Veterans Affairs Committee on Dec. 1st, 2022

[The Chair, Liberal, Emmanuel Dubourg]

I call this meeting to order.

Welcome to meeting number 29 of the Standing Committee on Veterans Affairs.

Pursuant to Standing Order 109 and the motion adopted on Monday, November 21, 2022, the committee is resuming its study of the impact of the new rehabilitation contract awarded by the Department of Veterans Affairs on the role of the case manager and quality of service delivery.

Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are therefore attending in person in the room and remotely using the Zoom application.

Before speaking, please wait until I recognize you by name. If you are on the videoconference, when you are not speaking, your microphone should be on mute.

A reminder that all comments by members and witnesses should be addressed through the chair.

For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function.

Please note that one witness was unable to be with us at the meeting today, but she wanted to submit a brief to committee members with respect to this study. The brief is currently being translated.

Before welcoming the witnesses, I'd like to acknowledge the presence of our colleague Francesco Sorbara, who is substituting for Rechie Valdez today.

I would now like to welcome our witnesses. We have Patricia Morand, occupational therapist and clinical care manager, by video conference; from the Royal Canadian Legion, Carolyn Hughes, acting director of veterans services, national headquarters; and from Wounded Warriors Canada, Scott Maxwell, executive director, by video conference.

I would now like to invite Ms. Patricia Morand to start. You have five minutes. I'm going to inform you when you have one minute left and when your time is over with these signs that I have here. You have five minutes or less for your opening statement. Please go ahead.

[Patricia Morand, Occupational Therapist and Clinical Care Manager, As an Individual]

Thank you, Mr. Chair, for inviting me to speak today.

I was asked to speak today as a service provider who may be impacted by the new rehabilitation contract.

By way of background, I am a registered occupational therapist in the province of Ontario and have been since 1982. I have been a service provider for Veterans Affairs Canada for well over 20 years. I have provided services as a field occupational therapist—or FOT for short—during that time and have had an additional role as a clinical care manager—or a CCM—since 2018.

It is the role of the CCM that I will speak of today because this role that is aimed at veterans who have complex needs and who are in the rehabilitation program.

CCM referrals in the past were made by the veteran's case manager. Involvement with the veterans varies depending on their needs and can include things such as helping the veteran reconnect with services in the community, assisting the veteran re-engage in community activities, or working with the veteran to facilitate re-engagement with their daily activities. The veterans I have seen through this role have multiple needs within the realms of physical barriers, social barriers and mental health struggles.

As a CCM, I work in conjunction with other people working with the veteran, including psychologists, social workers, family physicians when needed, and in the past with the March of Dimes vocational staff when needed, and case managers and those who may be involved with the veteran through community agencies or community services.

To date, I have not been able to identify how the CCM role, and subsequently my role as this provider, may be impacted by the new contract.

I received an email in the summer asking about my expression of interest and I expressed interest. I subsequently received an email from the new provider in late September, asking me to complete a data collection form. Upon reviewing the form I noted that there was no selection for an OT or CCM, so I was unsure if I should complete it. I reached out to the contact person with the new provider and subsequently spoke with that person. I was also directed to a link through Veterans Affairs.

Unfortunately, to date my questions remain unanswered. As an OT who has been providing clinical care management to veterans with complex needs who are in the rehab program, my questions include the following: Will the CCM role be used? If yes, will an OT still provide this role? If yes, will this need be done under the umbrella of the new provider or can this be done autonomously as it has been done in the past? If this must be done under the umbrella of the new provider, will there be changes to the compensation structure?

As a service provider for Veterans Affairs Canada for well over 20 years, I have always worked through my private practice and I am unclear at this time whether the new provider will use only providers under their umbrella or whether independent providers such as me will have any role to play.

Those are my comments.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Ms. Morand.

Now let's go to Ms. Carolyn Hughes for five minutes or less.

Please open your mike.

[Carolyn Hughes, Acting Director, Veterans Services, National Headquarters, The Royal Canadian Legion]

Thank you, Mr. Chair.

Honourable Chairman and members of the parliamentary Standing Committee on Veterans Affairs, it is a great pleasure to appear in front of your committee on behalf of our over 250,000 members and their families.

I am the acting director of veterans services at the national headquarters of the Legion, and I'm also a retired military health care administrator. I've been assisting veterans, including still-serving members, veterans who have retired—RCMP members included—and their families for about 16 years in various roles, in and out of uniform.

