HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

 

 

 

COMMITTEE

 

ON

 

VETERANS AFFAIRS

 

 

 

Tuesday, October 15, 2024

 

 

COMMITTEE ROOM

 

 

 

Medical Coverage for Veterans

 

 

 

 

 

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services.

 

 

VETERANS AFFAIRS COMMITTEE

Chris Palmer (Chair)

Tom Taggart (Vice Chair)

Hon. Keith Bain

Larry Harrison

Hon. Steve Craig

Hon. Ben Jessome

Hon. Tony Ince

Gary Burrill

Suzy Hansen

 

 

 

In Attendance:

 

Tamer Nusseibeh

Legislative Committee Clerk

 

Philip Grassie

Legislative Counsel

 

 

 

WITNESSES

 

Medavie Blue Cross

Kevin Lynch, Director, Federal Programs

 

Veterans Affairs Canada

Jane Hicks, Director General, Service Delivery and Program Management

 

Steven Harris, Senior Assistant Deputy Minister, Service Delivery

 

 

 

 

HALIFAX, TUESDAY, OCTOBER 15, 2024

 

STANDING COMMITTEE ON VETERANS AFFAIRS

 

2:00 P.M.

 

CHAIR

Chris Palmer

 

VICE CHAIR

Tom Taggart

 

 

THE CHAIR: Order. I call this meeting to order. This is the Standing Committee on Veterans Affairs. Good afternoon, everyone. I’m Chris Palmer, MLA for Kings West and the Chair of the committee. Today, we will hear from presenters regarding Medical Coverage for Veterans. Welcome to you all. At this point, I’d like to ask all of our committee members and everybody in the room if they can make sure their phones are turned off or put on silent so we don’t have any interruptions, if that’s possible.

 

In the case of an emergency, please use the Granville Street exit, and we’ll walk up to the Grand Parade, if that is something that happens. I would like to now ask all of our committee members to introduce themselves and their constituency, beginning with Vice Chair Taggart.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I’d like to recognize Legislative Committee Clerk Tamer Nusseibeh on my right and Legislative Counsel Philip Grassie on my left.

 

Welcome. Our topic this afternoon is Medical Coverage for Veterans. At this time I’d like to ask our guests to introduce yourselves and your title, and then I’ll come back to you for opening statements. We’ll begin with Mr. Lynch.

 

[The witnesses introduced themselves.]

 

THE CHAIR: I’d like to offer our guests an opportunity to make an opening statement before we get into our question period. I believe, Mr. Lynch, you have an opening statement you’d like to present.

 

KEVIN LYNCH: My name - we just covered that - is Kevin Lynch, Director of Federal Programs with Medavie Blue Cross. I want to thank the committee for inviting me here today. I’m here today with Veterans Affairs Canada. Medavie Blue Cross is contracted under the federal government as the administrator of the Federal Health Claims Processing Services contract. Guided by our mission to improve the well-being of Canadians, we are proud to support our veterans on a day-to-day basis by efficiently and effectively administrating benefits to support their overall health and well-being.

 

Through the Federal Health Claims Processing Services contract, we facilitate the processing of health claims for veterans. Our function as the administrator is to manage provider registration, required authorization services, claims processing, and reimbursements on behalf of the federal government. These services support claims related to medical services, treatment, prescription drugs, and other health benefits that are provided under the Veterans Affairs Canada benefit plan.

 

We are committed to supporting veterans to the best of our ability with partner organizations and providers in Nova Scotia and across Canada. We are forever grateful to our veterans for their service to our country.

 

THE CHAIR: I believe, Mr. Harris, you have an opening statement as well.

 

STEVEN HARRIS: Timely services and supports to Canadians are things everyone knows are of great importance to everyone. One in 84 Canadians is a veteran. They are the brave women and men who have stepped up to ensure for all of us here at this committee, our families, and friends, that we can enjoy the freedom, peace, and security we have today. Many did so at the price of their physical and mental health. This is why it’s so important that Veterans Affairs Canada is there after they leave the military.

 

We know that on average, around 8,200 regular and reserve force members transition from service each year. There are over 461,000 veterans and approximately 194,000 Veterans Affairs clients. This includes veterans and their families, still-serving Canadian Armed Forces members, RCMP members, and survivors. The veteran population covers a wide range of ages, from people in their early 20s to some over 100 years of age.

 

Most Veterans Affairs clients have physical and mental injuries with varying needs when it comes to support. Some individuals may need physical rehabilitation, some are looking for support to enter the workforce, while others need the support of long-term care facilities. Veterans Affairs Canada’s mission is to provide exemplary client-centred services and benefits that respond to the needs of veterans, our other clients, and their families. We recognize the important impact service can have on their health and their well-being, and we are committed to ensuring that they have the access to the treatment and services they need when and where they need them.

 

One way we’re striving to do this is by making faster disability benefit decisions and making the application process easier. To achieve this, Veterans Affairs is leveraging the use of technologies through innovation, improved processes for repetitive manual work for staff, and others. This will allow more time for us to devote to the processing of complex claims.

 

Our mandate of supporting veterans and their well-being is achieved through the delivery of our programs, such as disability benefits, financial benefits, rehabilitation, pension advocacy, and education and training supports. One of our programs, the Treatment Benefits program, was established in World War II and is one of the department’s flagship programs still. Veterans Affairs’ Treatment Benefits program provides financial support to eligible veterans to access approved health care benefits directly related to their entitled condition or based on a demonstrated health need when that health care benefit is not covered through provincial or private health care coverage. Treatment benefits are delivered through 14 programs of choice that include a wide range of benefits and services to best meet the health care of our veterans. The types of eligible treatment benefits, along with dollar and frequency limits and approval requirements, are all managed and updated by Veterans Affairs through a benefit grid and a drug formulary.

 

Veterans Affairs is also partnered with the Royal Canadian Mounted Police and Canadian Armed Forces since 1999 to manage authorizations, claims processing, and related services for these health benefits and services through the federal health claims processing service that contract with Mr. Lynch and Medavie Blue Cross. To receive reimbursement for a treatment benefit or service, the reimbursement request must be submitted within 18 months of receiving the service. The Treatment Benefit program also allows veterans to choose a provider of their choice as long as the provider selected has the credentials that have been stipulated by provincial regulation and/or Veterans Affairs. Claims payments are made to health care providers or through reimbursement to clients and authorized third parties.

 

To ensure that we are continuously improving our programs to meet the needs of our clients, we welcome feedback through various sources, including consultations directly with veterans, events and engagements, and our Audit and Evaluation Division. We also hear directly from clients through our national client survey.

 

Currently, there are over 80,000 veterans who access treatment benefits and services through VAC’s treatment program, and we continue to make efforts to ensure that all veterans are aware of the benefits and services we offer. Therefore, we have continued with a marketing and outreach approach that proactively communicates the benefits that Veterans Affairs offers to veterans and their families.

 

VAC understands the ever-changing health needs of our veterans and recognizes that new and emerging treatments become available on a regular basis. We will continue to ensure that these treatments and benefits for services are considered for coverage when their use is supported by scientific evidence.

 

Lastly, I would just indicate that we encourage any veterans or other clients and families who have questions about their eligibility for treatment benefits to reach out to us through one of multiple channels.

 

We’ll be happy to answer your questions.

 

THE CHAIR: Thank you, Mr. Harris.

 

As a reminder to our committee members and information for our guests today, we go around the table, and it’s 20 minutes for each caucus to ask questions of our guests here today. Once I get to 20 minutes on the clock, it will be a hard stop. I do have to stop you if you’re in the middle of a comment.

 

We will have questions until 3:40. We’ll begin with the Liberal caucus for 20 minutes, and then we’ll proceed from there. Liberal caucus, and I believe MLA Ince will begin.

 

HON. TONY INCE: First of all, let me say thank you to all of you for the work you do on behalf of veterans and those who have served. I know it’s not an easy task. I know that there are lots of challenges that are fraught within many organizations. Thank you for what you have done and are doing.

 

The Rehabilitation Services and Vocational Assistance Program is now administered on behalf of VAC by the national contractor called Partners in Canadian Veterans Rehabilitation Services. Can you tell us how this program may have or could have changed since it’s now not with Medavie?

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: There have been quite substantial changes since it was with Medavie Blue Cross prior to the new contract. We had two contracts. We had medical psychosocial rehabilitation with Medavie Blue Cross, and we had vocational through another contractor which was called Canadian Veterans Vocational Rehabilitation Services, or CVVRS. We had two different parties delivering rehabilitation.

 

One of the key changes was that we have now one contractor, so it’s a more holistic approach than what we had before. They’re specialized in rehabilitation. We have more standards. It’s strict. Case managers are integrally involved with their partner organization to wrap services around the individual. We have a comprehensive quality assurance network, and we’re pleased to say that we’re one year into full implementation and it’s certainly going relatively well.

