Proceedings of the Subcommittee on
Veterans Affairs
Issue 1 - Evidence, December 8, 2004
OTTAWA, Wednesday, December 8, 2004
The Subcommittee on Veterans Affairs of the Standing Senate Committee on National Security and Defence met this day at 12:18 p.m. to study on the services and benefits provided to veterans in recognition of their services to Canada.
[English]
The Chairman: Honourable senators, before we begin the main purpose of today's meeting, we have a bit of business to transact so that we can give the Minister all the time at our disposal until 1:30. The matter of our budget is before the subcommittee, a copy of which is before you. It is in the total amount of $9,670.
Do members of the committee have any comments to make on it?
If there are no comments, would any senator like to propose its adoption?
Senator Atkins: I so move.
The Chairman: Thank you Senator Atkins.
If there is no further discussion the budget is adopted as printed. That completes our business in that regard.
Good afternoon to you all. It is my pleasure to welcome you to this meeting as we pursue our inquiry into the services and benefits provided to veterans in recognition of their service to Canada.
Today we will hear testimony from Minister Guarnieri from Veterans Affairs Canada. She is accompanied by two officials whom the minister will introduce when she makes her remarks.
I am Michael Meighen and I chair this subcommittee. The deputy chair is Senator Day from New Brunswick. Senator Day holds a bachelor of electrical engineering from the Royal Military College in Kingston, an LLB from Queen's University and a Masters of law from Osgoode Hall. Prior to Senator Day's appointment to the Senate in 2001, he had a successful career as a lawyer in Ontario and New Brunswick. Senator Day is also deputy chair of the Standing Senate Committee on National Finance.
Senator Michael Forrestall has served the constituents of Dartmouth for the past 37 years, first as their member of Parliament in the House of Commons and then as their senator. During Senator Forrestall's tenure in the House, he served as parliamentary secretary to several cabinet ministers, including the Minister of Transport and the Minister of Regional and Industrial Expansion.
Sitting next to Senator Day is Senator Norman Atkins from Ontario. He came to the Senate in 1986 after more than 27 years in the field of communications. Senator Atkins is a former president of Camp Associates Advertising Limited and also served as an adviser to the former Premier Davis of Ontario.
Next to Senator Forrestall is Senator Percy Downe from Prince Edward Island who has served in numerous senior capacities, including that of the chief of staff to the office of former Prime Minister Jean Chrétien. Senator Downe is a guest and we welcome him warmly to our committee meeting.
Next to Senator Downe is Senator Colin Kenny, who, since 1984, has represented Ontario in the Senate. His political career began in 1968 as the executive director of the Liberal party in Ontario. From 1970 to 1979, he worked in the Prime Minister's office as special assistant, director of operations, policy adviser and assistant principal secretary to the Right Honourable Pierre Elliott Trudeau.
Senator Kenny is currently chief of our parent committee, the Standing Senate Committee on National Security and Defence. He is also a member of the steering committee of the Standing Senate Committee on Energy, the Environment and Natural Resources.
[Translation]
Good day, ladies and gentlemen. We are very pleased to welcome the Minister of Veterans Affairs, Ms. Albina Guarnieri. The Minister will make a brief statement. I would ask her to begin by introducing the people accompanying her today.
[English]
The Honourable Albina Guarnieri, P.C., M.P., Minister of Veterans Affairs: Honourable senators, I obviously find myself in august company after those biographies.
[Translation]
I would like to thank you for inviting me to be here with you today to discuss the priorities of Veterans Affairs Canada for 2004-2005. I hope that you are all in the holiday spirit.
[English]
Please let me introduce the officials from my department. I have with me Deputy Minister Jack Stagg; Associate Deputy Minister Verna Bruce; Mr. Victor Marchand, Chair of the Veterans Review and Appeal Board; Mr. Brian Ferguson, Assistant Deputy Minister of Veterans Services; Mr. Keith Hillier, Assistant Deputy Minister of Corporate Services; and Mr. Robert Mercer, Executive Director of the Public Affairs Branch.
You see, we brought a full complement today.
The Chairman: We are honoured.
Ms. Guarnieri: Thank you.
[Translation]
This is the first time that I have met with this committee. I know that we share a common purpose, namely to ensure that the men and women who placed themselves in harm's way for our nation will receive the care that they need and the recognition they so richly deserve.
I have the privilege of leading a department whose sole objective is to serve those who served, and continue to serve, Canada.
