Evidence of meeting #51 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was benefits.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Guy Parent  Veterans Ombudsman, Office of the Veterans Ombudsman
Sharon Squire  Deputy Veterans Ombudsman, Executive Director, Office of the Veterans Ombudsman
Bernard Butler  Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

4:50 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

We'll begin with six-minute rounds.

Mr. Brassard.

4:50 p.m.

Conservative

John Brassard Conservative Barrie—Innisfil, ON

Thank you, Mr. Chair. I have just a couple of questions.

Most of the answers to the questions were probably covered by the veterans ombudsman, but I want to focus on the simplification and access to the programs and the streamlining of services that you talked about. Clearly, when you look at this chart.... I posted the chart on Twitter for anyone who wants to see it. It's a good opportunity to check your vision, and your colour as well. It is complicated.

I'd like to get a sense from you about what the department is doing to simplify access to the programs and streamline the services, and how that compares to other jurisdictions that we're now going to be looking into.

4:50 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

I think I'll begin by commenting that this chart is very informative and very helpful. Interestingly enough, when this chart was first presented to the department, the ombudsman's office presented it in the form of a PowerPoint that essentially layered one benefit over another—

4:50 p.m.

Conservative

John Brassard Conservative Barrie—Innisfil, ON

To be clear, it would have had to.

4:50 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

—so in the original presentation, it actually didn't look quite so challenging.

The second comment I would make, of course, is that not every veteran is eligible for all these benefits. This chart shows the situation if you qualified for every single benefit that was out there, including those that may well be duplicated through other departments, potentially, as the ombudsman referred to, with vocational rehabilitation programming, the SISIP program, and our own ELB program. It takes on a bit of a different look.

With that, what I would say more specifically is that in the minister's mandate letter, he was, in fact, charged to reduce complexity. That is one of the initiatives that the minister and the department are very much focused on right now. As you may well be aware, the department has just now concluded quite an exhaustive service delivery review. In that review, there was extensive consultation with veterans, stakeholders, and others. The image conveyed by that was certainly validated in some respects. What veterans have been telling the department is that they need more support—some of them, not all—to help navigate systems, and that they also need a system that does not require them to take the initiative to ensure that they have access to each and every benefit.

In other words, we describe it as a bit of push-pull system. Instead of the veteran constantly trying to pull eligibility out of the department, we are going to move in a direction where there is more push. I'll give you a simple example. In our clientele, we basically identified three categories of veterans. There are those veterans who have complex needs. They need a lot of support. It may be because of mental health issues. It may be because of physical problems. It may be the complexity of their family context. For those folks, they need case managers.

There is another category of veterans who really don't need much help from the department at all. They may come to us one time. They may have eligibility for one particular benefit, and other than that, they're doing quite well.

There is a middle ground of clients who don't need case management services, but they do need guided support. We've been in the process right now of running a pilot where we have our veteran service agents actually providing more hands-on, direct support to that group. As we move out into the future, what we hope to see as part of our service delivery review model is more and more engagement by the department in supporting veterans' access to the benefits that they need, particularly those who fall in those case management and guided support categories. Also, we are looking now at ways and means of trying to simplify the array of benefits that are offered.

There is an irony in this, and I think the irony is that more and more benefits come online. We've seen a host of them with budget 2017. All of them are very important, and all of them help to meet gaps and address needs that are emerging. The fact of the matter is, however—and this would be my personal assessment—that the more individual program elements you create, the more you are at risk of adding complexity because you have to have separate eligibility criteria for each one. Eligibility criteria for the new education benefit, obviously, would be different than eligibility criteria for a rehabilitation benefit. I think that creates the challenge for the department to find ways and means to make the benefit suite simpler.

4:55 p.m.

Conservative

John Brassard Conservative Barrie—Innisfil, ON

Just by way of comment, I think I share your concern. You can create all of the programs that you want. It's the effectiveness and the efficiency of those programs that become important. In terms of measures on the uptake on some of those programs with respect, for example, to education and training, I could throw a billion dollars at it. If none of our veterans are participating in a training or education benefit, then it becomes a concern to me as a parliamentarian that we're not being very effective.

4:55 p.m.

Liberal

The Chair Liberal Neil Ellis

Thank you.

Mr. Fraser.

4:55 p.m.