 

TONY INCE: I’ll pass it to my colleague MLA Jessome.

 

THE CHAIR: MLA Jessome.

 

HON. BEN JESSOME: Thanks, folks, for your time here once again today. I guess the feedback that often comes through our offices is perhaps, to you, not always the rosiest of feedback that we hope to receive. Some of that feedback is tied to the wait times associated with seeing through disability benefit decisions. Some of the statistics that we have are relevant to 2022-23, noting that the average wait time was 28 weeks, improving from 39.7 in the previous year. For the benefit of the committee, would you please provide updated information on the wait times if you have it?

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: Where we’re at in terms of wait times now: The average turnaround time or wait time for a first application - the very first time a veteran comes to us - is 20.2 weeks. Our service standard is 16 weeks, so we’re clearly not yet meeting our service standard.

 

I will give a bit of background to say that just a couple of years ago, we had more than 23,000 files that were beyond our 16-week service standard. As of our most recent quarter of reporting, we were just over 5,000. We’ve made significant strides at Veterans Affairs Canada to reduce the number of applications that are waiting beyond 16 weeks. There is still more work for us to do, but we’ve continued to reduce wait times for veterans who are making applications for those kinds of benefits. We’ve been successful in that since we’ve had some additional resources - as I noted in some of my opening remarks - some changed processes to try to make it both easier for the veteran and for our staff to complete those applications and render decisions for individuals.

 

We continue to make strides in reducing wait times. Our goal, of course, is to get to our service standard, which is actually 80 per cent of decisions within 16 weeks. As of the last full fiscal year, we were at about 69 per cent - still not there, but much improved over the 23 per cent we were at about four years ago.

 

BEN JESSOME: That’s good progress. I appreciate that feedback. I guess part of the urgency related to that wait time has to do with the cost that potentially could come from out-of-pocket expenses that one might need to incur to manage their health. One of the recommendations coming from our national House of Commons Veterans Affairs report was a recommendation to expedite claims associated with out-of-pocket expenses to alleviate some of the financial burden that, like many Canadians generally, veterans would be experiencing. Can you speak to any context or progress with respect to expediting the recommendation to expedite claims for vets who are paying out of pocket?

 

[2:15 p.m.]

 

STEVEN HARRIS: Again, I’m happy to report some progress in that area as well. As we first noted, the wait time for veterans has significantly been reduced over the course of the last number of years, and frankly, that’s addressing the problem: to make the decisions within the service standard time, which then alleviates, as the member is raising, a question of whether somebody has to pay out of pocket for treatment. We've been able to make decisions more quickly.

 

Out-of-pocket expenses can be reimbursed going back once an application has been filed, given the time. I sincerely appreciate the difficult circumstances as decisions were taking longer and longer. That’s less the case now, so we’re taking some of the pressure off that.

 

We’ve also instituted something called the Mental Health Benefits initiative. The Mental Health Benefits initiative came into effect almost two years ago. What that did was if you made an application for a mental health condition or claim, say PTSD, major depressive disorder, something like that, you didn’t actually have to wait for a decision to be authorized to access treatment, recognizing that any delays to accessing treatment for mental health can have a serious impact on someone’s mental health and physical health along with that.

 

As soon as you made an application for a condition that was related to one of the major mental health issues, you were granted immediate access through Veterans Affairs, and ultimately through Medavie Blue Cross, to go out and get that treatment and for that treatment to be paid for a two-year period or until your application had rendered a decision. If that decision was positive, then you would just go into the regular treatment benefit program for Veterans Affairs. I think that’s another example: In addition to speeding up claims, we’ve made some provisions to allow for areas where we know that there are significant challenges for people to get access to benefits right away.

 

BEN JESSOME: That’s good news about presumed coverage - is that the right term? - for mental health benefits and would certainly lend itself to expediting those claims. I’m wondering if you could give the committee a sense of - it doesn’t have to be all of them, I guess, but some of the most prevalent types of medical issues that folks would be facing. Obviously, mental health is one, given that initiative, but could you give us some greater context on the scope of some of the more prevalent medical issues that come through the office?

 

STEVEN HARRIS: I’d highlight a few, and what I’d say is mental health concerns, and that includes a number of conditions - I mentioned post-traumatic stress disorder, major depressive disorder, anxiety, those kinds of things are all one stream of claims that we see quite commonly. Hearing loss and tinnitus would be a second. It’s quite common for both of those conditions to be part of claims being made by veterans. The last one I’ll highlight as a very common one is what we call MSK or musculoskeletal. That would be injuries to shoulders, joints, knees, things of that nature, due to repetitive activities related to military service. Those are the most common conditions that we see. They probably make up about half of applications that we see coming in, which means that there are 50 per cent that are not necessarily common or prevalent in big numbers.

 

Those could include things like cancers. They could include other kinds of diseases that are related to service in terms of folks making claims coming forward, or any number of other things: issues with vision, issues with other elements as well. As we try to make the process as streamlined as possible, both for the veteran and for our team who are responsible for looking at those applications and making decisions on them, we try to make them as streamlined as possible for obviously the most common conditions. We don’t want to neglect the fact that there’s a whole range of conditions that still come to us that are a little bit different.

 

We have something called the Table of Disabilities. I won’t go into the very deep details of it. It is essentially a big medical guide that indicates the full range of disabilities that veterans may face, military members may face, as part of their service. We’ve tried to keep that updated as much as possible to advance with recent medical research, new things that come forward to us. We have Entitlement Eligibility Guidelines as well. These are documents that guide decision-makers in terms of being able to render decisions on applications from veterans. We want the very lowest level, the very first people who see that application to be best equipped to make that decision. That’s what makes it go the most quickly for the veteran in that case.

 

However, we do recognize there are lots of different elements, so we have frontline staff, we have nurses and doctors and others who may look at an application depending on its complexity. There may be a couple of things that a veteran has come forward with in terms of a condition, and we try to keep those things updated and make them as descriptive as possible so somebody can look at an application and look at the guidelines and say, Yes, this matches. This is likely. The military service that this individual had is related to this condition - and being able to make a favourable decision in that case.

 

THE CHAIR: MLA Ince.

 

HON. TONY INCE: Thank you for raising the mental health and benefits. Since the eligibility has changed and the mental health and benefits were implemented, how many CAF veterans or eligible serving members - if you do - have access to programming, if you have the numbers?

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: Just over 19,000 have accessed that program since April 1, 2022, to date. It is a process that we have almost automated. When the application comes in, there’s an automatic check for the condition, the service, and then a letter is issued almost automatically. There are fewer than 20 per cent that we actually have to manually verify.

 

TONY INCE: Also, I just wanted to go back and ask - let me go back to this question here: The House of Commons Standing Committee on Veterans Affairs’ report on the new contract raised some issues from the unions and the Veterans Affairs. The committee recommended that VAC acknowledge that there was an issue - I don’t want to go into all the details there - but to commit to improving. Can you tell me where we are in that stage right now or what’s happened?

 

JANE HICKS: Absolutely. We’ve made significant improvements. When the review was done, we were still working through the implementation process. We’ve completely revamped the service delivery model. Since that period of time - we’ve been one year of full operation - our staffing model is in a much better place than it certainly was. We’re starting to get more data.

 

Also, we’re having some communication consultation with frontline staff. We had a meeting in March, in the Spring. We brought the contractor staff, frontline staff, management with back staff to really see what’s going well, what’s not, and we’ve developed an action plan based on three themes so that we’ll continue to improve the process. The three themes are communication, service delivery, and - what’s the third one? It’s escaping me at the moment - communication, service delivery, and improved processes. It’s working well. We’re setting up some working groups. The unions will be part of those working groups going forward.

 

We’ve also started a bi-monthly newsletter sharing tips, tricks, and information to frontline staff, and also encourage anyone who has feedback to let us know, because we really want to know if something’s not working well and to escalate the process or the issue.

 

THE CHAIR: MLA Ince with five minutes to go.

 

TONY INCE: It’ll be really quick; it’s just a statement. Again, I say thank you because I am one of those people whom you folks have helped. I’m a testament that I was processed within the 18-month period. I had no expectations. I had no idea. It is tinnitus, and the process for me was flawless. I loved it. Thank you. I think you folks - and that’s why I’m saying, because I’m also aware of many friends and other people who have gone through the process who had some challenges, but as you say, in the past two years it’s been great for me, so thank you.

 

THE CHAIR: MLA Jessome.

