Veterans Affairs Committee on March 10th, 2015

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

When you are asked by your bosses to find efficiencies, and it happens with all governments—it's happened for decades—is there a process you go through to find those efficiencies? I'm not talking about this particular government. It happens all the time.

For example, if one of your ways to find efficiencies is to let people retire and not replace them for a period of time until new budget cycles or whatever the case may be, perhaps there's more of a reliance on provincial and territorial health care systems in that kind of instance.

When you are asked to find efficiencies in your area, what is the process you use to go about doing that?

[Col Hugh MacKay]

I think our requirement, our mandate, is to find efficiencies always. We as an organization have tried very hard to be as efficient as possible.

We have something we call our quality and patient safety advisory committee. Within that quality and patient safety mandate, we are forever trying to find greater efficiencies.

A perfect example has to do with the management of back pain, for example. Many people expect that, when they show up at a doctor's office with back pain, somebody's going to do a CT scan on their back. Well, there's no clinical indication to do a CT scan. We actually had a look at CT scanning and identified that perhaps our clinicians were doing more CT scans than they should to manage low back pain. We put together a working group and have come up with a clinical pathway to guide clinicians on how to better use the resources they have at hand.

We have processes in place to look at what we're doing, evaluate whether or not we're meeting best practices, and try to make sure we do get in line with best practices and use the resources we have as efficiently as possible.

Thank you.

[The Chair, Conservative, Royal Galipeau]

Mr. Opitz, you may go ahead.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Thank you, Mr. Chair.

Thank you both for being here today.

I'm hoping to ask something directed at policy, so Colonel Bilodeau gets to weigh in on some of that.

As a former infantryman, I was broken a lot.

[Col Marc Bilodeau]

And you're still broken.

[Some hon. members]

Oh, oh!

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Yes, I am. I was even accused of being unskilled by my artillery comrade last week.

Anyhow, it was a very positive experience because anything I and my comrades needed, we got. We got put back together and we got back into service, or we were put back into a serviceable condition at least.

I have personal examples. I have a friend who's posted to the college right now. He has 38 years' service and was supposed to retire last year, but you didn't let him because you had to fix his knees and a whole bunch of other things, and he wasn't being released until he was 100%. This fall, perhaps you'll actually let him go, so that's very, very positive.

On similar lines to some of the questions we've already had, it seems to me you're not static: you're very dynamic in the way you're looking at treatments. You're looking forward. You're looking at the NATO example, in terms of the working group there. I presume you're working with CIMVHR, the Canadian Institute for Military and Veteran Health Research, and looking at some of the good papers they've come up with, and in collaboration with that.

Could you maybe describe some of that?

Last year, by the way, it pays to note that the defence committee did a study on the care of the ill and injured as well, which is a very detailed study that dealt with a lot of this, with a lot of the virtual reality treatments you're doing with people who have lost limbs and so forth, in concert with the Ottawa Hospital and so forth.

Can you describe how some of those dynamic principles are at work in what you do every day and how they help adjust and shape policy?

[Col Hugh MacKay]

I'll start out.

The medical world is very dynamic and we do our best to keep our finger on the pulse of what's going on in the medical community. We do that through our relationships with organizations like the Canadian Medical Association, the Canadian Psychological Association, and all of those kinds of groups. We absolutely are closely linked to CIMVHR and are looking at what they're coming up with.

We work closely with our allies. We have a lot that we can learn from our allies, and we have a lot that our allies can learn from us. It's very important that we maintain those relationships and look at what they're doing with respect to the care of their ill and injured, and to try to, where it makes sense, implement what they're doing within our organization.

We have a body called the Spectrum of Care Committee that sits periodically in order to evaluate what new technologies or new treatments come online. We assess those against criteria, the primary one being that of a good medical evidence base to support its use. Where it makes sense, our Spectrum of Care Committee will introduce those types of treatments within our spectrum of care so that we can stay on the cutting edge.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

When you said that case managers are overloaded—basically with 70 cases each—why is it so hard to attract good case managers?

[Col Hugh MacKay]

We have only 68 full-time positions for case managers. At the present time we're restricted as to how many case managers we can actually hire.

Case management is a kind of specialized field of nursing in our consideration, so there aren't a whole lot of case managers out there. Within the 68 positions that we have, 16 of those are filled through our third-party contractor because we haven't been able to attract nurses to come into the public service. Some of that has to do with competitiveness for that particular profession.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

What would your optimum number be for case managers?

[Col Hugh MacKay]

We've targeted 50 to 55 cases per case manager, which would suggest that I would need another 20 case managers in order to reach that particular target.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Okay.

In terms of doctors and mental health care professionals, why are they having such a difficult time coming up with doctors and mental health professionals on the civilian side?

Would you have any insight into that?

[Col Hugh MacKay]

Well, the universities have funding to produce a certain number of professionals in each of the professions. I believe it is the limitation of the training system to be able to produce greater numbers of these professionals at this time.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

So it's a focus on medical schools. For example, I think I may be wrong on the number, but last year my understanding is that one of the universities in Toronto graduated only two gerontologists for an aging population.

Is that the similar kind of issue that we're dealing with there?

[Col Hugh MacKay]

Absolutely.

Psychiatry hasn't been an attractive profession sometimes as well, so not a lot of residents would necessarily look at psychiatry as a profession.

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Now, you talked about introducing veterans correction....

[The Chair, Conservative, Royal Galipeau]

[Inaudible--Editor]

[Ted Opitz, Conservative, Etobicoke Centre, ON]

Say again? Am I done?

[An hon. member]

You're getting the evil eye.

[The Chair, Conservative, Royal Galipeau]

You're more than done.

However, with the committee's indulgence, I like your line of questioning, and if you don't mind I have some questions of my own, and they have to do with case managers.

Did you have spies here when we had the witnesses from the Department of Veterans Affairs 12 days ago?

[Col Hugh MacKay]

Sir, I didn't have a spy, but I read the transcript.

[Some voices]

Oh, oh!

[The Chair, Conservative, Royal Galipeau]

That's even better. You will have noticed in that transcript that we were told that the wait time for a case manager at DVA is a month. Here, with National Defence, it's seven days. The average number of cases for each case worker is 34 at Veterans Affairs. With you, it's double, 70.

The one question that I raise is how do we make the transition seamless, from being an active member of the forces to becoming a veteran? Is there a mechanism by which your case workers and those at Veterans Affairs speak with each other, so that one would know, that oh, my God, I have 70 cases actively but you only have 34, life is unfair.

[Col Hugh MacKay]

So, Mr. Chairman if I may, in fairness to my colleagues in Veterans Affairs—