Veterans Affairs Committee on Dec. 3rd, 2013

[The Vice-Chair, NDP, Peter Stoffer]

Good morning, everyone. I see a quorum here today.

Just to let everyone know, because of the vote this meeting will go on until a quarter to one, at which time we then move into committee business. Unfortunately, we'll have a short meeting.

First of all, the committee wishes to welcome Natalie Pham, Mr. Keith Hillier, who's a regular at our committee here, and Anne-Marie Pellerin.

On behalf of our regular chair, Mr. Royal Galipeau, who, unfortunately, is still under the weather, we welcome you to the committee today.

We understand that you have a presentation to make, so we'll look forward to your presentation. We thank each and every one of you for coming to us today to help us in our study of the new Veterans Charter.

Please proceed.

[Keith Hillier, Assistant Deputy Minister, Service Delivery, Department of Veterans Affairs]

Thank you, Mr. Chair, and good morning, colleagues.

Thank you for the opportunity to participate in this session. I am joined by my colleagues, Anne-Marie Pellerin, director, case management and support services; and Natalie Pham, our client service team manager from our Montreal office. We are happy to be here to support this committee's study of the new Veterans Charter. We realize that time is tight and we have a lot to cover, so I will get started.

The practice of case management began over 100 years ago in the United States, when, during the early 1900s, public health nurses and social workers coordinated health and human services for the poor and the immigrants. Throughout the course of history Veterans Affairs Canada has responded to the needs of veterans and their families through the delivery of programs, benefits, and support services, including case management. We have been providing counselling services to veterans for over 30 years.

In recent years, Canada and our department have faced an unprecedented shift in veteran demographics. Traditional veterans are, sadly, passing away in great numbers, while the modern-day veteran population is on the rise. We are also dealing with the fact that many modern-day veterans are being released from service with more complex health and re-establishment needs. These factors have forced us to re-examine what we do and how we deliver service as a department to ensure we are fully responsive to the diverse and changing needs of those we serve.

With the introduction of the new Veterans Charter, the department began focusing on ability over disability, on ensuring that veterans can make the best recovery possible, as quickly as possible. Our case management practices serve as the foundation of this modern service approach.

Since 2006, the provision of VAC case management services has evolved and additional improvements have been made to better support veterans with complex needs. Today, through our transformation action plan, we continue to evolve and enhance our case management practices to ensure that we are aligned with best practices in the field of case management.

The VAC case management model focuses on a holistic needs-based approach that is based upon the determinants of health as established by the World Health Organization. Case management services enable veterans and their families to establish and achieve mutually agreed-upon goals through a collaborative, organized, and dynamic approach. This interactive, problem-solving approach is coordinated by the VAC case manager, and includes six core functions: engagement and relationship building; comprehensive assessment; analysis; case planning and consultation; monitoring and evaluation; and disengagement.

Collaboration is the key. The case manager works in collaboration with an interdisciplinary team of internal and external experts, including physicians, nurses, occupational therapists, and mental health professionals. It is important to note that case management services are not required by all veterans. Case management is available to all veterans who require this service based upon their assessed level of risk, need, and complexity. As of the last quarter, just over 7,000 of the more than 135,000 veterans we serve are receiving case management services from a network of 220 case managers across Canada.

Our national standard ensures that the veteran-to-case manager ratio is within a range of 40:1. Today, we are well within that target. Approximately 91% of our case-managed veterans are Canadian armed forces veterans. War service veterans make up 6% of our case-managed clientele.

Our department offers transition services, including case management, at 24 integrated personnel support centres. Transition services enable us to work collaboratively with Canadian armed forces colleagues to ensure a smooth transition for those releasing from the military and re-establishing in civilian life.

Our case managers come with a diversity of educational backgrounds. Our qualifications require that they have a degree from a recognized university, with a specialization in social work, nursing, psychology, or some other specialty relevant to the position. A review of the education and experience of our case managers conducted in 2011 revealed that one in five holds a master's-level degree, and almost two-thirds have five or more years of case management experience. Additionally, an asset qualification when hiring, priority is given to candidates who have experience in dealing with a military culture, who were a member of the Canadian armed forces, or are experienced as a case worker in the rehabilitation environment. These factors indicate a varied and experienced workforce, something of which we are very proud.

