Veterans Affairs Committee on March 8th, 2016

[The Chair, Liberal, Neil Ellis]

I'd like to call the meeting to order. I'd like to thank everybody for attending today and welcome everybody in the audience.

Today the committee commences a study of service delivery to veterans through the Department of Veterans Affairs. It will also examine supplementary estimates. Today we'll be calling our first witness, the veterans ombudsman, Mr. Guy Parent. That will be our first hour.

In the second hour we'll have the assistant deputy minister of human resources and corporate services branch in Veterans Affairs, Elizabeth Stuart, and the director general of finance, human resources, and corporate affairs.

As we agreed at the first meeting on procedure, the routine motion that was adopted states that witnesses have 10 minutes to make an opening statement. Members will then take turns questioning the witnesses, and we can make that order known as we go. In round one, if we don't have it in front of us, the first questions will be Conservative for six minutes, Liberal for six minutes, NDP for six minutes, and then Liberal for six minutes.

Starting with that we will call the ombudsman.

Good morning, sir. We'll give you 10 minutes. You said you might only need nine, but we could extend that to 11. The floor is yours.

[Guy Parent, Veterans Ombudsman, Office of the Veterans Ombudsman]

Thank you, Mr. Chair.

Mr. Chair, committee members, thank you for inviting me to appear before you as you begin your study of service delivery at Veterans Affairs Canada.

Delivering high-quality services on a timely basis to veterans and their families is a key component of the responsibility of Veterans Affairs Canada. For you to take up the study of service delivery at the beginning of your mandate speaks to the importance you place on it.

You now have the opportunity before you to not only influence today's service delivery and standards for Canada's ill and injured veterans and their families, but to also shape tomorrow. To get it right I encourage you to set your sights on the big picture, the outcomes, and the interrelationships of other support elements in VAC's arsenal.

You may ask why I am emphasizing outcomes. Two weeks ago I spoke to the Senate subcommittee on veterans affairs about the importance of keeping a laser-like focus on outcomes. The reason is that understanding the outcome we are trying to achieve should be the starting point rather than the end point. If you use that approach you will find the root causes of problems and be better able to solve them.

Let's start with the question of why some veterans and their families are still struggling. Simply put, benefits are too complex, not only for veterans but for VAC staff as well. After decades of layering regulations and policies one on top of the other, with no apparent regard for how such overlapping would affect veterans and their families, a system has been created that is difficult to administer on the best of days.

Everyone involved in veterans' issues recognizes these problems, but they still remain. They need to be solved as quickly as possible because every day they cause frustration to ill and injured veterans and their families.

To right the situation and give veterans the services that they deserve, it is time to start focusing on outcomes for veterans and not outcomes for programs.

Veterans programs typically only measure program outcomes. They do not measure the effect that a particular program has on veterans. For example what does giving a veteran a $500 a month benefit accomplish in terms of creating a better life or a better outcome for that veteran? It is true they will have a little more money, but did it make a difference in their lives?

When looking at outcomes for our current programs, we need to ask the hard questions. What does it mean to provide financial stability? What does it mean to meet the basic needs of veterans? What does it mean to improve veterans' wellness? How do we measure success with those outcomes? What does the service experience feel like to the veteran? We struggle to answer those questions. If we cannot answer them, how do we know we have it right? How far do we still need to go?

Let me take this a step further. Did you know that there is no benchmark defined for a fair level of financial compensation to veterans for either income replacement or pain and suffering? There are benchmarks for individual programs, but we do not understand the overall outcomes we are trying to achieve with these benchmarks. At the Office of the Veterans Ombudsman, we look at these programs and services through the lens of fairness measured by the accessibility, sufficiency, and adequacy of programs. If we do not have an agreed-upon comparison point, how can we measure whether our efforts are being effective?

What is the added value of applying an outcomes focus to veterans’ service delivery? Let me give you an example of how we could shape tomorrow. What if the desired outcome was a veteran-centric, one-stop shop approach to VAC service delivery? This could mean that at the beginning of the release process, Veterans Affairs Canada would conduct a file review and adjudicate any and all benefits to which the veteran would be entitled. The veteran would then be presented with the results without having to apply for a single benefit.