 

HON. BEN JESSOME: I want to go back to those common applications for benefits - PTSD, anxiety, hearing loss, tinnitus, musculoskeletal. You indicated that approximately 50 per cent of the applications that you receive are related to those three headers. I’m wondering if you have a sense of how many of those applications are over the 16-week service standard, given that they’re the ones that you have the largest pool of applications coming from.

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: I don’t have a precise figure that I can share with you. I can indicate that when we did onboard new staff, we trained them in the most common conditions so that they would be able to do those things most quickly. I can probably get some information that I can share back with the committee through the Chair to come back to you.

 

But I would say that those applications for mental health and for issues related to hearing loss, tinnitus, musculoskeletal are actually going through the system quite quickly. The things that don’t go through the system quite as quickly are the much more complex issues, and unfortunately, a mental health issue isn’t necessarily a complex issue. It’s relatively straightforward from a diagnosis and from an application point - from a Veterans Affairs point of view.

 

Something where there may be cancers involved, something where a disease is involved, whereby the line between somebody’s service - a veteran’s service - and the relationship to that service may be more difficult. Those things might take a little bit more time. It can also take time to get the information in - not only the information that comes in with the application for the veteran, following up from a doctor, getting a diagnosis from a doctor, going through that. The more complex the condition, the more likely it is to take a little bit more time. I’d be happy to try to get some material back to the committee.

 

THE CHAIR: Thank you. The clerk’s made a note of that.

 

BEN JESSOME: Mental health is - I’m using the term “presumed coverage,” because I think that’s the accurate one. Correct me if I’m wrong. Are there other presumed coverages other than mental health care that would fall under your purview?

 

STEVEN HARRIS: I will indicate that that is not correct. It is not presumed. We do not have any probable relationships or presumptive relationships in terms of conditions. What we have done with the mental health benefit is if you make an application for that, we will cover you for up to two years of treatment. The likelihood of your getting approved for mental health benefits through Veterans Affairs - I don’t mean the benefit where you can actually access the treatment, I mean the actual condition and recognition of the condition - is quite high. So while it is not a presumptive benefit, in terms of if you apply for it, we assume you have it, the likelihood of your getting approved is quite high in terms of what we see from our numbers. It’s well over 90 per cent of applicants for those kinds of conditions are ultimately approved.

 

What we’ve recognized is the difficulty that people have in being able to access treatment for mental health and the speed that is required to help them get access to mental health - because any delay only makes it much worse in terms of a condition for the individual - we wanted to make sure that was in place. But we don’t have any presumptive benefit. What we have is we look at the likelihood or the probability. When we use the examples of things like musculoskeletal and you have a veteran who presents with really bad arthritis in shoulders or knees or something that’s related to 20 years of serving in the army, that’s likely. That’s a probabilistic kind of approach to it, but it’s not presumptive.

 

THE CHAIR: MLA Jessome, 10 seconds.

 

BEN JESSOME: I’ll pass the microphone to MLA Burrill or . . .

 

THE CHAIR: Very good. Order. We will now move on to the NDP caucus. MLA Burrill.

 

GARY BURRILL: In our party, the main place where we have engaged with these questions has been the federal Standing Committee on National Defence, and that report that has come out within the last 12 months - I believe the tail end of last year. There are a number of recommendations in that report that, to a non-specialist, are startling, in the sense of: You mean you don’t do that already? I just want to highlight a couple of them and maybe get you to speak to them.

 

One, that the federal government should take active measures to ensure that service members are connected to a family physician and relevant specialists upon their discharge. That doesn’t happen now? If it doesn’t happen now, then where are we on the quick, I hope, path to getting so it does happen?

 

[2:30 p.m.]

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: Perhaps, Chair, I could start and I might ask my colleague, Ms. Hicks, if she wants to add. While I can’t speak on behalf of the Department of National Defence or the Canadian Armed Forces, we do significant work with them in terms of supporting veterans through the transitional process. I think, as the member would know, Canadian Armed Forces members, while they serve, are within their own health care system. When they leave the Canadian Armed Forces, then they come back into whatever provincial health care system they exit into. Sometimes that’s the area in which they were serving, attached to a base, for example, and sometimes they choose to move back to maybe a home location or where there may be other family.

 

When they release, there isn’t a specific opportunity for somebody to make necessarily a connection to a medical doctor and having a family doctor (interruption) in any province across the country at the moment is a very difficult enterprise. I think that’s probably true in Nova Scotia as much as it is in lots of other places.

 

What Veterans Affairs and the Canadian Armed Forces have done is for those members who are releasing medically, we’ve ensured that there’s a virtual option for them. In other words, they can connect to the national virtual health care provider that can provide them with some element of support over the course of time while they return to whatever home situation, province that they want to go back to, and hopefully, with the assistance of the provincial health authorities across the country, find a family doctor who can help support them.

 

The challenge also exists for their families. Their families, who are moved around quite significantly with a serving miliary member, don’t have access to the Canadian Armed Forces model of health support and, in fact, of course, rely on provincial health authorities to provide them with medical services. When they move regularly, their opportunity to have a secure and sustained family doctor is also under compromise, because they move from Nova Scotia to British Columbia, and they might have to move almost overnight with their military member who’s been transferred from one location to another. The challenge is they pick up and move, and whether they were on a list for medical services or others, they might have to move immediately with that.

 

GARY BURRILL: In our world, we’re really familiar with this question for the population as a whole. The startling part about this was the case of injured veterans: that there is no assurance, as I read the report, at present by means of policy, that an injured veteran is placed in the care of a civilian physician. If that’s true, it’s a shortcoming. It’s the path to getting that fixed that I want to ask about.

 

STEVEN HARRIS: Maybe I can start. I’ll be shorter, and then Jane can add some more credibility to what I’m going to try to say. I appreciate the difficulty and the concern expressed here. That’s why we’re trying to put in place virtual supports for veterans who release, be they ill or injured at the moment, or perhaps for a greater population. Whether it’s the Department of National Defence, Canadian Armed Forces, Veterans Affairs has no authority over the provincial health care system. We do not operate a system for non-serving Canadian Armed Forces members. What we try to do is make sure that all of their needs - and I know the Canadian Armed Forces does an excellent job of this - are being addressed before they’re released, and that we as Veterans Affairs try to put in place all the supports that we can on our part to make sure that their illness or injury is going to be able to be treated. Jane, I don’t know if you want to add something to that.

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: We have a virtual telemedicine pilot so that when members are releasing medically, they and their families have access to the service for a one-year period of time. Its intent is to help them transition from the military health care system to the public health care system. Things like prescriptions, referrals, X-rays, things like that - it just helps facilitate access while they’re transitioning and trying to find that doctor. It’s a bit of a bridge to the provincial health care system.

 

GARY BURRILL: Thanks for that explanation. Another dimension of this in that standing committee report is the relationship between Canadian Armed Forces physician specialists and VAC forces specialists. One of the recommendations, as I’m sure you know, was that when you have a determination of injury by Canadian Armed Forces health care personnel, the injured veteran be able to carry that forward, establish it as fact, and not have to reestablish it in the world of VAC health care. I was shocked that that was not the case now. It certainly seems like a shortcoming. I wonder if you would acknowledge it as a shortcoming and, if so, speak about how this might be being rectified.

 

STEVEN HARRIS: I think it’s a challenge, for sure, and I’ll certainly acknowledge that. It’s based on the fact that they have different roles. A Canadian Armed Forces doctor is meant to treat the individual serving member, make sure they’re well and healthy. Their focus is making sure that they’re operationally ready, and that if they have suffered an illness or an injury related to that, they get well and they can go back and return to serving. They’re a primary health care giver.

 

Veterans Affairs, while we do have doctors and nurses, we are not a frontline service provider. We don’t provide direct health care treatment from Veterans Affairs itself. What we do is certainly make sure that we’ve got experts in place to make sure the policies are correct, that the diagnoses are correct. We don’t actually do the frontline service division of health.

 

The issue that you’ve raised I know has been raised in a number of committees. I would say that the Canadian Armed Forces health care network is likely quite strained in terms of what it’s actually capable of doing. That’s why it focuses on its core operational role rather than looking at long-term things. You may have an issue where somebody hurts their knee as part of their military service. They’re not leaving. They’re not getting out. What they need is sustained treatment to be able to rehabilitate and go back and continue to serve. That’s where the Canadian Armed Forces medical system focuses. It doesn’t focus on long-term issues.

 

However, a member whose military injury is documented - that helps for when somebody comes forward later. If you have a knee injury that’s been rehabilitated but ultimately will provide you with persistent pain - perhaps arthritis - as you age as a veteran, that information is contained in the veteran’s medical record and will be shared with Veterans Affairs as part of the application process here. I think there are parts of what the member’s indicating that are a part of the process, but the Canadian Armed Forces doctors themselves are focused on the still-serving military members and aren’t focused on making diagnoses for a perhaps future element of an application.

