Veterans Affairs Committee on Nov. 7th, 2017

[Colin Fraser, Liberal, West Nova, NS]

Great.

I'd like to turn now to the Veterans Bill of Rights and how that compares. We're doing a comparative study right now with other jurisdictions, one of them being the United Kingdom.

The United Kingdom has a military covenant. I'd like to hear from you what the difference is between a veterans bill of rights and the United Kingdom model of military covenant, and whether the military covenant in the U.K., as you understand it, is legislation or policy.

[Bernard Butler]

I think this is a classic example of the need to look at the different contexts in the U.K. and Canada.

In the U.K., much of the programming is provided through agencies that are external to government. They have a large cohort of charitable organizations and other formal organizations that deliver benefits and services to veterans, unlike in Canada, where we have a legislated Department of Veterans Affairs and a very clear legislative framework and mission and mandate for the support of veterans. In the U.K., if I understand correctly how their covenant works, it's a reflection of how communities and all the organizations that support veterans' programming have acknowledged and recognized the basic concepts of what is important in supporting veterans.

In Canada, we have more of a statutory framework. Our bill of rights evolved out of the notion that it would be good to have some basic principles of fairness and respect and so on to help guide the department and support veterans in the process. The bill of rights is a policy statement that reflects and guides the Department of Veterans Affairs and informs veterans of what they should reasonably expect from government and the department in the benefits they apply for and how they are managed and processed. It's actually a different context.

That said, the basic principles are of value in both of those contexts. They include showing respect for veterans, trying to provide the best quality of service that we can for them, expectations in terms of timely management of their claims, and so on. All of these very fundamental tenets are laudable.

[Colin Fraser, Liberal, West Nova, NS]

Thanks.

[The Chair, Liberal, Neil Ellis]

Ms. Mathyssen is next.

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

Thank you, Mr. Chair.

Thank you for being here. I truly appreciate it. I have a number of questions, and I'll try to be succinct. I look forward to your answers.

The minister's mandate letter says that one of the goals is to “re-establish lifelong pensions as an option for our injured veterans...[while ensuring] that every injured veteran has access to financial advice and support so that they can determine the form of compensation that works best for them and their families.”

Veterans took that to mean that a lifelong pension would be re-established, period. Can you elaborate on what this does in fact mean, and how it differs from what veterans expected during the federal campaign in 2015?

[Bernard Butler]

You're absolutely right. This is a very clear element of the minister's mandate commitment. It has been the subject of much discussion and debate over time.

I think you're absolutely right. There are some stakeholders who interpret it literally, meaning re-establish or bring back the Pension Act as an option. There are other views of that, though, in terms of whether it may really mean bringing back or supporting financial security in one form or another for veterans.

At the end of the day, I can tell you that the department continues to do a fair amount of work on this particular piece, but it will be the minister who will come to cabinet when he is in a position to do that and it will be the Government of Canada that will respond to this significant policy issue.

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

Thank you.

There has been a lot of discussion about the costs involved in claims—the assessment of claims, the denial of claims, and dealing with all of that—in regard to processing, person-hours, court appearances.

Do you have any idea about how much money is spent in all of these interactions in terms of staff, court time, etc.?

[Bernard Butler]

If you go to the public accounts, you'll see clearly the amount of money spent by the department on all of its programming. I think you'll find that about 93% of of our annual expenditure is directed to programs in support of veterans. In other words, it's flow-through money to veterans.

At the end of the day, it is a sizable investment that the Government of Canada makes to veterans and to supporting all of these programs. I don't have a figure in front of me for the program expenditures on disability benefits, which I think is the one you're alluding to.

It's interesting that if you look at our legislation, you see we're dealing with the Pension Act, legacy legislation that dates to 1919. That essentially set the framework, the same framework that guides most other countries, although we see a little movement away from it. The basic framework is service attribution. In other words, the philosophy and underpinning of this is that benefits paid to veterans are based largely on the premise that if you have a service-related disease or disability, then you should receive support for it.