The key question is this. If this were done in a timely manner, would it better prepare the veteran for transition, reduce workload at Veterans Affairs Canada, and increase trust in the system? I believe it would. I also believe that Veterans Affairs Canada should be proactive, so veterans don’t have to be experts in navigating its complex system.

What about veterans with mental health conditions who complain about how they are continually traumatized by having to tell their stories again and again to justify why they should receive benefits? With a veteran-centric one-stop shop model, veterans would only have to tell their story once to a health care professional. As well, we know that service contributes to certain conditions, so why do we put the veteran through the hassle of proving a service relationship when common sense says there is one?

For example, would it be unreasonable to assume that a soldier working around large-calibre guns may have diminished hearing, that an air force search and rescue technician with hundreds of parachute jumps may have injured knees, or that a submariner working in cramped quarters may have back problems?

There are some who are going to balk at these ideas because this is not the way we do business today. But I say to you that the way we do business today is not working as well as it should. If it were, we would not have as many frustrated, ill and injured veterans as we do.

Let's go beyond today's ideas, look at the outcomes, the end results that we want to achieve, and figure out the steps needed to achieve that optimal result for veterans and their families. It only makes sense that intervening early with a one-stop shop approach would likely result in better outcomes for veterans. From a national security perspective, such an approach would better support recruitment and retention than the current stream of veterans' bad news stories. From a VAC service delivery perspective, front-loading the benefits could eliminate the bureaucracy of determining eligibility at the point of need. From a veteran's perspective, needs would be met in an effective and timely manner.

If I had a magic wand, what would I do to transform the current state of affairs? I would start with a clean sheet of paper and I would list all the outcomes that we need to achieve to support veterans and their families, such as financial security for life, the best possible health care, fair compensation for pain and suffering, a successful transition to civilian life, and a veteran-centric service delivery with timely decisions.

Then, I would design the benefits and administrative processes to achieve those outcomes, because without a clear understanding of veterans' outcomes, tinkering with existing benefits is a recipe for complexity and disappointment.

Now let me take just a moment to share with you our analysis of the current status of the ACVA recommendations. Some recommendations have been addressed, and you will find as an annex an updated chart of their progress. However, some of the major substantive recommendations have yet to be implemented. As my office has reported previously, increased earnings loss benefit, better permanent impairment allowance grade determination, and compensation for family caregivers need to be addressed, because the implementation of these recommendations will significantly improve outcomes for veterans and their families.

In conclusion, as you travel across the country, please take the time to meet and listen to veterans and their families, as well as to VAC front-line workers, and see their challenges through their own eyes. If you combine that experience with evidence-based analysis and an unyielding focus on outcomes, you may be able to accomplish what others tried to but could not achieve in the almost 100 years since the Pension Act came into existence.

If you do, as a veteran with over 50 years of service to Canada, I will be at the front of the line to congratulate you.

In the meantime, my team and I stand ready to help you achieve your goal.

Thank you, Mr. President.

[The Chair, Liberal, Neil Ellis]

Thank you.

With the first round of questioning, we have Mr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Parent, for your thoughtful comments and your dedication to the job you do.

At the start you mentioned that if you give someone money, where is it going to leave them, and that the money's not necessarily the issue. I'd like to focus on that part, if I can. I think what you said makes a lot of sense.

When we focus on the issue of money, we start to look at how we provide services to the veterans. The issue would be—and I believe you touched on it a bit in your statement—the moment that they become released, knowing up front all the services available to them, versus trying to find them for themselves.

I'm wondering if you could expand upon that from your experience. It is new for me, and probably for a lot of committee, as to how that process rolls out when someone is released. What information are they given? Are they told, “Okay, now you're a veteran, let's move on”, or are they actually given the steps that are available to them based on what's gone on, and touching on the issues. You have someone who might come from the artillery and been a gunner all his life. He's not experiencing hearing difficulty right then, but there's a good potential that this individual is going to have hearing loss later in their life.

I'm just wondering whether those are issues that are presented. Could you just expand on that for us?

[Guy Parent]

Certainly.

Thank you very much. It's a good comment.

I would say right now that the biggest challenge, of course, is the transition of a military member to civilian life. Some people call it reintegration, but it is not reintegration for a military career professional who has spent 35 years in the military environment. It's not reintegration; it is integration. It's brand new, and there is a lack of good communication during the transition process, in fact on both sides: the military and Veterans Affairs Canada. In essence what needs to happen is that there has to be proof of service and there has to be an injury that has been diagnosed—and the relativity of those two—to be an eligible client of Veterans Affairs Canada.