Since 1926, we have been assisting veterans and their families with representation to Veterans Affairs Canada and with the Veterans Review and Appeal Board for disability entitlement and treatment for their service-related injuries and illnesses. Our 27 professional command service officers across the country and their assistants are trained professionals, are government security cleared, and provide free assistance to those they need to help whether they are Legion members or not.

This past year they met, spoke with, and assisted thousands of veterans and their families in obtaining VAC benefits and services that they deserve for their service injuries and illnesses. As such, I believe we can speak confidently and with credibility about what we are seeing and hearing about the rehabilitation contract. Veterans Affairs Canada case managers establish relationships and help veterans to determine and to help them with their individual goals to assess if there are any barriers to achieve these, and to identify the available information and services for the veterans in order to achieve these.

Public Services and Procurement Canada awarded the national contract to Partners in Canadian Veterans Rehabilitation Services in June 2021 on behalf of Veterans Affairs. Under the contract, we have been advised that case managers will continue to work directly with veterans and their families to ensure the best possible outcomes for health and well-being. These are at the heart of what we want for our veterans and their families and are what they deserve.

The new contract intent, from our understanding, is to reduce administrative burdens and to provide more time to assist veterans facing complex challenges. We believe the contract could be beneficial as long as it does improve these services and the overall health and well-being of veterans and their families by allowing the case managers to spend more time with them instead of on administration functions. So far to date, we haven't received any complaints. However, the Legion continuously monitors the quality of services provided to veterans for the impact on those we serve.

We see that this contract may be a positive step in focusing personal efforts on the health and well-being of veterans, and this must be paramount in any arrangements.

Mr. Chairman, we would like to thank you for the opportunity to make this presentation, and I would be happy to take any questions later.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you so much.

Mr. Scott Maxwell, the floor is yours for five minutes or less.

[Scott Maxwell, Executive Director, Wounded Warriors Canada]

Good afternoon. Thank you for the time.

Wounded Warriors Canada is a national mental health service provider that supports approximately 3,000 members of the Canadian Armed Forces, veterans, first responders and their families every year.

Our specialty is group-based, residentially facilitated group counselling that supports our members and our clients in their healing journey on their path, mainly when it comes to veterans and their transition to civilian life.

Our big thing with VAC has always been about...there are a few things that we interact with most commonly when it comes to the clients we're serving who are VAC clients. Those are the wait times, the cultural competency of the care and how adding new service providers would repair what's going on in the system right now. Our big concern is focused around those areas.

When we're talking all the time about wait times, as we've been doing for, seemingly, the last 10 years, is a contract like this going to address wait times? Is it going to address the cultural competency of the care? Is going to address the timely access to care? Is it going to be robust enough to support the unique needs not only of our veterans, but of their families?

That is what we deal with. That's who we support here at Wounded Warriors Canada.

The one area of concern we have with what has happened with this contract is, of course, that we were not consulted at all. It's interesting, when we support the population that we do—so many of whom are VAC clients—that there was no consultation on this particular agreement. We heard from the new provider thereafter.

What's that relationship going to be like going forward? I find it interesting that we have heard from Lifemark and folks now, whom we've never heard from before.

I would like some answers to these questions. Why is that? How were these decisions made? What is their level of cultural competency for the care they're going to provide?

Let's get this straight. If you do not serve this population the right way at the right time, we will continue to see the demonstrative gaps that form, and when they fall into these gaps—not just the members, but their families—we continue, as a country, to see the fallout of those effects.

That's what I'm interested in discussing. That's what we're here to learn from. I look forward to the opportunity to have the discussion.

Thank you very much.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you so much. That's wonderful. It was less than five minutes by all of our witnesses.

Now let's go to the first round of questions. I'd like members to name the witnesses to whom they're addressing their questions.

I invite the first vice-president of the committee, Mr. Blake Richards, to take his six minutes or less.

[Blake Richards, Conservative, Banff—Airdrie, AB]

First of all, thank you, all of you, for sharing your experiences with us today.

I have some specific questions, but the first thing I'd like to do is ask each of you to give me a quick yes or no to the following question.

Were you consulted on this decision to move to an independent contractor for this? Please answer yes or no.

[Carolyn Hughes]

No.

[Scott Maxwell]

No.

[Patricia Morand]

No. We were not consulted by Veterans Affairs.

[Blake Richards, Conservative, Banff—Airdrie, AB]

All three witnesses have indicated “no”.

Please give a yes or no to this question as well. Do you feel like you have enough information about this process and what's transpiring, starting from two days ago?

[Scott Maxwell]

No.