[English]
Before I begin, I would like to thank the Senate for once again being a wonderful host for a most spectacular group of veterans who joined us in the launch of Veterans Week. I know the veterans were grateful to be able to launch their week in a chamber brimming with art that reflects the military history of Canada.
I want to thank Senator Meighen and all the members of this committee, for the good work you have done for so many years for our veterans.
I also want to compliment the chair on the flawless Italian that he demonstrated in the Senate chamber.
[Italian spoken - Si espresso molto bene]
Actually, I think your accent was better than mine.
For years, the Senate has been a focal point for veterans here in Parliament. There is no better place for sombre reflection than the chamber of sober second thought. That is why we decided that it should be here in the Senate that the government should announce its decision to designate 2005 as the Year of the Veteran.
At Veterans Affairs, every year is the year of the veteran. We serve hundreds of thousands of veterans and their survivors through our programs. We need the recommendations and insights of parliamentary committees such as this to assist us in dealing with service gaps and new needs of our veterans and survivors.
Many of this committee's past recommendations have been acted upon and implemented by the department. A very successful residential care strategy was developed in response to concerns raised by veterans' organizations, our findings, and the report of the Senate subcommittee on Veterans Affairs entitled ``Raising the Bar: Creating a New Standard in Veterans Health Care.''
Over the past number of years, this committee, and I single out Senator Callbeck, has been instrumental in recommending changes to the Veterans Independence Program. Today, 18,300 veterans and primary caregivers, including surviving spouses, benefit from the VIP program.
Voices from across the country have spoken on behalf of some 4,000 additional primary caregivers who are still not included in the program, but had at one time cared for a veteran and received VIP services. I announced yesterday, that we will be providing lifetime continuation of VIP services to eligible primary caregivers of veterans who once benefited from the housekeeping and grounds keeping services since the inception of the program.
We have addressed another important issue. We will ensure that primary caregivers are not cut off from VIP benefits when a veteran is admitted to a long-term care facility. Essentially, we are providing comfort to veterans. They will know that their decision to go into long-term care will not cause their spouse or caregiver to lose VIP benefits. As well, all eligible primary caregivers who saw services to their homes cut off in the 1980s will be reinstated. The successful VIP program will be reborn with a greater number of deserving caregivers.
This committee and the Commons committee have helped identify a need and the government has acted. We have combined the money and the mechanism to deliver for our veterans.
I am sure honourable senators are also aware that the Auditor General recently tabled her November 2004 report in the House of Commons.
I want to mention chapter 4 of this report, as it focuses on the management of federal drug benefit programs, one of which is VAC's pharmacy program. The Government of Canada agrees with the Auditor General's recommendations and will act on all of them.
Our primary concern is client safety and we share the Auditor General's concern about preventing the inappropriate use of drugs.
All six departments including VAC are working to identify additional tools to support health care professionals in deterring inappropriate drug use. I am pleased to say that VAC's Drug Utilization Review Process, in place now for seven years, was noted as best practice. VAC takes a holistic approach to managing clients' needs including pharmaceutical needs. The Drug Utilization Review Process involves case management and screening, and personal contact with our clients to ensure that all their needs are being met.
In the report, the Auditor General also highlights VAC's implementation of the first national completely electronic real time pharmacy adjudication system. This system is so popular that the Canadian Forces and the Royal Canadian Mounted Police have now partnered with us to use the same system. It is my view, that the Auditor General's report acts as a tonic to further improve our drug plans and provides Veterans Affairs Canada with impetus for more focused collaboration with federal health care partners. I look forward to what can be accomplished.
The Auditor General has acknowledged our responsiveness. I will take the liberty of quoting her directly: ``They have been very good about this audit and very responsive to it. I look forward to doing a follow-up which will show that they don't have to be told three times.''
I must confess that I feel particularly blessed to be in a department that is so proactive in dealing with emerging issues that it has earned the praise of both clients and auditors.
Let me turn now to our priorities. July was an opportune time to be appointed Minister of Veterans Affairs as I had the privilege of participating, with our veterans, in an ambitious schedule of events to mark key anniversaries. In short order, I got to know the veterans and the veterans organizations that are our clients, our partners and the reason we are all here today.
I joined Canadian veterans who returned to Belgium to celebrate the sixtieth anniversary of its liberation and I have recently returned from Italy where veterans returned to mark the sixtieth anniversary of the Italian campaign. These experiences mark the need for us to do more here at home to keep the memory of our veterans charged with enthusiasm and ever present in our consciousness. We need to pass that tradition of respect and awareness on to Canada's youth and make sure they take full advantage of the living history that our veterans carry with them and are willing to share.