 

GARY BURRILL: Thanks for that explanation too. Here’s another in the same category. One of those recommendations was that medically released personnel be retained on the payroll until their VAC benefits are in place. I guess they don’t do that now. Sounds pretty startling. Again, would you acknowledge that doesn’t sound very good, and could you speak about the path to getting it fixed?

 

STEVEN HARRIS: I would suggest that part of the issue is that it’s unclear around when members come forward with applications for their illness or their injury. About 25 per cent of applications that we receive are from still-serving members. They may be members who are hurt as a result of their military service but will continue to serve. They may also be from members who are hurt and hurt to an extent that they won’t serve anymore. Those are the individuals who may be medically released during a period of time and those individuals likely come to us and have those benefits put in place.

 

It also means that 75 per cent of the applications that I receive are from members who’ve left service, who are already out and who, at the time of their release, didn’t recognize that they may have had an illness or an injury as a result of their service. So they’ve come to us six months after release, five years after release, 30 years after release to say, I didn’t realize that this was an issue when I released, so they’ve come after. When the report says make sure that everything is in place before somebody leaves, that’s fair, I think, for those individuals who’ve suffered and are likely going to be medically transitioned out of the military.

 

For a great many of those individuals who have come forward, they come forward after, and that’s okay from a Veterans Affairs point of view. You can come to us whether you released six months ago, six years ago, and, frankly, even longer than that, and we’ll make sure that those benefits can be put in place for you.

 

GARY BURRILL: Just one last area from the standing committee. Something that’s always really important, as you know, in Nova Scotia is policy for the reservists. There’s a lot of concern there on the subject of continuing Reserve veterans’ benefits. For someone who is not familiar with that world of policy, it seems like a pretty arcane, complicated world of policy - the Canadian health benefits for reservists. There’s kind of an allegation there that this is rather a mess and that there are inconsistencies and ambiguities, and that, in general, those who are coming out of the Reserves with health issues are not being at all well served in the present situation and that it’s a particular focus of attention. Because this is such a major matter in Nova Scotia, I wonder if you could speak to it.

 

JANE HICKS: Veterans Affairs Canada works very closely with the Canadian Armed Forces through the Transition Group, and we’ve been working closely to standardize the transition process. We offer transition interviews for regular serving and primary reserves. The initial focus many years ago was on the ill and injured. Recently, it’s been on all releases, and most recently, the focus has also been on the primary reserves. It’s hard to get in touch with all the reserves, make sure they’re all aware of the benefits and services that VAC has to offer, and that’s certainly something we’re working on with the Canadian Armed Forces right now. In fact, I think there is a trial, and we can certainly get some additional information for you on how they’re reaching out to the reserves.

 

GARY BURRILL: If I understood it right, one of the allegations was that units don’t uniformly advance claims - that they don’t have uniform processes and there’s a lot of unevenness around this. This sounds like a big problem and not an administratively fixable problem. Could you speak to it?

 

JANE HICKS: Certainly. I can’t speak on behalf of the Canadian Armed Forces and their processes, but I can tell you that there is work under way to standardize processes for the primary reserves. With VAC, we do have standardized processes, and all releasing individuals are offered a transition interview where we go through a screen based on the domains of well-being to ask, How are you doing? Do you have any concerns? Then we try to line them up with the appropriate benefits and services if they require them.

 

GARY BURRILL: Thanks for that whole range of responses to those concerns under the report. I wanted to just go back to where MLA Jessome began on the general question of wait times, the processing of disability-related benefits. One of the things raised in the Auditor General’s report from a couple of years ago wasn’t just the length of the wait times, but the variability of the processing of the wait times. It wasn’t the same for women and men. It was pretty different for Canadian Armed Forces members and RCMP members. It seems that it’s not just a matter of reducing the wait times to within the service standards, it’s also a matter of bringing administrative uniformity to it, to bring a system that people would have the kind of confidence we want to have. Could you speak to that particular problem and if there are advances being made about it?

 

STEVEN HARRIS: There were, as recently as just a couple of years ago, significant differences that existed between the wait times for applications from women and men, and applications from English or French speakers in both of those cases, and they were both identified in the Auditor General’s report. They had different reasons.

 

In one case for English and French applications, we simply didn’t have enough French adjudicators, people who were comfortable in the French language. We had people who were bilingual, but maybe weren’t as comfortable with all the very detailed medical terms that may come forward. What we’ve done as part of the hiring that we’ve done over the course of the last little while is emphasize Francophone-first speaking adjudicators, nurses, doctors, and others who might help us in that case. Essentially, over the course of the last couple of years, we’ve eliminated the difference in the wait time between English and French applications.

 

[2:45 p.m.]

 

With women, it was different. The primary number or the majority number of applications that we received for many years came from men. As such, what we tried to do was speed up the way in which we were looking at issues that men came forward with. As applications from women grew - and now they’re about 16 per cent of our overall applications as they come in - as they grew, they were sometimes different from the applications from men. The conditions for which women were applying were different, and they were different from the models that we put forward. As we put forward models that were meant to simplify the process of adjudicating conditions primarily faced by men - we sped that up - it meant that anything that didn’t look like that was treated differently and took longer.

 

There’s been an immense focus. Our parliamentary committee in Ottawa looked at a very detailed study on women veterans over the course of the last little while and came forward with about 50 recommendations. We just responded to it from a government point of view noting some of these disparities and differences. What the department has done over the last number of years is actually very much focused on applications from women veterans, the kinds of conditions that are coming forward, the kind of treatment they experience as part of that.

 

I’m happy to say that we’re at near par essentially in terms of the wait times between applications from men and applications from women. We’ve put a great deal of focus on making sure that we’ve improved the way in which we respond to applications from women veterans, both in terms of understanding the conditions that they may come forward with, seeking some kind of disability benefits or treatment, and in the approach that we’re using with the women veteran community. There’s been a lot of effort put forward in modernizing our tools and modernizing our approach with our frontline staff to achieve that as well.

 

GARY BURRILL: The progress on the uniformity of men and women, the progress on the uniformity of anglophone and francophone - what about the front of RCMP and CAF members?

 

STEVEN HARRIS: In those cases, we’ve improved the wait times for Canadian Armed Forces members, and we’ve improved the wait times for the RCMP. There are slight distinctions. While we administer both of those programs, we’re like a frontline administrator for the Canadian Armed Forces piece, and then we’ve agreed to take on the disability adjudication program that the RCMP wants to do. They seek their funding to provide to us to be able to navigate the claims that they put in. I would say in both instances, both the Canadian Armed Forces and the Royal Canadian Mounted Police, we’ve seen exceptional gains, both in terms of our processing time, but also the number of claims coming in.

 

The number of claims that we have coming in from the RCMP has jumped substantially over the last number of years, following a trend that we saw in that from Canadian Armed Forces members going back to about 2015. In the last couple of years, the RCMP has seen a similar growth in terms of the applications that they’ve come forward with. We continue to work with the RCMP to make sure that we have the resources to ensure that we can meet wait times and expectations for them as well.

 

THE CHAIR: MLA Burrill, 40 seconds.

 

GARY BURRILL: I just very much appreciate these precise and detailed answers.

 

THE CHAIR: That concludes the NDP question period. We’ll now move on to the PC caucus. MLA Taggart.

 

TOM TAGGART: Really, truly, thanks for everything you do for our veterans. I’m very happy with the questions that MLA Burrill asked. I really want to drill down a little bit more on them. I have to tell you, I’m most concerned - I think part of it’s because I have some friends, but those veterans who are medically discharged, in particular with severe mental health challenges - I’ve had this discussion with a friend of mine who was released after 30 years with severe PTSD that came from an event 20 years prior. I have known this gentleman for years and never dreamt that he could be impacted that way.

 

In my discussions with him - and I’ve had a lot, because he’s a very good friend - he talked about making sure that he had everything before he got medically discharged. I guess I’ll go to my questions. I just wanted to lead with this preamble because I do believe that in these cases in particular, whether it’s a physical or mental wound, that they’re being discharged for that reason - they’re discharged and saying, There you go, basically.

 

Can you explain the comprehensive health coverage that active Canadian Armed Forces members receive, and why that coverage is no longer available?

 

THE CHAIR: Who’d like to take that first here? Mr. Harris.

 

STEVEN HARRIS: I might just ask if we could get a bit of clarity on the question around the comprehensive Canadian Armed Forces health care approach.

 

TOM TAGGART: I’ll ask you - you’re very close to this situation - you do this every day. I’m sure you answer these same questions every day.

 

How would you rate the medical health system within the active-duty members?