Liberal

Colin Fraser Liberal West Nova, NS

Thank you, Mr. Chair.

Mr. Butler, thank you very much for being here today.

You mentioned best practices. I'm wondering, in the course of our study here comparing different jurisdictions and how they deal with veterans, whether you could point us to some way to take a look at best practices. Is there any report or any documentation you're aware of that's been compiled regarding best practices around the world?

4:55 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

I would start by complimenting the ombudsman's office on the excellent report they did on fair compensation. When you go through the annexes of that report particularly, there are some very helpful comparatives in terms of what different nations are doing.

However, I think the important point, the difficulty, is that you always have to look at the benefit suite that any given country is offering and the context in which it's offered. They all differ. They have agencies administering their benefit suites for them. They may have departments of veterans affairs. They may have their military, their department of national defence, delivering some of their programs.

From our perspective, we try to look at our own context. We try to understand what some of these other countries are doing, particularly the ones that have programming most similar to our own, which would be countries like Australia, New Zealand, and the U.K. We then look at our own individual context and try to figure out—hearing what veterans and stakeholders are telling us—the most efficient and effective way to deliver the business.

The challenge from our point of view is that, again, simple comparisons are not easy to make. With our service delivery review as an example, we've taken particular time to try to understand from the veteran's perspective and the family's perspective what challenges they have when they come to Veterans Affairs. If they had their druthers, what would provide better service to them? Some of the modelling, which I've just talked about in terms of guidance, support, and so on, is effectively coming out of those types of consultations.

May 1st, 2017 / 5 p.m.

Liberal

Colin Fraser Liberal West Nova, NS

I appreciate, of course, that context is very important in not making direct comparisons. For example, in the field of mental health service delivery to veterans in particular, that's going to depend on the health care system in that particular country and whether it's a federation and whether it's a jurisdiction of a state or a province.

In particular with PTSD and its prevalence, which we know exists in Canada among our veterans, I assume it's similar in other countries. There will be a higher propensity of PTSD and mental health issues amongst veterans than the general population.

Is there any way that we can get a handle on best practices to deal with those types of issues in particular and have an ability to hopefully incorporate some of those best practices into our model in Canada?

5 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

Thank you for the question. It's very appropriate.

Again, I think you will obviously have that opportunity to engage with experts from other countries. If you look at the American experience, where they have such a large number of veterans, they have a much bigger research budget and so on than we do. They have a very tailored mechanism for delivering mental health services through their health care facilities. You may well wish to look at that kind of a model.

The challenge for us in Canada is that health care is the responsibility of the provinces. What we have tried to do from a Veterans Affairs-Government of Canada perspective is to try to determine how we can best leverage the work that the provinces do. The best example, obviously, is our network of OSI clinics. As you know, the department funds those clinics but the services are delivered and administered by the provinces. Those clinics have proved to be, from our perspective, a very effective way of targeting the resources and support to veterans struggling with things like post-traumatic stress disorder, because it gives them a context.

The other thing that we're doing, of course, which was announced in the budget, is the development of this centre of excellence in PTSD. The intent there is to try to ensure that through that mechanism, the Government of Canada has a source of advice for this very type of thing. What are the best treatment methodologies out there? What is most effective? That, in turn, will inform programming for Veterans Affairs.

5 p.m.

Liberal

Colin Fraser Liberal West Nova, NS

Again, it may not be fair because direct comparisons are difficult. I understand that. The earnings loss benefit being increased to 90% of pre-release salary, having that extra amount of money, is obviously going to be helpful to many people in that situation. How does that compare with other countries? Are you familiar with other types of disability compensation in other jurisdictions, and how does that compare?

5 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

There are other programs not dissimilar to this one, so what you'll find is that, particularly in the countries I've mentioned—the U.K., Australia, and New Zealand as examples—they have similar income support programming. There are ranges, and this is what you will discover when you start to look at them. Some countries will offer ranges of 75% to 90%. They may be based on taxable, pre-taxable income, or net income, so you have to take that into account. That changes the equation again as well.

Every country has its own social construct and its own other programming that's offered either through their military or through their own national government. Again, it makes a simple comparison difficult, but our programming is not dissimilar to those countries that I've just noted. There are variances and so on, but the basic concepts are very similar.

5:05 p.m.