Now, this is a multi-step process. The first, let's say, to get a disability award, is one step where all of these things have to come into play. Then there has to be determination, adjudication, as to the amount of disability, the amount of the award. Subsequent to that, if a person wants to go to a vocational rehabilitation program, again there's an application process. There's an acceptance process by the department.

What we're saying is that we need a one-stop shop where all these things are determined in advance, so that when there is a need it's already been determined that the eligibility is there. It's just the quantity that has to be decided.

Right now we are doing, jointly with the military ombudsman, a study of the transition process. The problems we see, which we've already identified, are a lot of duplication of effort, a lot of complexity, and a lot of misinformation. I will give you a quick example. A case manager, for instance, in the military side is a health care professional. On the VAC side, the case manager is a social services professional. To an injured veteran, especially somebody who has a non-visible injury, it's very confusing to say that now you will switch case managers but they don't do the same thing.

All of these things contribute to the complexity. It's a long answer, but....

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

If I can expand on that a little, we know what happens a lot of times when veterans retire from the service is that they tend to congregate in the last posting, in that area where they've been most comfortable. Certain areas tend to have a lot more veterans. For example, around Trenton, a lot of people from the air base tend to congregate in that area. It's the same for Kingston, etc.

I come from Saskatchewan. We have a lot of veterans out there who are dispersed throughout the huge community. They're well aware of the fact that they are in, say, White Bear, Saskatchewan, which is two hours to anywhere, and more than likely if they're going to go see their.... They understand. They're not expecting services to come to them. They are prepared to go. However, if you've travelled the roads in Saskatchewan, the weather changes in a heartbeat and the next thing they know they're stranded because of a snowstorm or something. Oftentimes, the process is in a place that they're supposed to have pre-approval for authorization for that service, and it's difficult to do.

Have you seen any of that, and can you maybe comment on your experiences travelling across the country when discussing things with veterans?

[The Chair, Liberal, Neil Ellis]

You have about a minute to answer that. I'm sorry, but we're almost at our time limit.

[Guy Parent]

If I understand the question correctly, it's about the business of being isolated from the services. It is a challenge, and it is a challenge across Canada. In fact, even in terms of the reopening and closing of offices, veterans are dispersed among thousands of communities across Canada. Very few have access to services.

How do we cater to those veterans? There are two items involved there. The first one is Service Canada, obviously, and the other one is the website. There is a lot of information on the website that is available to veterans now. They can actually look through a benefits browser at what services are available and where.

[The Chair, Liberal, Neil Ellis]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

Mr. Parent, thank you very much for being with us today and for making your presentation.

I have a couple of questions. First, following up on Mr. Kitchen's question, I'm wondering about the service levels across the country for veterans specifically and whether or not there are different service levels in isolated areas. I come from a rural place in Nova Scotia where there are lots of veterans. I know that one of their big challenges is transportation to Halifax in order to get to the services that are offered in the major centre in our province.

I'm wondering if you could comment on the service levels and whether there is, in your mind, sufficient outreach to those folks who have difficulty getting transportation to the major centres.

[Guy Parent]

To answer the first part of your question, yes, service levels obviously are different. In big cities they have big offices for services. But I think we have to make a distinction here between access to services and access to health care, for instance, and treatment. There is compensation provided to veterans and their families if they have to access medical care, whether it's medical appointments or services.

With regard to information and communication, I think what's important to realize here is that with the demographics of veterans in Canada, we still have a lot of older veterans, the older generation from World War II and Korea, and they need a different level of service, with different types of communication, from the modern-day veteran.

On the level of service, of course the expectation levels are different now. The modern-day veteran has access to information and they have expectations. It's quite different. The challenge right now with Veterans Affairs Canada is making sure that they can meet the needs of all generations of veterans. That's not an easy thing to do, especially when there are regional discrepancies.

In the area of health care, for instance, Veterans Affairs Canada complements whatever the province is offering. That handles the problem of regional inconsistency as far as level of care is concerned. There are different levels. It's a challenge for Veterans Affairs Canada not only to meet the needs but also to meet the evolving needs of veterans.