The department has a comprehensive youth strategy that will be proactively and aggressively put into action. At VAC, we have the dual responsibility of recognition through remembrance activities as well as through the services and benefits that we provide to enhance interdependence and quality of life for our veterans and their families. Caring for aging veterans, guarding the memory of our nation's sacrifice, and preparing modern day CF veterans for productive civilian careers are our priorities.
Our operational challenges at VAC mirror Canadian society in general. We need to find the balance between managing the needs of a large population of seniors while providing transition services to younger clients leaving the Canadian Forces and re-entering civilian life. VAC has for many years been focused on helping primarily senior veterans live out their lives with a maximum of independence, care and support. The fact that so many veterans want to be included in the VIP program is an indication that the program is working for veterans and delivering results for over 70,000 clients.
VIP is also the basis for an upcoming continuing care research study that will help shape home care services for the broader population of seniors. The continuing care research project is a joint initiative with the Province of Ontario to examine the costs and outcomes of the Veterans Independence Program. It will gather research evidence on how home care works best and show what mix of home care services such as homemaking versus professional care services is most effective in keeping people at home longer.
[Translation]
Knowing that the Veterans Independence Program has been instrumental in allowing veterans to remain independent in their homes is certainly a point of pride for my department.
[English]
In fact, taking some of the calls from widows yesterday, I must confess I felt moved to have been able to do what all of us in public life aim for; that is to help people. To help thousands more surviving caregivers stay in their homes longer with a higher quality of life, is our way of caring for those who gave so much care to our veterans. It was simply the right thing to do.
I should say I could not have done this alone. The department worked for months under Mr. Stagg's leadership in conjunction with the Department of Finance, the Department of Justice, the Privy Council Office, and of course, the Prime Minister himself who has always been a strong supporter of our veterans.
We could not ignore the sage voices of this committee and other advocates across the country. VIP has been an unquestioned success and we invite other jurisdictions to copy our outline. The challenge for all levels of government is to promote the kind of healthy independent living that allows seniors to be part of the community longer, to be in a caring family environment longer, and to be in an institutional environment as a very last resort. When it is needed we want that residential care to be of the highest possible standard.
Earlier, I mentioned the department's residential care strategy which benefited greatly from your committee's report.
[Translation]
This strategy provides a framework for long-term care quality assurance across the country.
[English]
It involves national accreditation, the monitoring of VAC outcomes through client satisfaction and facility questionnaires, and the involvement of provincial monitoring staff. It also provides for specialized services for dementia and palliative care in our large contract facilities where veterans reside. The department strongly encourages the accreditation of all priority access bed facilities through the Canadian Council on Health Services Accreditation. The VAC worked in partnership with the Dominion Command of the Royal Canadian Legion to integrate VAC's 10 outcome standards into the accreditation process so as to better measure the quality of care provided to veterans. To date, 93 per cent of priority access beds are in accredited facilities.
Other initiatives that VAC has in place include the client satisfaction questionnaire, which our area counsellors conduct on an annual basis. The purpose of the questionnaire is to measure the satisfaction level of veteran clients with the care and services in 10 major areas. Should any concerns be identified by the veterans during the course of the interview, they are followed up by VAC officials and with the facility's administration staff.
The client satisfaction survey surveyed 2,884 clients and their family members during 2003-04. The overall satisfaction rate was 94.4 per cent and it appears that the current trend in client satisfaction is holding to last year's levels.
Finally, in response to a number of requests from outside organizations to monitor the quality of care in Ontario, a director of quality care position was created in the Ontario region in April 2001. The director of quality care works closely with the three largest priority access bed facilities in Ontario: The Perley and Rideau Veterans' Health Centre, Parkwood Hospital and Sunnybrook and Women's College Health Sciences Centre, and with various stakeholders to resolve any care issues.
I am pleased to say that this pilot has been so successful that the department is proceeding with a similar position in two other regions. In Quebec, work is well under way on the modernization of Ste. Anne's Hospital. These renovations will bring the hospital in line with provincial standards and will optimize the institution's bed capacity. The $67.7 million project will result in 446 beds, a conversion of dormitories into private rooms, and will provide veterans with an environment adapted to their specific needs.
Ste. Anne's is the centrepiece of our joint VAC-DND networks of excellence in mental health, and provides clinical expertise, diagnosis and treatment of operational stress injuries to a network of clients in long-term care facilities across the country.
Operational stress injury clinics are now open at Parkwood in London, Ontario, Paul Triquet in Quebec City and Deer Lodge in Winnipeg. The DND network is comprised of five operational trauma, stress and support centres.
