Veterans Affairs Committee on June 10th, 2019

[Craig L. Dalton]

Yes, it's clearly a very big issue and one that nobody would accept.

I would just highlight a recommendation that we have made to VAC, among a number of recommendations, around triage. It is that, when veterans apply, cases be triaged to determine who is most in need, so that veterans who need immediate access to care or might be in financial difficulty or might be aged or might be terminal, in some cases, get the support they need as quickly as possible.

VAC has done some good work in that regard, but we think that triage needs to be taken a little further and it needs to be clearly explained to the veterans community so that when they apply, they share all the information they can share that might help them avail themselves of a quicker process if it's needed.

I'll defer to VAC, and I know they have testified before you on the stats and the reality with the number of increased applications, the increased production. That's their story to tell and I'll let them tell it. But clearly I have nothing more sophisticated or intelligent than to say that we need to find something disruptive or it's not going to change. We'll be at the whim of the number of applications that come in.

The one thing I think we should look at, and I mentioned it earlier, is granting access to treatment right away. When you look at the approval rates for the disability claims that VAC processes, they're very high and the PTSD one jumps out at me. If we're at 96% or 98% after reviews are taken into account, why do we have a six- eight- or 10-week process? If you have the diagnosis, it's clear and you have that medical assessment, you should get immediate access to treatment.

I don't know what that would look like. We haven't done any work in that regard, but I think treatment would be the most important thing for veterans to get access to, so that they don't become more unwell.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Blaney.

[Rachel Blaney, NDP, North Island—Powell River, BC]

I just want to go back to the reservist veterans. You spoke to the fact that what's maybe working well for the veteran community doesn't necessarily mean it's working well for the reservist community.

I'm just wondering if you could highlight what the difference is.

[Craig L. Dalton]

Yes, I could give you an example. There is the income replacement benefit, which is a very good program, formerly the earnings loss benefit. The education and training benefit is another one.

There are certain eligibility criteria for those programs. The time of service is calculated differently for regular force members and reserve force members. We've received a couple of complaints related to what is now the income replacement benefit that suggest that, not intentionally but when those eligibility criteria were developed, they ultimately resulted in what is an unfair scenario for reservists.

I can give you a quick example. For regular force members who are released medically after 30 years of experience and are eligible for the income replacement benefit, that income replacement benefit will be calculated based on their salary at the time of release.

In the case of some reservists who go on and come off of different classifications of service, different types of service, which is very complicated, they may suffer an injury.

For that regular force member, that initial injury may have been suffered 15 or 20 years previously, but may have been aggravated to the point where they could no longer serve and there might be diminished earnings capacity.

For a reservist, that individual may have suffered an injury 15 or 20 years earlier at the rank of corporal, and may have released at the rank of chief warrant officer because they were no longer able to serve. Their income replacement benefit is based on rank and salary at the time of injury. You advance 15 years and you have a wife and two kids, a mortgage and perhaps are putting kids through school and those types of things.

That's one example of a really good program for which it appears, in the cases that have come before us, that we'd probably need to look at the eligibility criteria.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

One of the things you said in your report is that health care and support continues to be one of the biggest challenges. I look at the report card and I see there was improvement in one. One is improving but the rest are still a significant challenge.

You talked about the children getting mental health support. I'm looking at some of these and they seem like real practical steps: eliminate the inconsistencies; merge programs so there is a continuum of care as opposed to having all these separate parts.

I'm just wondering if you have any understanding of what the barrier is, what resources the department might need.

[Craig L. Dalton]

I suspect it's capacity to manage change and to tackle these recommendations. As I mentioned earlier, if you look at the recommendations that have been implemented, you see it tells a bit of a story. I think the focus has been on addressing financial security after the transition from the Pension Act to the Veterans Well-being Act. At least the recommendations we've made have been knocked on the head.

I think that's what it is. We recognize that these recommendations need to be put in the broader context of what's on the department's work plan, but our job is to continue to shine a light on them and maybe to do a little more homework and make a more compelling case. I think that's probably the reason.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you so much. I believe that's my time.

[The Chair, Liberal, Neil Ellis]

Okay. That ends it for today's testimony.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Can I ask one more question since we have an hour to go?

[The Chair, Liberal, Neil Ellis]

Yes. Sure, that's not a problem.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

It's one area that was missed out on. We heard testimony that VAC was directing veterans to outside service providers when they called for emergency fund assistance. One million dollars was set aside from VAC, which is great, to deal with emergency cases, but the case managers were instead referring them to Veterans Canada down the street here in Ottawa because they could respond so quickly. I just wonder about your perspective in seeing the big picture like you do.

What is VAC's role and what should be the role of these amazing organizations that are very effective? They know the veterans and they serve 365 veterans in their first year of service, and none of that money has come through VAC. They don't let them end up in an overnight place. They move them right away to a hotel. They know what they need to do to make sure they don't fall into that cycle.