 

STEVEN HARRIS: I’d offer - it’s very difficult for us sitting here, whether we work in Veterans Affairs or elsewhere, to evaluate the supports in place. I would say the Canadian Armed Forces - and I think they’ve acknowledged that - have their own difficulty in recruiting medical professionals at this point in time. They use a mixture of permanent resources. Budgetary constraints can make that difficult as well. They’re certainly putting forward the very best approach that they can to help support the core health of still-serving members.

 

There are excellent facilities across the country. There are excellent physicians and other medical professionals helping to support individuals. The challenge, I think, is can they have enough capacity with the rhythm that they are expected to keep, the budget, and the challenges they face? I think that’s a question that you need to ask them specifically to be able to answer. I know they put in place a very impressive approach to caring for the full-body health. That doesn’t just mean when you get sick or when you get ill or injured. That also means making sure that you’re healthy when you come in, and healthy as part of a regular physical-training regimen - exercise and everything else that comes along with that - and supports and regular checkups, whether that be dentists or others along the way. They provide that full service for all still-serving members.

 

TOM TAGGART: Sorry, I just don’t want to let that go, actually. I’m talking about - I understand that one of the roles of the medical system within the military is to make them battle-ready, so they can go to the field and do their job. But it seems when they’re not able to do that, they don’t have any resources for them. I think you yourself commented earlier in the afternoon here that the challenges that are faced across Canada with receiving primary medical care in particular - you didn’t use the work “primary,” but to me, it’s much more than primary medical care. It’s something that, because of their employment and their employer, they’re not able to perform their duties and often not able to perform duties outside of the military.

 

I’ve rambled too much, I guess, but I just believe that they need to be more responsible to those soldiers and sailors and Air Force members.

 

I guess I’ll move on. Are there specific health services that you believe should be prioritized for coverage after discharge, and how is Veterans Affairs Canada planning to address the ongoing health needs of veterans of any age?

 

THE CHAIR: Ms. Hicks, you got the nudge.

 

JANE HICKS: I’m wondering: Would it be possible to come back to the previous comment or question that MLA Taggart had just mentioned? With respect to the Canadian Armed Forces, we work very closely with them on the transition process, and the Canadian Armed Forces has set up the Transition Group and transition centres right across the country. There are 27 that are fully operational across the country as of March 31st, and part of that process is for all releasing members once they’ve been identified, for medically releasing as well.

 

Those who are medically releasing, they’re typically assigned a nurse case manager prior to release, and then as it gets closer to release, then Veterans Affairs Canada case managers will work with them to ensure that they have the benefits and services post-release. There’s a whole wide variety of services and benefits, from the rehabilitation program to operational stress injury clinics to other things that hare available for members and veterans who suffer from PTSD or occupational stress injury or other mental health injuries and illnesses. Sorry, I just thought I’d come back to that.

 

TOM TAGGART: So then through this system that you just spoke of, they’re not released unless you and Veterans Affairs are confident that they’re going to get the services they need when they need them. Is that correct?

 

JANE HICKS: Typically what happens is that when they’re medically releasing, Veterans Affairs and the Canadian Armed Forces work together on that process. It’s early in the process, sometimes as early as six months or earlier in the release process to ensure that benefits and services are in place at release.

 

TOM TAGGART: I just have one quick question and then I’m going to pass it off to MLA Craig. With respect to the older veterans who may be two, three, four, five, or 10 years away from service when they feel they need help, and I’m sure there are a lot of veterans around who struggle with all the paperwork and bureaucracy, do you folks have people to advocate on their behalf?

 

STEVEN HARRIS: We do. If individuals have challenges and those veterans want to come forward and seek assistance in some way, shape, or form, they can come forward and work with our frontline staff. We have area offices across the country, including multiple offices here in Nova Scotia - come and talk to us about the kinds of benefits that might be available, and maybe get some help with paperwork. There are also excellent organizations such as the Royal Canadian Legion, not only here but across the country, that offer service officers who will sit with veterans and fill out applications directly. There are other organizations that do that as well. The Legion is probably the most commonly known and certainly the longest-standing in terms of doing that, having worked with us successfully and understanding all of the different elements that might be required as part of applications.

 

THE CHAIR: MLA Craig.

 

HON. STEVE CRAIG: Director General Hicks, SADM Harris, and Director Lynch, thank you for being here this afternoon. As a son of a Navy veteran of the World War II and Korean conflicts, who passed away in 2006 at Camp Hill Veterans Memorial Building, I am very familiar with the services provided to my father and to my mother as well during that period in time. I know that things have changed greatly since those conflicts ended. Our veterans are getting older, and a lot of what you’re seeing now does come with time as, SADM Harris, you mentioned. Things like asbestos may not appear under discharge. We had a lot of asbestos in our country, in our ships, in our plants, and those types of things do occur later on in life.

 

I’ve got a couple of questions, especially as we’re entering Veterans’ Week and Remembrance Day coming up, and certainly October 23rd is the 55th anniversary of the HMCS Kootenay disaster. The services have greatly increased, I know through Veterans Affairs, since those times.

 

[3:00 p.m.]

 

I wanted to come back to the provisioning of services. Medavie Blue Cross and Veterans Affairs Canada do not provide the end services to the veteran. The costs of providing those services are somewhat out of your control. The costs of those services, let alone the availability, vary across Canada. If I’m moving from Belleville, Ontario, to Yarmouth, Nova Scotia, I may or may not be able to find a service provider. If I do, it may be more expensive than what I had, and I may have out-of-pocket costs for those.

 

I’m just curious to know a couple of things. Between you, Director Lynch and SADM Harris, you can play this back and forth, and that is: How do you look at circumstances when the availability and costs vary across the country when it comes down to the client, the veteran, the person who is looking for those services? Do you go and provide a subsidy? Do you provide and look for alternative service providers? In the selection of the service providers - we mentioned mental health throughout - there are companies and peer support groups like Rally Point Retreat and Landing Strong who provide those services who may not meet the definition of a qualified or may not qualify for a service provider under DVA or perhaps Medavie Blue Cross. How do you look at those types of things?

 

I know I’ve packaged that quite a bit, but, Chair, if you can allow our witnesses to expand a little bit back and forth, I’m sure they get the gist of the questions. I thank you for your time, and that would be my only question, albeit with many parts.

 

THE CHAIR: Who would like to begin unpacking the package? (Laughter) We’ll go with Mr. Harris.

 

STEVEN HARRIS: Perhaps I can start, and I’d certainly offer Mr. Lynch the opportunity to weigh in on the work that Medavie Blue Cross does in supporting this. The member’s quite correct: Services vary across the country in terms of availability of services for veterans, but also what provincial health care systems and health authorities can provide. At Veterans Affairs, we deal with all 10 provinces; we deal with three territories. We have veterans who are located in all of those, and the member is correct. As veterans may move across the country, what they had access to in one place may not be the same in others.

 

We try to provide a bit of a level playing field and make sure that veterans have access to what they need, no matter where they live. If Province A provides this but Province B doesn’t, we will help to step in and make that, as much as possible, level and even for the experience of veterans across the country. That’s not easy when you face rural and urban issues, remote access for supports for services, differentials in terms of costs of both the cost of living, cost of services across the country, but it is our role to try to make sure that we can smooth those uneven lines across the country.

 

We can’t do it alone, and part of the reason why we have a contract like we do with Medavie Blue Cross is to use and leverage their expertise to know: What is the availability of services in a particular area, and what’s the right fee for service for those locations as well? I might stop there and ask if Mr. Lynch wants to talk a little bit about the work that Medavie Blue Cross does in supporting us in those areas.

 

THE CHAIR: Mr. Lynch.

 

KEVIN LYNCH: From Medavie’s standpoint, we play a role in having a full network across the country in terms of providers, and we’ll work through - whether it’s feedback or with Veterans Affairs - to identify where those gaps are. We obviously do have some limitations in terms of what we can do in controlling the fees, but I think from a service standpoint, it’s important for us to have availability of the information. Before the veteran goes, they can get that information to know what will be covered, what wouldn’t be if they go to that provider.

 

A great deal - probably over 80 per cent - of our payments for reimbursement are directly to the provider, meaning we have them bill us. They can do a predetermination as well, so they know before they provide that service to the veteran. Trying to make it as seamless and as convenient for the veteran as possible, we have a key role to play in that, but we also work with Veterans Affairs to identify where those gaps are. If we can help fill them, we certainly will.

 

STEVE CRAIG: I’ll circle back on this and ask the other question. In attempts to provide the service, if we go back to the out-of-pocket cost for the veteran who in most likelihood is a senior on a fixed income - we know what pensions are, and we know how they are. Certainly as a military brat, I know what they are.

 

What exactly are your policy thoughts around providing subsidy based on location and service availability?