[Colin Fraser, Liberal, West Nova, NS]

Thank you.

With regard to the mental health aspect, I understand there are many layers to that complex issue of dealing with mental health issues for veterans. As you say, the demographics are changing and there may be different issues there.

Can you explain why they have to tell their story over and over again, and why a veteran-centric approach would be a better model so that they only have to tell their story one time? Why is it broken right now? Why is that happening?

[Guy Parent]

The application process for different benefits requires people to fill in different forms, to have different interviews. Where there's an adjudication mechanism, there's an assessment of their ability and disability. In every one of those instances, somebody suffering from PTSD or any non-visible injury has to repeat their story: why, what is the cause, what is the reason for their state of being? That happens all the time.

I'll give you a good example. If we have a file, for instance, that needs to go to the military ombudsman, we do a hot transfer of the file. We tell the military ombudsman what the story is so that the individual doesn't have to do that again. Sometimes it's a matter of switching case managers, or a matter of switching the personnel who are looking after that veteran, and they have to retell their story. It's the same thing when you're talking about tombstone data. Why do you have to refill, 26 times, 26 forms? Fortunately, there is some work being done in that area right now.

[Colin Fraser, Liberal, West Nova, NS]

Does your office have anything to do with the Veterans Review and Appeal Board?

[Guy Parent]

We have no jurisdiction as far as decisions are concerned. Our jurisdiction extends to the process.

If there are any questions of the procedure with law, natural justice, process problems, then we can get involved.

[Colin Fraser, Liberal, West Nova, NS]

My understanding is that some concern has been expressed regarding the time it takes to have a matter adjudicated by the board. Would you agree with that, and do you have any recommendations on what we could do to resolve that?

[Guy Parent]

I would certainly agree that the time it takes to arrive at a decision is one of the challenges not only at the appeal level of the decision but also on the adjudication. It's frustrating for veterans and their families to the point where some people suffer from what we call process fatigue. They just give up and they shouldn't. That's why we always emphasize where they need to go and what they want to achieve.

Again, it's the question of an outcome. If the goal of what they want to achieve is set, and they try to meet that outcome, a lot of things come into play due to the fact that many departments are involved. There needs to be some information coming from DND to VAC and then to the Veterans Affairs Canada structure. A lot of people are involved there as well, and then the VRAB takes over in the appeal process and they redo a lot of the analysis and review. It takes a long time and certainly improvements are to be made there.

[The Chair, Liberal, Neil Ellis]

Thank you, Mr. Fraser.

Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much, Mr. Chair.

Merci beaucoup, Monsieur Parent. I want to thank you for the time you've spent briefing us, individually and here today.

I wanted to come back to one of the briefing notes you've provided, help for veterans. What percentage of contacts do you get specifically from the five different groups? I'm also wondering what percentage of your contacts from veterans are resolved and your definition of a resolved case. First, what percentage of the contacts does the ombudsman get from wounded veterans?

[Guy Parent]

On average we get 5,000 calls a year. That all comes in different ways: email, website, electronic form. What's been increasing in our contacts is that we do more intervention than we did before. A lot of our calls are informing or guiding people through the process, helping them to navigate the complexities. Then the other one is resolving cases.

In the last few years the number of interventions has been increasing. We have to engage Veterans Affairs Canada to resolve a problem. The majority of those issues have to do with health care regulation. We spoke earlier about reimbursement for travel to attend health care treatment. It's these kinds of problems, people not being reimbursed fast enough or not to the level they expected.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

You referenced health care.

Any idea how many of those health care questions would be with regard to mental health issues, including PTSD?

[Guy Parent]

We don't have mental health issues as a category of complaints. They're all related to health care. It would be very hard for me to....

Mr. Chair, I can send the committee some of the data that we have on the type and number of complaints we get, if that would be useful to the committee.

[The Chair, Liberal, Neil Ellis]

I think the committee would enjoy having that.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Any idea how many issues about transfer from DND to VAC you would have in the course of the year?

[Guy Parent]

I take it you're talking about the transition issue, the types of complaints. Most of them fall into other areas like the application process. It can happen during transition or after, but we don't have a specific category of transition issues. They all fit into other types of categories like vocational rehabilitation complaints, application complaints, and that sort of thing.