Veterans Affairs Committee on April 12th, 2016

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

As far as the case managers and the 25:1, I would think that over time you'd get a good sense of who needs the services. Do you try to even it out so that there are some tough cases for each manager and some that aren't as time consuming?

[Michel Doiron]

Absolutely. We do the 20-60-20 rule: 20% complex, 60% more in the middle of the road, and 20% easy. I say we try because it's not always 20-60-20, but we try to manage that so they have a mental break. If you deal with a homeless veteran, you may be spending three days on that, and it's very difficult.

[The Chair, Liberal, Neil Ellis]

We have about two and a half minutes.

Mr. Kitchen.

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

Just to clarify, Mr. Clarke had asked a question earlier about finances. Can we have that put in writing, so that it could then be presented, and then get a written answer on that so we can get to the questions Alupa asked at the beginning?

[The Chair, Liberal, Neil Ellis]

Yes. Mr. Clarke, we'll have that.

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

Thank you. They were more financial, which you say you're not prepared to answer, or cannot.

You talked about medical care and providing those services, which is what we need. We need to provide for these veterans. You talked about diabetes. You mentioned it's not service related. If you've ever eaten a month's worth of MREs, I would question that. We're talking about lifestyle choices.

Who makes those decisions? Let's take that situation. If someone ends up with type 2 diabetes, which in a way we're looking at as a lifestyle situation for this individual, we can possibly attribute that to his lifestyle. Who makes that decision to say yes, that is, or no, it isn't?

[Michel Doiron]

That's part of the adjudication process. The member will supply evidence of what they think, and we will adjudicate it. Often cases like that are more complex. We'll rely on jurisprudence. Is this something we've paid before? Where was the onset of the symptoms? There are certain rules regarding that.

As I said earlier, we have doctors. That's when we will refer the files to our medical experts to say, “This is what the individual is telling us. Does this make sense? Have we seen this before?” That's where we get that information.

[The Chair, Liberal, Neil Ellis]

Mr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

We were talking earlier about transitioning the medical care of veterans to primary care providers in the community, particularly to family doctors. We talked about this yesterday in the health committee. There needs to be an investment in the health community for a more readily accessible and transferable form of medical record-keeping, particularly with electronic medical records.

There's great disparity across the country and even within health regions. I know that in my own city of Winnipeg, different hospitals have different medical records. Some are still using paper and illegible handwritten notes. Is any work being done on making the medical records of active service personnel and veterans electronic, and in a form that can be transmitted, or that can be readily transferred to primary care providers and emergency departments, should they present?

[Michel Doiron]

That's a good question on that side. There's a lot of work being done to transfer the medical health records from CAF to us and to have them available. For serving members now, their records are electronic. They're historic. I don't know the exact year, but prior to that they're still paper. I don't know if anything is being done to do that.

I do know the member can ask for a CD of their medical records to provide to their health care professional, but I don't know if there's any concerted effort to do that between health care systems.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

If it's not inappropriate to make a suggestion as part of my question, I'll note that this could be very useful. Transferring records to family doctors is not as time sensitive, but again—this is my bias because of my career—very often these patients will present to an emergency department, and someone might very quickly need to get that vital information where you can just sit down at a computer terminal, pull something up, and get the information you really need for an ill veteran.

Changing gears from the mandate letter, I've been trying to keep track of what was asked so far today, but forgive me if this has been asked before. There is a family caregiver relief benefit of approximately $7,200 per year. Do you think this is sufficient to support family members in the care of veterans in their families?

[Bernard Butler]

The family caregiver relief benefit was introduced in budget 2015. It was clearly directed at supporting veterans and their families where care was fairly intensive and where the primary caregiver—oftentimes it's the spouse—needed some breaks. That's essentially what the relief benefit did. It basically was based on a calculation of the value of 30 days of care in a year. The idea was that the veteran could use that money to bring in a professional caregiver and thus afford the spouse or whoever was providing the care an opportunity to get away from it, to maybe take a vacation. It's very flexible. The money could be used to bring a family member from away to help out.

The ombudsman has tabled a report in which he has identified a number of issues and concerns around supports available to families. From our point of view, I think, we're very interested now in looking at those issues. As I said earlier, one of the initiatives we have under way through the direction of the minister is to establish an advisory committee on families to help us look at some of these issues, as a way to informing where we might go in the next round as part of the minister's mandate.

There's always more, I think, that one can do. I think we're making significant progress in that respect, but we will certainly be looking at these issues much more closely over the coming months, particularly given the ombudsman's expression of concern on the file.

[The Chair, Liberal, Neil Ellis]

Thank you.

Mr. Kitchen.

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

We've talked about medical care. I'll go back to that. I appreciate the comment on electronic records. Again, it's important that doctors have access to them. When we're talking about rural communities and dealing with computers, etc., and possibly even starting to talk about robodocs and dealing with that aspect, robodocs from the point of view of diagnostics are going to be wonderful to help in rural areas where you don't have access.