 

STEVEN HARRIS: A couple of things. I would just offer that we do offer variability for rates. Somebody who needs to have their driveway cleared in a remote location may not get the same rate that somebody does in an urban centre like Halifax - or as a flip side, more costly in an urban location than somewhere else. We do have that opportunity to make adjustments and make sure that it’s fair for the veteran in the location in which they may reside.

 

The second part of that is: How do we offer flexible service provision as well? The last number of years have shown flexibility in health care provision from a virtual or remote setting as well. People who may live in remote areas who need access to complex care can sometimes get that care remotely - virtual in other settings as well, rather than being located here. For example, I know Ms. Hicks mentioned earlier our occupational stress injury clinic. We have one here in Halifax. Not everybody can travel to it.

 

Of course, during the pandemic we learned a lot about having to deal with and address issues remotely when people either couldn’t travel or couldn’t be in person. I think there are some opportunities that have developed out of that that allow for people, no matter where they live, to have access to a similar level of care and to find ways to do that.

 

We can also help people travel. We do that as well, particularly for medical care. If you live in a remote location where a particular service may not be available, we will pay for you to travel to the location where that service is available, be it a specialty or be it something of critical importance for the well-being of the veteran.

 

Between all of those kinds of things, we do have an exceptional benefit authority. If there are instances where somebody is disadvantaged - significantly disadvantaged - as a result of their location, remoteness, et cetera, there are ways in which we can perhaps pay more to allow for them to still get that service.

 

STEVE CRAIG: Thank you all for those answers and engagement. I’ll basically close by saying thank you for what you do. Our veterans deserve all the assistance they can get. Here in Nova Scotia, you may or may not be aware, we are the only legislature that has a Standing Committee on Veterans Affairs - something of which everyone around this table is very proud, especially here in the Halifax area in Nova Scotia, where we have so many veterans.

 

Thank you for that, and thank you, Chair. Back to you.

 

THE CHAIR: We will move on to the Liberal second round. I’m giving all the caucuses 11 minutes in their second round for the next round of questions.

 

MLA Jessome.

 

HON. BEN JESSOME: My first question, through the Chair, is to Mr. Lynch. With Medavie Blue Cross as the service provider, would you be able to note any distinctions between your civilian and veteran clients in terms of addressing the need, processing applications - I’m thinking more generally. If there are any notable distinctions, could you communicate them, and additionally, what Medavie may have done to build capacity to better cater to the base of veteran clients?

 

THE CHAIR: Mr. Lynch.

 

KEVIN LYNCH: From our standpoint, I would say that eligibility, broadly, isn’t determined by Medavie. We receive that information from Veterans Affairs. But from a management of the services we provide, we have specifically designated units that are designated for Veterans Affairs and the overall FHCPS contracts.

 

From our frontline staff who deal with inquiries from members and veterans and from a processing standpoint, they’re all specifically trained and skilled in working with those clients and the certain benefits that are provided. It’s not a blended unit with Medavie’s broader business, if you will. We take pride in that. We have many employees who spend a lot of time supporting veterans and working specifically on the FHCPS contract. I think that lends itself well. They understand the general needs and how we need to work each day and provide - we try to bring that through in our training as well, so they understand that context in which they come into our unit that deals with this contract in particular.

 

BEN JESSOME: As communicated to me, it’s often more comfortable for veterans to approach other veterans. Do you have a sense of whether there are - or how many of Medavie’s human resources, the people who interface with veterans, are veterans themselves?

 

KEVIN LYNCH: I don’t have that information with me today, but I would generally say that it’s not a large makeup of our staff. Individually, I know there are a number who are involved with us, but I wouldn’t want to suggest that it’s a large number today, in terms of the types of roles that we have.

 

BEN JESSOME: I’d like to ask a question related to a conversation I had with a veteran who expressed concerns around, in this particular conversation, the over-prescribing of medication. What is VAC’s role in ensuring there are checks and balances associated with approving first-time applicants? Or as they go through their medical journey, if there are changes in the prescription over time, is that monitored? What sort of checks and balances are in place to ensure that veterans who are going through a vulnerable situation are not - that someone’s got their back?

 

THE CHAIR: I’ll go to Mr. Harris first.

 

STEVEN HARRIS: I think the starting point on any of these is that decisions around treatment are primarily those between the veteran and their medical care team, be that their primary physician, or be that a treatment team, or things of that nature. We have a formulary in terms of drugs that are approved to be used, and much like any other kind of system, there are rules in place around how many of any kind of prescription or how much of a certain kind of prescription is typically being authorized as part of that.

 

All of those claims go through Medavie Blue Cross in terms of those issues. In the case of any area where we would have a concern or if concerns were raised to us, we would work with the local provincial licensing board for any medical profession, be it for prescriptions or be it for inappropriate treatment in other areas. We don’t really intervene in the treatment decisions that are put in place between a veteran and their medical team for the most part, unless we were to see something that would be of significant concern - unless something is raised. In that case, that would be something that we would likely raise with the medical community, the local licensing community, to say that this is something that’s been raised from that point of view.

 

A veteran who is pursuing prescriptions from several different medical facilities as well, it would be flagged in the same way as a Canadian doing that, in terms of trying to go through a pharmacy system to get access to something. It would be treated in that way as well. But our role is not primary health care delivery, and it’s not necessarily for us to be in between and suggesting this is an appropriate treatment or not. It’s something that would fit within the provincial guidelines, the provincial licensing bureaus, for each of those medical professionals or health professionals.

 

BEN JESSOME: I should be more careful with my comments. For the record, I would state that the medical teams that surround these veterans certainly are there to have their backs as well. I’d be careful with my words, particularly on the record.

 

[3:15 p.m.]

 

There was a reference made to when service people are exiting CAF. There’s an optional exit interview that’s associated with someone’s departure - retirement, medical discharge. This is something that’s often reported by the groups that we see at this committee about how difficult it can be to track where veterans go following their time serving the country. Do you have some statistics on how many you’re actually picking up? The ones that you would know have a medical condition leaving - are those numbers pretty solid with respect to being able to continue serving those clients, or is there a large number of people who would have been injured who are not on your radar because we’ve lost track of them?

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: Through the transition process, we offer a transition interview to everybody. I don’t have the statistics with me, but I can certainly provide the statistics to the committee. Veterans Affairs and CAF have also been working on the information available. They used to have SCAN - or Second Career Assistance Network sessions. They are now calling that My Transition Seminar where we have information online available to members, even the transition handbook - everything available with respect to transition so that if they don’t do an interview, there is information that they can access on benefits and services.

 

What we want to do is, through the process - whether it’s through the transition interview, through My VAC Account, or other tools - is get information to members so that they know when they have an issue where to go to get the issue resolved. They know who to contact and how to contact Veterans Affairs or the Canadian Armed Forces, depending on whatever the situation may be. We’ve improved the process, and we continue to work closely with CAF on that.

 

THE CHAIR: MLA Ince.

 

HON. TONY INCE: I’ve got a question. In our packages, we received a letter from a vet of the Persian Gulf. In this letter, it states that they have yet to receive full recognition or support for their service. Can you give us an idea if there are discussions around that, and what’s happening around those who served in the Persian Gulf?

 

THE CHAIR: Mr. Harris, with about a minute and 20 seconds.

 

STEVEN HARRIS: I’ll try to keep it as brief as possible. The parliamentary Standing Committee on Veterans Affairs is currently studying Gulf War veterans through a number of studies, and a number of Veterans Affairs representatives appeared not all that long ago, along with veterans of the Gulf. I think they’ve raised a couple of issues. One is recognition and commemoration: seeing themselves within the commemorative program that Veterans Affairs undertakes, but in other places as well. How they are recognized, commemorated publicly through events, through the marketing of key events as part of the Gulf War, and whether that recognition extends to, perhaps, adding something to the National War Memorial in Ottawa - other kinds of recognitions as well.

 

I know the Assistant Deputy Minister responsible for that file at Veterans Affairs works very closely - and probably works very closely with the individual who wrote you the letter - on a regular basis to make sure that element can be noted and recognized. There’s a great deal of conversation around that whole term of “war,” and whether or not the Gulf War is considered a war because the definition that exists from Veterans Affairs/Canadian Armed Forces says that war service is World War I, World War II, and Korean War, and everything else is special duty areas, defined somewhat differently.

 

THE CHAIR: Order - sorry. That concludes the second round for the Liberals. I will now move on to the NDP caucus and MLA Hansen.

 

SUZY HANSEN: I just have one question and then I’ll yield it to my colleagues across the table. We were talking about mental health and talking about making sure that those folks get the services that they need, barring the time until a diagnosis is made. I was curious to know whether physiological and psychological harm due to racism and discrimination are included within those criteria so that they also fall under when you mentioned PTSD and such. Are those also part of the mental health criteria?