In the new Veterans Charter, the disability award benefit is similar, in that you need to show a service connection to receive it. As soon as you impose that standard, that eligibility criterion, on a benefit process, you automatically require a fair amount of administration to make that determination. It's a very complex piece that all of our allies experience too.

It's interesting in that the public tends to focus on disability benefits. In the current programming, the new Veterans Charter, it's the disability award. That's what people focus on when they consider the administrative burden: timeliness of processing, accessing service records, and so on. All of this is essential to satisfying eligibility criteria. I would ask the committee to bear in mind that the disability award program is only one element of the vast array of programming that the Government of Canada provides through the Department of Veterans Affairs. There are multiple programs that nobody ever focuses on but that are very important in supporting wellness and the re-establishment of veterans. The basis of the new Veterans Charter is our rehabilitation program, which focuses on wellness, re-establishment, and reintegration. Applications for access to our rehabilitation programming and our income support programs take a few weeks to process, because the eligibility criteria are somewhat different. The thrust of that is to get members and their families supported so that they can be rehabilitated, get employment, find a sense of purpose, and move into civilian life.

I think it needs to be positioned in that context before we can understand and appreciate it.

[The Chair, Liberal, Neil Ellis]

Thank you.

Go ahead, Mr. Samson.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Thank you.

To start, I'd like to put two extremely important questions to Mr. Doiron.

I visited a clinic that treats operational stress injuries or OSIs. I have to say that what I saw there was very impressive.

These clinics offer state-of-the-art services to support veterans. However, veterans in my riding and in the Halifax region don't find these clinics work well when there's a crisis that happens outside of normal business hours, as these clinics are open from 9:00 a.m. to 4:30 p.m. Since veterans can't plan when they're going to have a crisis, this really doesn't work very well.

Moreover, if a veteran is in a crisis situation and goes to the hospital, and this hospital doesn't have information on hand or on the challenges he's facing, the services won't be up to standard.

Clinics want to work with the federal government and the provinces to be able to offer 24-hour service.

What do you think about this?

[Michel Doiron]

Thank you for the question. I'd like to raise a few points. Firstly, I participated in discussions on the OSI clinics and on services offered 24 hours a day. However, it is very important to understand that health care is under provincial jurisdiction throughout the country. It is clear that the Government of Canada offers an additional, superior level of care, especially with regard to mental health. That is the purpose of our OSI clinics. I would remind you that we hire provincial staff so that they can offer services in our clinics.

Notwithstanding the second point you raised in your question, it is critical that an individual in crisis present themselves to a hospital, to an emergency service, and that they see a health care professional to obtain immediate care. Even service points offering 24-hour-a-day service—and this is an aspect that we are trying to get our colleagues to understand—are not emergency service points unless a province decides otherwise. The provinces, under their mandate, have the powers and capacities necessary to do so, but in my opinion, an individual in crisis should go to the emergency room.

Our chief psychologist, Dr. Heder, and our chief physician, Dr. Courchesne, both hold this opinion. They believe that emergency rooms and hospitals are the places where our veterans can receive adequate care. Nonetheless, we understand—and this relates to the second point in your question—that, for some individuals, especially if they are in crisis, going to the emergency room is not necessarily appropriate. That's why we are working with doctors and clinicians' associations throughout the country in order to educate them about the unique needs of our veterans. The first aid received by a veteran in crisis is administered by health care professionals. However, going to the emergency room to get into a hospital is not always easy. That's why we have a service that veterans can call 24/7. We also have other mechanisms to help them.

That said, if the province of Nova Scotia wants to, we are ready to work with the province and discuss possible ways forward, but health care is a provincial responsibility.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

The fact remains that the situation is a bit different in Nova Scotia. There is Camp Hill Hospital, which we could use. Like all of the other hospitals that you mentioned, it could offer services and that would be a good thing. That being said, I will not get into this subject today because I don't have time.

Before moving on to Mr. Butler, I would like to ask you a question about doctors. Some veterans have had the amount of cannabis allotted to them reduced from 10 grams to 3 grams. However, if they're not in agreement or if they wish to receive the amount that they were entitled to previously, they can consult a pain doctor. If I understand correctly, that's the process for reaching this objective.