The concern I might have is that with robodocs, especially when we're dealing with mental illness, I anticipate that there would be a huge increase in the cost of replacing robodocs because of the frustration that some people would have in dealing with them. If we're looking at that and we're dealing with mental illness, I don't know whether that's even on the agenda. Perhaps you can comment on that.

[Michel Doiron]

We weren't at this point looking at robodocs in that sense. We do a lot of the electronic things, but you're talking to a real person, right? I'll take that back to my senior medical adviser, but at this point I'm not aware that we are actually going down the road of robodocs for mental health.

In our OSI clinics, either the individual meets in person with a psychologist or psychiatrist, or they do it via a secure transmission. I don't want to say Skype, because it's not Skype, but I've drawn a blank on the name.

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

You talked about evidence-based practices, and they are known to be extremely helpful and that's the way a lot of things go in health care. One of the difficulties with that is getting the administrators, the practitioners, and the doctors who spent 30 years training one way to all of a sudden come up with dealing with those best practices. Who supervises the supervisors who are making sure it is being followed?

[Michel Doiron]

We have to be very clear. The provincial health care systems have a huge role to play in the health of the veteran. VAC is not here to police whether it is the medical health system, provincial health care systems, or VAC. I say that because it's often been said when we see something identified. I think you will be meeting the chief medical officer, Dr. Cyd Courchesne, on Thursday. She's a retired commander from the navy, so she understands the Armed Forces quite well; she was DG Pol. When we notice something, we have a committee that will take it up. We have written letters to the medical associations or the College of Physicians of the various provinces because they have the ultimate responsibility. When we identify something, our doctors will look at it and then refer it to make sure they're getting proper care. The care of the individual is with his or her doctor and often we're not even privy to all the related information. It's a doctor-patient relationship, so we're not even privy to all the information when it comes to service-related issues that we're dealing with.

The only exception to that would be on the mental health side, where we pay the provinces to run operational stress injury clinics throughout the country. They are not our employees, however they work only for veterans and RCMP members—when I say veterans I do include our colleagues, the RCMP—and we pay the full bill. If it's a psychiatrist, psychologist, mental health nurses, caseworkers, or social workers, Veterans Affairs pays. We give them what we expect them to deliver, we track the performance, and we follow up with them. That's the only area where we put a caveat and it's in the realm of mental health and our OSI clinics, because that I think is more specialized care for our soldiers.

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

Who determines the successes?

[Michel Doiron]

The psychologist or the doctor working with the individual.

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

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen.

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

Thank you, Mr. Chair, and, again, thank you for being here.

I've heard a great deal about the care of the individual and of course that it is so very important, I think that's why we're all here. The reality is that over the last few years there's been a lot of anger from veterans, a lot of frustration with regard to what was available to them, how they access care. I think some of the remnants of that still exist. I wonder, in terms of the relationship between those veterans and VAC, has any thought been given to how we repair it. It's very important to have a relationship, so have you given some directive in that regard?

[Bernard Butler]

It's a very important question because we are very sensitive to that. What I would tell you is that over the last year or two we have developed, at the direction of our deputy minister, and supported by our minister a strategic plan that clearly calls for three things. One is fixing the scene and one is service excellence. Through that approach of trying to address those issues, there are three principles that are underlying it, and they are to show care, compassion, and respect to veterans.

I think it's all part of a cultural change, basically, within the department. It's trying to achieve ways and means of understanding what the veterans' needs are and ensuring that we put the veteran first. In other words, it's a veteran-centric approach in terms of not only all the services that we deliver but also in terms of the way we deal with our policy formulations, our business processes, down to including our program design.

As we go forward, the pillars are service excellence, fixing the scene, and being veteran-centric, driven by the principles of care, compassion, and respect, which we believe will actually translate into establishing a much more positive relationship with the veteran community. Together with engagement with veterans and stakeholders going forward, we believe there's a tremendous opportunity to improve that relationship into the future.

I can tell you that we hear that a lot now. It is true. There will always be some veterans who, for whatever reason, are not happy with the level of service they get. Our mandate is to try to ensure that this number is reduced to zero, if we can. In the process, we have a strong commitment on the part of our minister, our deputy minister, and our staff to basically achieve those ends.

[The Chair, Liberal, Neil Ellis]

Thank you.

On behalf of the committee, I'd like to thank both the deputy ministers for appearing again, and it was great having you here today.

Having said that, we will take five minutes here, and if the members are ready to make a decision on the main estimates 2016, we will vote on that today.

VETERANS AFFAIRS

Vote 1—Operating expenditures..........$870,518,397

Vote 5—Grants and contributions..........$2,725,592,000

(Votes 1 and 5 agreed to)

VETERANS REVIEW AND APPEAL BOARD

Vote 1—Program expenditures..........$9,451,156

(Vote 1 agreed to)

Shall I report the votes on the main estimates 2016-17 to the House?

[Some hon. members]

Agreed.