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: I would just answer quite simply: Yes, it is. Much like lots of conditions that could be a result of service, we’re interested in the effect, in the impact, in the condition that the veteran is suffering from, less around the cause of the condition. In a circumstance where discrimination or harassment has been made, we’ve talked also in various other committees around military sexual trauma. That may cause severe impacts on the individual veteran related to their service. That would certainly be something that would be viewed as key to a condition that a veteran is facing and considered.

 

SUZY HANSEN: I appreciate your time here today.

 

THE CHAIR: You’re yielding your time?

 

SUZY HANSEN: I will yield it over.

 

THE CHAIR: We will now move on to the PC caucus with 11 minutes. MLA Harrison.

 

LARRY HARRISON: I want to say up front, this is an enormous difficulty, no question. It’s very confusing and complex and all the rest of it, especially with the backlog, getting things in place. Are there any strategies that you have now or future strategies to try to get that backlog under control?

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: The one thing that we can’t control is intake, the number of veterans coming forward and putting in claims. The percentage of veterans coming forward and putting in claims has grown by about 75 per cent over the course of the last eight years. We're seeing more applications. You’re quite right: We need to make sure that we’ve got capacity in place.

 

We’ve put in place a couple of things: additional human resources. We’ve hired more than 300 additional staff in the area to make sure that we have the capacity to be able to address the pieces that are incoming. Innovation and automation are also important, both in terms of how we make it easy for veterans to apply, get information, communicate with us. That’s important. We’ve put in place systems to help with that. For our staff, how do we make things run more smoothly and more quickly? Ms. Hicks mentioned the automation that’s in place, or the almost automatic process for the mental health benefit. When somebody applies, essentially the information comes in to us, it goes through the system immediately, and at the other end it will say, You are entitled to treatment benefits for this condition for two years, without any real human intervention. A simple process. That kind of automation is important.

 

We also have automation in place to look at the way in which we get a medical record. We may get a medical record digitally now. That’s great, but we may have a medical record with 500 pages, 3,000 pages. If you had to look through each page, it would take forever. We now have an ability to scan and pull out the inferences or the references to a particular condition. Again, I’ll use an example of somebody who hurt their knee. We can go through a large medical file very quickly to pull out the references that are specifically related to somebody’s knee to help somebody make a decision more quickly.

 

We need to do more of those things going forward. That’s some of the planning that we have coming up to make sure that we can be as efficient and as quick as possible.

 

LARRY HARRISON: How do you measure the changes that will be taking place? Is there a way of doing that?

 

STEVEN HARRIS: For each of the changes that we make, we try to measure in the amount of time that it saves. How much time can we save by doing a particular intervention? More generally, of course, how much more quickly are we making decisions on things? As was noted earlier, where were we in terms of the average decision time three years ago versus today? That’s significant progress. We’re down to about 20 weeks. Again, not quite at our service standard, but getting closer to it. That’s a measure of how much faster we’re being able to do things.

 

On individual tasks, how much time does it take somebody to do an individual task? Veterans’ files and applications can all be slightly different. We can get applications that have English and French notations in them because somebody served in Quebec and went through medical processes in Quebec and also in B.C., and that’s all in English. We need to make sure that we can efficiently move things around and do that. We just need to make sure that each individual claim is being treated of course appropriately, but as quickly as possible as well. We try to measure each of those stages to make them as efficient as possible.

 

LARRY HARRISON: One more question: Medavie Blue Cross is a partner in this. The backlog, I’m sure, is everywhere. Is there any accountability between your department and Medavie Blue Cross?

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: Yes, 100 per cent there is. We work very closely with Medavie Blue Cross. They have service standards for all the benefits that they provide. We meet with them regularly. They provide us a dashboard of all the service standards - where they’re meeting, where they’re not - and we communicate, we develop strategies on how we can - if they’re not meeting, how they can resolve those.

 

I’m pleased to say that by and large, the vast majority we’re meeting most of the time. There are a few little problem areas that we work closely with, but absolutely, we work together on that. We have multiple meetings at multiple levels to talk about our services and performance.

 

LARRY HARRISON: God bless, folks. I wish you all the best. I’m going to hand it over now to my colleague.

 

THE CHAIR: And that’s from a minister.

 

MLA Bain.

 

HON. KEITH BAIN: Not a political minister, either - that is the important thing to note.

 

First of all, again, thank you. This is certainly an education point for us as well, to learn some of the things that we - questions that we get that we can’t answer. Maybe it’s going to help us as we move along the way.

 

I want to go back to something first of all: services that are provided. I think, Mr. Harris, you made reference to lawn mowing, snow removal, and so on and so forth. Victoria-The Lakes is a rural and remote area. We know that if a veteran requires services - and I’m going to use - and I’m not pointing a finger - north of Cape Smokey, there are lot of a contractors who don’t want to go to a remote area like that, and if they do, it’s at twice the price.

 

I guess my first question: Is that taken into allowance when it comes time for those veterans to receive that service?

 

THE CHAIR: Ms. Hicks.

 

JANE HICKS: It is taken into account. We have what we call a grant-determination tool - a tool that we use to determine how much groundskeeping or housekeeping a veteran may receive across the country, and it’s based on regional rates. I’m not sure if there are 77 regions, but there are quite a variety of regions across the country. It is based on region. We use that tool.

 

If there is an issue, then often the case manager or the veteran services agent will work with the veteran to determine what an appropriate provider might be, or with Medavie Blue Cross.

 

KEITH BAIN: I’m going to keep on the rural and remoteness topic here. Given the high rate of chronic pain and mental health conditions among veterans, how is Veterans Affairs addressing the gaps in specialized mental health services and access to them, especially for the more remote and rural areas?

 

THE CHAIR: Mr. Harris.

 

STEVEN HARRIS: Sure, I’ll take that. With Medavie Blue Cross, we try to identify providers across the country - rural providers and those who may be able to provide services remotely as well, in terms of a helpful way.

 

The second thing I’ll add is that we’ve funded two centres of excellence: one on chronic pain, and one on issues related to mental health, primarily. Their role is to conduct research and also conduct education. The education is really focused on frontline service providers across the country: the family doctor who may see only a couple of veterans as patients - not primarily veterans - or the provider who might be in a small rural location, who may not get exposure to that on a regular basis. What they do is they provide educational materials. They provide seminars and other things that those individuals can participate in to learn more about the conditions that veterans may bring to them that they may not see quite regularly.

 

[3:30 p.m.]

 

Veteran health care may be different than that of a regular Canadian, and if you’re in a rural or a remote community, you may only see a couple examples of that on an annual basis, versus some clinics that specialize in veterans. So in addition to the kinds of supports we’re trying to put in place from a provider point of view, we are also trying to foster education of those individuals who may see veterans and their families only sparingly, so that they have the same access to tools and supports to allow them to better serve their veteran clients and families as well. That’s another example of where we’ve invested money in these centres of excellence that are actually sharing their research, sharing best practices across the country to individual doctors, physicians, and third-party organizations that could benefit from them.

 

KEITH BAIN: Thank you for that response. My last question, I guess, will be to Medavie Blue Cross because the individual’s been getting off fairly easy today. (Laughter)

 

THE CHAIR: He only has a minute, so he’s doing all right.

 

KEITH BAIN: How has Medavie managed its role as Veterans Affairs’ claims administrator, and what measures are in place to ensure veterans receive timely access to care and support? I think timely access is key to this whole thing.

 

THE CHAIR: Mr. Lynch with a timely answer.

 

KEVIN LYNCH: In terms of the services we deliver, it will start with the service levels that Ms. Hicks mentioned. We’re trying to adhere to those. The majority of our processing, for instance, is to relate to an authorization that would come to us to get services. We are to return that to the provider if it has come through within 10 business days. Our goal is to always adhere to those standards. Then, from time to time, if there’s missing information, if we need to go back and forth with that provider, we’ll work our best to move as quickly as possible because then you’re trying to avoid a veteran waiting and not knowing or not understanding what the status is. Our best efforts are put forth to make that happen.

 

THE CHAIR: Thank you, Mr. Lynch. That officially concludes our question period by our committee members to you today. We thank you for all your answers today and the information you provided.

 

I’d like to offer anyone some opportunity for closing remarks, if you’d like. We can begin with Mr. Harris.

 

STEVEN HARRIS: I’d just like to take the opportunity, Chair, to thank you and the committee for the invitation. Thanks for the excellent questions. It is a very complex matter, the administration of veterans’ health both in terms of the importance of it, but also the complexity of working through a multitude of provincial health authorities and others in terms of delivering it. I thank the Province of Nova Scotia for their partnership in delivering health care and support to veterans and their families, and we appreciate the opportunity to be here today.