How do you believe a Nova Scotia veteran could follow this process, when there are no doctors recognized for this purpose and there is a 24-hour waiting list?

Can it be said that this service is sufficient for Nova Scotia veterans?

[Michel Doiron]

Thank you for the question.

Pain doctors are not the only professionals who can prescribe an exemption. A psychiatrist can also do so if mental health is an issue. Some people say that they are being treated by a psychiatrist for mental health issues. Having discussed this, I know that the issue of psychiatrists is truly a problem in some parts of the country, particularly in Saskatchewan. One of your colleagues raised this issue with me, and rightly so. These people can consult a psychiatrist and obtain an exemption. The policy does not rule out this option. It specifies pain specialists and psychiatrists. These are the two types of doctors that people can consult.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Thank you. You are the first person who has given me this answer. To date, I have asked seven or eight people about this, including the department here in Ottawa.

The last question is for Mr. Butler.

[The Chair, Liberal, Neil Ellis]

Make the question quickly, and then he can mail the answer to you.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

My only point is transition, as you said. How can we expect any other profession in the public service to receive their benefits when they leave when veterans don't have that same right?

[The Chair, Liberal, Neil Ellis]

You can give that answer to the clerk.

Go ahead, Mr. Bratina.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Thank you.

On the comparison study, we've had the 2017 review of satisfaction, and 82% was the number that you said. Are we aware of any of our counterparts that have done similar satisfaction reviews? It's hard to compare jurisdictions, as you've explained, but one thing you can compare is the relative satisfaction of veterans with regard to their services. Are we aware of other jurisdictions who have done this kind of survey?

[Michel Doiron]

Personally, I am not aware of other jurisdictions. They may have, but I am not aware of any.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

With regard to this one, could you give me, once again, what the 82% and some of the highlights of that survey were? The last one was 2010. This one is 2017. What do we have?

[Michel Doiron]

In 2017, we went out and surveyed just over 1,500 veterans. I say “we”, but we hired a firm to do it. It wasn't Veterans Affairs. It was the first survey since 2010. We had not done any survey of our clients.

The top five results were that 95% agreed that VAC's staff were respectful, and respecting our clients is important to us, so we thought that was good; 93% agreed that they were able to find people to help with the veterans independence program; and 91% were satisfied with the number of service providers and pharmacies where they can use their card. This was all on the service side.

As well, 88% agreed that the letters they received in the previous 12 months were clear. I will admit that we were a little bit surprised by that finding, but we're very pleased with it. We have been working on trying to streamline and clarify our letters a lot more. As well, 88% who had contacted us in the last 12 months were pleased.

On our rehab side, we have areas for improvement. We have to work on rehab, as just 53% felt that families could come to case management appointments. This disappointed us, because we always encourage family members to come to the appointments in case management, but only 53% thought they could, so there are areas to work on.

We work very strongly on the well-being of our veterans, and 61% reported that their health was good. As well, 85% were satisfied with their life in general, 80% were satisfied with their overall well-being, 82% were satisfied with their main job activities, and 78% were satisfied with their financial situation.

The reason I raise those specifically is that we talk often about the seven determinants of health and we know that being financially stable is an important point in being healthy. Then you get into the family. There are seven of them, but among three of the main ones is having a sense of purpose.

That told us that we still have work to do, because 72% is not 100%. We're not going out there yelling, “Eureka, we've succeeded.” However, it's telling us that some of the stuff we're putting into place and some of the work we're doing is in the right direction, and 82% were generally satisfied with the services from VAC at a general level. Those are all good points, but it also indicates that we have work to do. I don't want this to sound like I'm just... There's work to do.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Wouldn't the study be relatively parallel to the 2010 study? Can you compare the two?

[Michel Doiron]

We did compare it to 2010. I don't have the comparatives here. I can always provide that, because we did do a comparison. In most cases, but not all, we are doing better than we were in 2010. You have to also put into context what 2010 was versus 2017.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

Of course.

[Michel Doiron]

We are doing much better in most cases, though.