To ensure veterans and their families receive the best service possible, we need to equip our case managers with the very best tools and training available to support them in this very important role. Our transformation action plan is aggressive in this regard. Over the past two years, our department has implemented various tools, supports, and training to enhance case management services. We have reinforced standards and best practices, provided extensive training, particularly in the area of mental health, and provided tools to better manage our workload and our resources.

Investments in case management to date include workload intensity tools that measure the risk, the need, and the complexity of cases that are managed for veterans. These tools enable us to evaluate the work and workloads of case managers based on the level of risk, complexity, and the intensity associated with each and every veteran's situation. They also include a national case management learning strategy that focuses on practices, skills, and development; improved national standards and guidelines; and the development of a national competency profile for case managers.

The investments we have made in the practice and delivery of case management, and in our case managers, is paying dividends for those veterans who are most at risk. As a result, we are now better able to identify veterans who are at risk, and much more, able to ensure that the appropriate resources are in place to address those risks.

As a result of our work over the past several years, we have strengthened service delivery with a view to improving outcomes for those we serve.

Thank you, Mr. Chair.

[The Vice-Chair, NDP, Peter Stoffer]

Mr. Hillier, thank you very much.

Ms. Pellerin or Ms. Pham, do you have anything to add?

Thank you very much.

We then move on to questioning with Mr. Sylvain Chicoine, please, for five minutes.

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

Thank you, Mr. Chair.

I also want to thank our three witnesses for joining us today to answer our questions.

To start things off, I would like you to give me the current number of case managers. How many of them were there before the implementation of the VAC transformation action plan? How many of them will there be at the end of that plan? Finally, when will that plan be completed?

[Keith Hillier]

The number of case managers is a factor of the demand. We operate with about 230 case managers. Those numbers have been constant in recent years. You may see a dip from time to time due to staffing. It may drop down to 225, maybe go to 232, but it's in that 230-range. In fact, within the resources that we have in service delivery branch, I have in excess of 1,600 full-time equivalents, and the amount that we allocate to case management is consistent with the need in any particular geographic area, bearing in mind that our standard is that there will be one case manager for every 40 case-managed veterans. So over time, the answer to your question is, if the need for case management increases, the numbers will increase. And if the need goes down, which I suspect probably is not going to happen, that we will make the adjustments on a location-by-location basis.

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

Those nine offices will be closed within a few months. When exactly will they be closed? The announced date may have changed. Will the closing of those offices result in fewer case managers?

[Keith Hillier]

First of all, I have a point of clarification, Mr. Chair. One office in Prince George, British Columbia, closed nearly a year ago. The other eight offices will close to the public on January 31, 2014.

There may be a small decrease in the number of case managers. We are looking at each office individually, at the current workload of the office that's closing, and at the existing workload of the offices that are receiving additional work. We will make the necessary staff adjustments. Potentially, some offices may see an increase in their case managers to be able to deal with the coming workload.

I would also point out, Mr. Chair, that in offices we are closing we did give case managers the opportunity to relocate to another VAC office to continue their case management career. That would be with full removal expenses paid by the Government of Canada.

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

The minister announced that, as of February 1, some case managers would be assigned to Service Canada offices. How many case managers will be affected? Where will they be reassigned?

[Keith Hillier]

I can give you the number of case managers who will be affected off the top of my head, sort of: two in Corner Brook, I believe three in Sydney, one in Charlottetown, two in Windsor, I believe one in Thunder Bay, and three in Kelowna. The number of case managers is all in the single digits.

I don't have those numbers, but I'll get them. That's the order of magnitude: it's two, three, two, three, because these were very small offices.

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

So there may be about 20 of them altogether.

[Keith Hillier]

It's probably about that.

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

Okay.

[Keith Hillier]

I think that's the right magnitude.

[The Vice-Chair, NDP, Peter Stoffer]

You can always come back, Mr. Chicoine.

We'll now move to the parliamentary secretary, Mr. Gill, for five minutes, please.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Mr. Chair.

I also want to thank our witnesses for taking the time to be with us to help us in this important study that we're conducting.

We've been told that medical research indicates that the Pension Act did little to nothing for veterans' rehabilitation, meaning the Pension Act was not geared to generate the best possible outcome. We heard last week that there is a misconception that the Pension Act provided a well-paid pension and that in most cases this is obviously not true.