 

KEVIN LYNCH: I just wanted to take the opportunity to say thank you to the committee for allowing me to be a part of the discussion today. Medavie Blue Cross certainly takes our role very seriously and understands the importance of timely and efficient services for our veterans. We are committed to supporting the well-being of veterans going forward and are proud of the role we’ve played over a number of years.

 

THE CHAIR: Once again, thank you for coming in today. Thank you for the conversation. We’ll now take a five-minute recess for our committee members to allow you to leave and any final conversations they may want to have with you, and then our committee will come back for committee business in about five minutes.

 

We stand in recess.

 

[3:34 p.m. The committee recessed.]

 

[3:39 p.m. The committee reconvened.]

 

THE CHAIR: Order. I call the committee back to order. We’ll proceed with our committee business for this meeting. The first topic here is a list of witnesses that have appeared before our Standing Committee on Veterans Affairs since 2020 to 2024. This was a request made by MLA Jessome at a recent meeting. Our clerk has graciously gone ahead and provided that list. I think it was forwarded to everybody. Is there any discussion about that list? MLA Craig.

 

HON. STEVE CRAIG: I’d like to know what MLA Jessome is now going to do with it. It was compiled.

 

THE CHAIR: We’ll move over to MLA Jessome.

 

HON. BEN JESSOME: I’m going to call them at the wee hours of the morning to see what they’re doing. No, I thought I did mention it at the time, but as we prepare for our topic for consideration of the committee having to do with a possible mandate change to include issues pertaining to military families, what I am choosing to do with this list - and thank you, Mr. Nusseibeh, for providing it - is reaching out to groups, mainly ones that are external to government on this list and engaging them to get their feedback with that context in mind.

 

To date, I have met with Helmets to Hard Hats Canada. I’ve met with Respect Forum - it was actually not on our list here. I met with the Halifax & Region Military Family Resource Centre, who - I’ll state for the record - are positively intrigued by the idea of this committee modernizing and stepping up to focus more specifically on military families as part of our collective mandate. Full transparency, that’s why I asked for it. That’s what I’m doing. In the interest of providing committee members with some complementary information to consider when we look at this agenda item down the road, that will be information that’s compiled and presented to the committee for consideration.

 

THE CHAIR: Our second topic on our committee business here was: Commissionaires Nova Scotia has requested to appear before the Standing Committee on Veterans Affairs. We would have received a letter - MLA Burrill.

 

GARY BURRILL: Not to cut you off, just to speak to that.

 

There are two similar items here . . . (Interruption)

 

THE CHAIR: There are. Would you like to add them together in the same conversation?

 

GARY BURRILL: Yes, and the second-to-final point about the Persian Gulf veterans. Our system has been that access to the agenda is on the recommendation of the individual caucuses. I think this is a system that serves us well for a number of reasons, but one of them is it serves as a certain protection on the agenda space of the minority parties. I don’t see any reason to change the system, so I would like to recommend that both of these requests for access to our committee’s agenda be referred to the individual caucuses for determination of whether or not they would wish to recommend.

 

THE CHAIR: Is there general agreement? I think there’s general agreement around that. Further to that, I could ask our clerk to maybe submit correspondence to those organizations explaining the topic selection process and how we do that here, and then they’ll have an understanding of how that works too. MLA Taggart.

 

TOM TAGGART: On that, I recall reading the letter. I don’t really recall the details other than I do believe that there may have been something that they wanted to discuss that was outside of the veterans or military concept. I would ask that when that letter goes out that they clarify what their topic might be and make sure that they understand that this is, at this point, strictly veterans. It may even move a little bit into the active duty, but I just think we need to make that clear before we engage them too much, both groups, although I think the Persian Gulf group has to be pretty well totally military-related.

 

THE CHAIR: I think the point’s taken, and I think the clerk will be mindful of that when they send the correspondence back to those groups. Thank you, MLA Burrill, for putting them in the same conversation. That makes complete sense.

 

We’ll move on to correspondence from King’s Trust Canada, formerly Prince’s Trust Canada. King’s Trust Canada no longer supports veterans. They wrote to the committee explaining their decision and stating they would not attend to speak on Veteran Entrepreneurship with one of their program’s alumni, as agreed to in the last agenda setting. It was a PC topic, but I would like to open it up for conversation.

 

[3:45 p.m.]

 

TOM TAGGART: If I could, I think that maybe we should have an agenda-setting meeting sometime in the near future. This was, as you say, a PC topic, and our caucus chose this topic to discuss their veterans’ entrepreneurship program. Since that program is no longer in place, we should explore other topics, consider inviting some other of the witnesses who have requested to attend this committee. I’m not speaking for the caucus, so to speak, but maybe that might be a good time to address the Persian Gulf and Commissionaires Nova Scotia issue as well. I don’t know, but that would be my recommendation.

 

THE CHAIR: MLA Hansen.

 

SUZY HANSEN: I’m just curious because I don’t know the process if a presenter is not available or if we’re not able to put forward that specific topic. Is there a process in which another topic is chosen, or does it just go down the line until we get to the end, then we re-up again?

 

THE CHAIR: I just want to clarify that to your point, MLA Hansen. I just want to clarify that. Are you suggesting that we direct the clerk to make this the last topic in this round of topics, and then at that time frame, we’ll just have an agenda-setting meeting?

 

TOM TAGGART: Have we gone through the process? Has everybody had their day or their topics, so to speak, except for this one?

 

THE CHAIR: I believe we have a few topics left here.

 

TOM TAGGART: I don’t want to get ahead of them, so I think that I would ask to recommend that the PCs take this back, have a look at it, and see if there’s someone we could find who would fit the bill of what that particular topic was, which was Veteran Entrepreneurship. If not, then I guess it would be our place to bring one of the others forward, wouldn’t it?

 

THE CHAIR: To maybe clarify something that MLA Hansen brought up about the process, I’ve been informed by the clerk that the caucus could make a motion at any meeting suggesting a topic for that time frame. It doesn’t have to wait for agenda-setting if the PC caucus did not want to do that. You could make a motion at any meeting to propose another topic to fit that.

 

MLA Jessome.

 

HON. BEN JESSOME: Just remind me of the process. Like in this case, we have a witness who’s not planning to attend. If there was an ambition to bring somebody in who could speak to the nature of that topic, what would the process be to bring in a different witness to cover that subject matter?

 

THE CHAIR: The process is that there can be a motion put on the floor to replace the topic completely - that’s done through a motion - or to change the witnesses if they wanted to, but they have the opportunity to put a motion forward. That’s done at committee.

 

TOM TAGGART: I move that we defer this discussion to a future meeting at which time we’ll have a discussion to see if we can find folks who can fill that bill. We will advise the committee accordingly after the next meeting. I move we defer this at this time.

 

THE CHAIR: I’ll just finish my statement, MLA Ince. MLA Taggart has made a motion to defer the conversation to, I believe, the next meeting. That’s an official motion that’s on the table. Is there any discussion about that motion? MLA Ince.

 

HON. TONY INCE: I just want confirmation just to be sure: We’re talking about the King’s Trust Canada?

 

THE CHAIR: Yes.

 

TONY INCE: Okay, thank you.

 

THE CHAIR: There is a motion on the table. No further discussion?

 

All those in favour? Contrary minded? Thank you.

 

The motion is carried.

 

We also have a letter that was received from Ginette Petitpas Taylor, the Minister of Veterans Affairs Canada, who has responded to the committee’s letter regarding support for peer support groups. All the members would have received the letter from the minister. Any discussion about the letter? We’ll make a record that it has been received.

 

The last item is that the Standing Committee on Veterans Affairs 2023-24 annual report is ready for approval. It’s about to hit the press. It’s a hot item. Is there any discussion about that annual report?

 

If there are no concerns, I’d like to ask someone to move that the annual report be tabled at the Clerk’s Office.

 

MLA Craig.

 

HON. STEVE CRAIG: I move that the annual report of the Standing Committee on Veterans Affairs be approved and move forward.

 

THE CHAIR: All those in favour of the motion? MLA Ince.

 

HON. TONY INCE: I’m in favour. (Laughter)

 

THE CHAIR: Oh, okay. I thought you wanted discussion.

 

All those in favour? Contrary minded? Thank you.

 

The motion is carried.

 

Your eagerness is welcome, MLA Ince.

 

Those being all of our items for our committee business today, our next meeting will be November 19, 2024, and the topic will be an Update on the Veterans Affairs Canada Programs and Supports in Nova Scotia.

 

That being said, our meeting is now adjourned. Thank you, everyone.

 

[The committee adjourned at 3:51 p.m.]