[Carolyn Hughes]

No.

[Patricia Morand]

No.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I think I got three “nos” again there.

I'm not surprised by that, because everything I've heard from everyone, whether they be service providers, veterans and even the employees at Veterans Affairs, is that they don't feel they were consulted. They don't feel that they have any information about something that is now in place, as of two days ago. That is my understanding, unless they've extended the date again. Nobody seems to know anything.

Let me start with Mr. Maxwell. You asked a series of questions at the end of your remarks. The last question you asked was about the level of cultural competency. You were asking questions.

I'm going to ask you, in relation to that, what should the level of cultural competency be? What is required to ensure that these people who will now be working with veterans...?

What's required in terms of education, training and competency in order for them to be able to best serve our veterans?

[Scott Maxwell]

You hit the nail on the head, Mr. Richards. The word is training. How do we expect or anticipate civilians, who are the majority of the case managers, to support the ill and injured population if they're not trained in cultural competency just generally with the occupation and the unique needs of this population? It's never happened. I've understood that there's training happening as a result of some recent headlines. I don't know what that training looks like. I don't know what it is. We've offered our occupational awareness training and our trauma-exposed professional training for VAC with no response.

To me, if you're going to put civilians in front of this population, training has to be at the forefront of their role. Unfortunately, it's not been the case. I have not seen it to be the case in 10 years. I would suggest for the department that it be the focus for today going forward.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I appreciate that. I think you're absolutely right: that's critically important.

It was interesting that you note the training that you have available and have offered to Veterans Affairs but haven't even received a response to.

[Scott Maxwell]

This is the situation that followed MAID, the tragic story around MAID and the story that continues. We received phone calls and outreach from the department on their behalf and responded in kind. We are obviously a provider, a partner of the Department of Veterans Affairs Canada as a service provider to the population. We just await the ongoing dialogue and conversation about how we can offer our training to case managers throughout Veterans Affairs Canada.

[Blake Richards, Conservative, Banff—Airdrie, AB]

I'm glad that you brought up the topic of MAID. I have some other questions on today's study as well, but first I'd like to go down that trail of MAID for just a second.

What do you think is required to ensure that the news stories we've been hearing about veterans being offered and, in some cases, pressured about the utilization of MAID don't happen again, and how does Veterans Affairs go about making sure that happens?

[Scott Maxwell]

As I've said all along, from when the story broke, frankly, that we obviously have to be very careful and watchful of two things. One is that no veteran and their family experiences this ever again. Second is that for the veterans who become aware of it, they must always feel comfortable to reach out for the help they're entitled to receive.

About how to prevent it, this is an extreme situation, generally on the fringe of some of the challenges that affect the department. Understanding that, as we've said right after learning of this, if we're not preparing case managers, people, to interact with and support and have these complex and difficult conversations they're having every day with ill and injured veterans, then what are we ever going to expect to be an outcome or result of this not happening?

Our position has been clear: This is an extreme situation and should never happen again. We have to make sure that we take care of that veteran and their family and we have to support the veterans who might feel concerned about contacting the department they are after, as we are doing right now.

Beyond that, my goodness, what can we ever look to expect or receive when we're not providing the proper training that I would say and I feel for at times? The case managers, if they are asked to do this job, and are coming in to do this job and care about the work they do and how they do it, then we should be there to provide them with the resourcing they deserve to help the population they are serving.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you.

[Blake Richards, Conservative, Banff—Airdrie, AB]

Thank you. I appreciate that. I certainly hope the Minister of Veterans Affairs is listening because this is really important.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Maxwell.

Now let's go to MP Churence Rogers for six minutes or less.

[Churence Rogers, Liberal, Bonavista—Burin—Trinity, NL]

Thank you, Mr. Chair.

Again, welcome to all of the witnesses today. It's good to have you here. We're looking for you to provide some answers to some of our questions.

During some previous meetings, we've had some concerns expressed by witnesses to this committee. We also heard from some of the other officials from VAC about what's being done to prepare for the transition to this new system, but there seem to be concerns expressed about how it's going to work and how it's going to be implemented and so on. It seems to me that it's not going to be done in one event. It's going to be a phased event, which is going to see the system transferred to try to remove some of the administrative burden on case managers.

If you look at some of the rationale being provided, it seems to make some sense, but of course what makes most sense is what's the best service we can provide for veterans, which is what we want to do here as a committee and as an organization.

Ms. Hughes, if I could, I'll ask you some questions. Has Veterans Affairs Canada provided you with information about this new contract?