In all that you do, what do you see in the relationship there between these organizations that veterans will flock to because word of mouth says they take care of them, and the role of VAC, which is also very important? How should those two be coming together?

[Craig L. Dalton]

The first thing I would do is just acknowledge the good work that VETS Canada and many other organizations out there do to support veterans at the coal face. I've had a chance to visit with them and see where they do their work and how they do it. They do accomplish great things. I can understand why they and the many other organizations.... When I say “they”, I am referring to organizations from the Legion to Veterans Helping Veterans to Wounded Warriors Canada, a whole host of organizations.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Absolutely.

[Craig L. Dalton]

Those organizations have developed tremendous capacity in recent years. I would say that we should seek to leverage that, and if there are better ways to deliver programs to veterans in need, then we should consider those as options or alternatives.

I think it's that question of outsourcing and in-sourcing and who's best positioned to deliver that program to achieve an outcome.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

There's a move now in the health care system to allow the patient to determine the direction that they want to go. Is that not something that would work well for our veterans as well, to be able to be funded, but appropriately, for the right organization to meet their needs?

[Craig L. Dalton]

I think we should be. I have experience with that personally in the past in a disability support program where we offered the client the option of how to access services, case managing, inside government or outside government. For a variety of reasons, folks went one of those two ways. I think being as creative as we can and ultimately looking at what works best for the veteran should guide those types of questions. They're certainly good questions to pose.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Chen, did you have a question?

[Shaun Chen, Liberal, Scarborough North, ON]

Thank you, Mr. Chairman.

I'm going to be blunt because this is a report card, and to me, this is a failing report card.

I want to thank the ombudsman for making these recommendations, but I just find it very disheartening to see that—I'll give credit where credit is due—50 out of 63 have been implemented or partially implemented, but in the category of health care and support for veterans, eight out of 10 are not implemented. To me, that is incredibly tragic. Our veterans, our service men and women, put their lives on the line, put their physical and mental health at risk to serve our country. We need to make sure that we are doing better.

In looking at some of the areas where improvement is needed, Mr. Ombudsman, you said earlier that you believe it's the capacity to manage the change at the department. That is partly why some of these things that seem incredibly simple and logical lead me to ask this question. We see so many other parts of this report being addressed adequately. Why is it that when it comes to health care and support, we are lagging behind? Why is that not a priority in terms of making sure that, for example, veterans don't have to wait in the 40,000 backlog of cases. Why, for example, are they not getting the same access to dental care as they would under the public health care plan? Why is this not being prioritized?

To me, it's one of the most important things, to make sure that veterans and their families get the supports they require when it comes to their health and well-being after they have served.

[Craig L. Dalton]

We would certainly like to see them all implemented as soon as possible as well. I think what I should do, in recognizing this, is not assume why VAC has or has not implemented these recommendations. I think we need to do a better job of capturing that information so that, when we appear before you, we can address those questions.

In the interim, I would refer you to VAC with those questions, if you have VAC appearing before you.

[Shaun Chen, Liberal, Scarborough North, ON]

How does the accountability work? The ombudsman issues a report, addresses certain areas and highlights issues and problems that you have identified based on input and experiences of veterans. Is that simply just provided to the department, and then it's up to them where, how and when they address the concerns you have raised?

[Craig L. Dalton]

Yes, I think the first thing to note is, with our mandate, we don't compel. We use moral suasion. We try to use evidence to suggest that these changes should occur.

The practice that we've shared between our office and the department over time, over a number of ministers, in terms of communicating these recommendations and in capturing VAC's specific response, has been varied. I would like to be able to sit here and say, “This is the exact response we received in relation to these four recommendations,” and in some cases, we have that, but we don't have it in response to all of these recommendations.

As I mentioned earlier, as we take this report forward and as we make recommendations to the department in the future, we're going to ask each time we do that for the following in response, “Do you agree or not? If you do agree, when do you anticipate being able to move on this recommendation and achieve implementation?” That way, when we track, we can get an update on why or why not they have or have not moved forward. We don't possess that information at the moment, unfortunately.

[Shaun Chen, Liberal, Scarborough North, ON]

I think that's very key because, if these recommendations are being made, the first step is to determine whether or not the department agrees with the recommendation. The second piece is, if they do agree with it, what is their plan. Where is the action plan? What steps are they going to take? What are the achievable targets and where is the accountability? To me, these things are extremely important.

You're the connection to veterans who are upset, who are frustrated and who are not getting the service that they deserve and should be entitled to, and they need to know what the answer is. It's one thing for them to raise the concern, but there has to be a response and it has to be formally communicated so that there is accountability and transparency with respect to these recommendations and what specific actions the department is going to take to address them.

[Craig L. Dalton]

I fully agree.

[Shaun Chen, Liberal, Scarborough North, ON]

Thank you.