an initiative for seeking out homeless veterans. We are also working closely with the Royal Canadian Legion and other non-governmental organizations to try to search for, locate and bring together those in need who are invisible to us.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

We'll now go to Mr. Lobb for five minutes, please.

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

Thanks, Mr. Chair.

Thank you both for coming here today. My first question is for Rear-Admiral Smith.

In your presentation you talked about the ill and the injured. On page 2 it says, “It is up to us to ensure that all initiatives and policies for the ill and injured....” Further in that paragraph you talked about the transition to their new pursuits and their new lives.

What I want to do is back up one step before they would get into this transition service. I want to ask a couple of questions about a young man or woman who would be in service. They have a unique injury, one that is different from a sprained ankle or a broken arm, one that is somewhat specialized in its treatment and diagnosis. I'm wondering how that process works. They would see, obviously, the Canadian Forces health services team, but beyond that, if there isn't a specialist who can deal with that injury, how is it identified and then how is it referred on to a specialist who could be outside the Canadian Forces health services?

[RAdm Andrew Smith]

Frankly, it's not a lot different from the provincial system that members of this committee may know and appreciate from your respective provinces. As you may know, we operate the fourteenth health care system in Canada—ten provinces, three territories, and ourselves as the fourteenth.

Unique injuries or different injuries are no different in the Canadian Forces from anywhere else. We have unbelievably competent medical staff to look at them. That's for both physical and mental health injuries. We also have specialized medical officers, including psychiatrists, psychologists, trauma surgeons, and respiratory surgeons. We have medical specialists.

In cases in which either we don't have them or there is a capacity issue, maybe in a remote location, we have an ability to refer them to provincial authorities. There is une entente between ourselves and the various provincial authorities to have our Canadian Forces members seen wherever and whenever.

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

Okay. I think that's a good answer.

The next question I have is this: what assurances do members of the Canadian Forces have to know that the people who are looking at their injuries are at the same level as in the other 13 jurisdictions? Is there a way for them to have gaps and strengths identified for them? How would a member of the Canadian Forces in a certain location know that somebody is a specialist?

[RAdm Andrew Smith]

I might turn the question or the answer around a little bit.

I say, unabashedly and with full pride, that notwithstanding that we operate the 14th health care system in the country, in my view—and I think objective evidence would support this—it's the best health care system in this country. Men and women in the Canadian Forces know that. Whether in terms of wait times to be seen with their injuries, in terms of the follow-up, or in terms of the specialized care that they get, the men and women in the Canadian Forces have an unquestionably high regard for the level of health care they receive.

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

Just so we're clear, I'm not questioning that. I think it's important that we're having this discussion in the committee, because all the events that take place prior to their getting into the queue at the transition are important for knowing about the care they receive.

[RAdm Andrew Smith]

Certainly.