Can you elaborate on what principle of this research this new Veterans Charter is based, and what support is provided to assist veterans in their recovery and transition to civilian life?

[Keith Hillier]

The fundamental principle of the new Veterans Charter is about rehabilitation and reintegration. It's about people getting well as opposed to people continuing to be ill.

Under the old system of the Pension Act, individuals were given a monthly pension, but the amount was rather small. On average I think it was somewhere around $700. That's not a lot to live on in today's world. It did not provide the type of supports that are there today.

In the early 2000s, with Canada's involvement in Afghanistan and our previous involvement in the Balkans and Rwanda and other places, it was becoming increasingly clear that we were not meeting the needs of veterans by simply giving them a pension.

Through a lot of research that was conducted by academia, veterans organizations, and the department, it was determined that we needed a more holistic approach. The holistic approach was the new Veterans Charter, which provides support before somebody leaves the Canadian armed forces. We work very closely with our colleagues at the Canadian armed forces. That is why today I have over 100 staff who go to work at Canadian Forces bases or wings. They work shoulder-to-shoulder in the integrated personnel support centres. Veterans are also given a transition interview before they leave the Canadian armed forces. In fact, for those who are being medically released, our case manager works with the DND or the Canadian armed forces case manager hand-in-hand so that, when somebody is medically released from the Canadian armed forces, they're not with a new case manager. That way they've already developed a relationship.

In addition, we have introduced various rehab programs with the goal of getting people reintegrated into the workforce. But also there are various what I would call financial safety nets. The reality is that the extent of injuries of some veterans are such that they will probably not be able to gainfully participate in the workforce. We have financial safety nets for the small numbers of veterans who just cannot go through the rehabilitation program and go back into the workforce.

In summary, it's holistic. It's about getting better. This is where our network of case managers come in. They work with the veterans to ensure that they get the services and benefits they need to recover.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you.

Aside from the frequently mentioned initial disability award, what programs and services are available under the new Veterans Charter that were not previously available to Canada's veterans under the former act?

[Anne-Marie Pellerin, Director, Case Management and Support Services, Department of Veterans Affairs]

The cornerstone program of the New Veterans Charter is the rehabilitation program. This program was not available under the previous legislation, prior to 2006. What the rehabilitation program offers veterans with a service-related disability or rehabilitation need is a combination of three streams of service: medical services for physical and mental health conditions; psychosocial supports to allow the veteran and his family to adapt to a disability or service-related issue; and the vocational rehabilitation stream, which supports the veteran in gaining the skills and education and expertise to transition into civilian employment.

That's the cornerstone of the new Veterans Charter programming. Associated with the rehabilitation program is a suite of financial benefits. Those provide economic support to the veteran who is participating in the rehabilitation program.

There's an economic support that pays monthly. The minimum payment would be $42,000 per year. It pays at the rate of 75% of the veteran's pre-release salary.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you very much, Madam. We're slightly over time on that, but we greatly appreciate it.

We'll now move on to....Welcome back, Mr. Casey. He used to be a very good shadow critic for the Liberal Party on Veterans Affairs, but now he has moved over to Justice, replacing Mr. Karygiannis.

Mr. Casey, sir, you have five minutes.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair. It's nice to be back.

Mr. Hillier, I understand that this may be the last time we have you as a witness before this committee. I'm just a substitute on the committee today, but I think I'm safe in speaking on behalf of the committee, sir, in saying thank you very much for your years of service, and not just in Veterans Affairs Canada. I understand it has been a long career—42 years, you were telling me—in the public service.

We here, at least in my time, certainly appreciate the professionalism and the balance that you have always brought to your testimony and to your work. To spend 42 years in the service of Canada is truly commendable. I guess on behalf of the committee, but certainly on my own behalf and Kathleen's, I wish you all the best as you move into the next chapter, sir.

[Some hon. members]

Hear, hear!

[Keith Hillier]

Thank you.

[Sean Casey, Liberal, Charlottetown, PE]

I want to ask you about the district office in Charlottetown. I understand it is winding down.

At its peak, how many people were employed there?

[Keith Hillier]

There are probably about ten people in Charlottetown.

[Sean Casey, Liberal, Charlottetown, PE]

And what was the number of case managers at its peak?