Liberal

Colin Fraser Liberal West Nova, NS

Thank you, sir.

5:05 p.m.

Liberal

The Chair Liberal Neil Ellis

Ms. Ramsey.

5:05 p.m.

NDP

Tracey Ramsey NDP Essex, ON

Thank you so much for your presentation today.

Really, a lot of the things I think we're asking cross the questions we had for the ombudsman earlier.

My question is about how international studies are used to support treatment for our veterans. I wonder if you can speak a bit about how at Veterans Affairs you look at international studies.

5:05 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

Thank you very much for the question, and it obviously is an important one.

For Veterans Affairs programming, we do not provide acute care, as you know, but we do provide treatment benefits for service-related disability, as an example. In the normal course, Veterans Affairs is guided by Health Canada. It's guided by acceptable medical practices and treatments in Canada, so there are standards we follow. It's not arbitrary, by any means. If a veteran comes to us and says, “I understand that a certain treatment is provided in another country”, we will certainly look at that and try to determine whether there may be some opportunity for recognition in Canada of that particular treatment. If not, then depending on the nature of the claim, the frequency of it, and so on, we will look to ways and means to try to help out.

I think the ombudsman pointed out the example of service dogs for psychiatric conditions, which was a very good example. The challenge we had there was that we had veterans coming to us, saying, “Look, you know what? I have a service dog, and it's really providing me with a lot of relief.” The challenge was that there were no standards in the country for training and acquisition of service dogs. Secondly, there was no evidence to show that having a service dog is an acceptable treatment methodology for a mental health condition.

What the department has done, basically, is embarked on a bit of a research project through a third party to look at both of those issues. If the results of that prove favourable, then that would be something we would immediately move to put on our treatment benefit list. Equally, you should be aware that the Americans were facing a very similar problem, and I understand that they have a very big study under way looking at similar issues. We will equally look to that to see what other research is out there that might help to support us going in a given direction.

The issue for us, obviously, is that we always have to be very concerned about not doing any harm by supporting a treatment benefit if there's no scientific basis for it and no foundation for it. That is always a concern.

5:05 p.m.

NDP

Tracey Ramsey NDP Essex, ON

I think that's interesting because, when it comes to mental health, I don't know that it's as much science as it is that it has a positive benefit and impact on that individual's life. An individual says that this allows him or her to live his or her life to the fullest extent versus some type of scientific data backing that up. It's really relative to that person and determined by them.

How would Veterans Affairs decide on what therapies are approved for treating veterans?

5:05 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

The example, I suppose, would be pharmaceuticals. With pharmaceuticals, we have a pharmacist now on strength. We have a director general of health services who is a former Canadian Armed Forces physician. We work with Medavie Blue Cross, the service provider for our treatment benefits, who have a formulary expertise as well.

Basically, we look to see what other jurisdictions in Canada are doing, and what Health Canada is doing by way of its formulary. Is this particular pharmaceutical already approved? If not, we would not approve it if it is not approved in the Canadian context. We would look out then and determine what evidence there is.

5:05 p.m.

NDP

Tracey Ramsey NDP Essex, ON

How often does Veterans Affairs look at new therapies offered?

5:05 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

We look at new therapies offered as they come to us. I don't think it would be—

5:05 p.m.

NDP

Tracey Ramsey NDP Essex, ON

Would it be an individual, or would you have to have a collection of people? What would trigger you to say, “Okay, we need to look at this as a new therapy. Where do we go from here?”

5:05 p.m.

Assistant Deputy Minister, Strategic Policy and Commemoration, Department of Veterans Affairs

Bernard Butler

If a veteran comes to us with some indication or some evidence of a therapy that's being offered, we don't simply decline it because it's not on our formulary or on our approved treatment benefit programs of choice, as they call them. We would look at it and try to determine whether there may be a basis for recognition of it as an acceptable treatment.

5:10 p.m.

NDP

Tracey Ramsey NDP Essex, ON

My next question is about something that has been a hot topic in the news. It's about military sexual trauma. Has Veterans Affairs looked at how other countries have treated those with military sexual trauma, who may or may not qualify for benefits under our current rules of service delivery?

5:10 p.m.

Liberal

The Chair Liberal Neil Ellis

I'm sorry, but you will have to keep it short.