[Translation]
We are pursuing other initiatives to meet the needs of CF members and veterans suffering from PTSD and other OSIs.
[English]
We are piloting a telemental health project in Newfoundland and Labrador to help us find alternative ways to deliver mental health services in rural communities. I am very pleased to report that this pilot is working very well.
We have introduced a new policy that will provide treatment services required to address the health needs of family members of clients where the need is related to the client's PTSD or other mental health injury. The operational stress injury social support peer support network has been implemented on schedule and is currently located in 13 cities across the country.
The prevalence of operational stress injuries is another reminder that our current service personnel are far from what used to be considered a peacetime military. Our future veterans are today standing in harm's way for the peace and security of others. They are also candidates susceptible to a wide variety of injuries and illnesses that could last a lifetime.
Canada's contribution to peacekeeping, peacemaking and the war on terrorism is a source of national pride.
[Translation]
It has also meant that Veterans Affairs is responding to far more servicemen and servicewomen who are turning to us for help.
[English]
Their numbers have increased 58 per cent in the past three years. We anticipate over 58,000 CF clients by 2013, and where we currently provide disability pensions to 7 per cent of the total eligible CF population, that number is expected to rise to 11 per cent in just five years.
As our focus on operational stress injuries indicates, these veterans often have a complex mix of physical and psychological ailments that challenge conventional notions of medical treatment or available social services. As they try to cope with the injury or illness, they are often doing so as they transition back to civilian life, trying to get well while trying to get a job.
Although both Veterans Affairs Canada and the Department of National Defence have made great strides in coping with younger veterans in recent years, our existing programs have neither the scale nor the focus to deliver all we could for these veterans. It was clear that a new veterans' charter for a new century was needed, and that is exactly what my predecessor acknowledged last spring when he announced the most fundamental review of veterans' programs and services since the Second World War.
[Translation]
This charter will include a new suite of programs in the following areas:
[English]
Disability awards and health wellness programs for our newest veterans; medical and psychological rehabilitation services, including vocational training and education; earnings loss support for veterans undergoing rehabilitation, as well as longer-term loss of earnings support for those who simply can no longer work because of a service-related illness or injury; and job placement assistance and health care for veterans and their families.
The service and program modernization task force has been working hard to determine the design of the new programs and prepare the required legislative changes. Part of this work involves extensive consultations with the major veterans' organizations and other involved groups. We are dedicated to getting this right.
In the coming weeks, we will be testing the broad program areas with still-serving members, veterans and their families to see how they feel about the proposed changes and how they would like to receive information about the services and benefits to which they may be entitled.
The range and scope of change envisioned by this new charter represents a true transformation of the suite of programs and services we are providing to CF veterans and their families. Can you think of a better initiative to be working on during the Year of the Veteran?
We have new programs on the way for Canada's new veterans and a very special year for all our veterans. The Year of the Veteran will be a national history lesson, a national show of gratitude for our veterans and an opportunity to renew our commitment to remembrance and pass on that tradition to a new generation.
[Translation]
The year 2005 will indeed be a year to refresh our memory, restore our monuments, retell our history and re-inspire our youth.
[English]
Deputy Minister Jack Stagg chairs an active federal advisory council on remembrance. This council, currently made of 13 federal departments and organizations, provides advice and guidance to the Minister of Veterans Affairs on the subjects related to remembrance.
In support of the work of the council, the department also seeks input from stakeholders and other partners as required. In May, we will ask our veterans to cross the ocean yet again to join the Netherlands in celebrating its liberation by Canadians. Our Dutch friends are already well under way with their planning.
The new Canadian War Museum will be opened in May. I am so pleased that veterans will be among the first guests of honour. The Canadian War Museum, under the Department of Canadian Heritage, will be a further way for Canadians to pay tribute to our veterans.
We will be unveiling the seventh book of remembrance at Parliament Hill to commemorate Canadian Forces' members who died in service since the Korean War. We will continue the important battlefields restoration project at the Vimy memorial in France, which is scheduled to be completed by 2006. Restoration work is already complete at seven of the 13 memorials in France and Belgium, including Masnières in France and St. Julien in Belgium. Of course, we will have special celebrations of VE Day and VJ Day.
I personally invite all honourable senators to our get-together on December 14 for a Year of the Veteran event on Parliament Hill. We have invited a number of local area veterans to join us and I know your presence would be mean a lot to them.
Veterans Affairs is a department for the ages. We have programs for youth, for modern-day veterans and for aging war veterans. Our plan is to ensure that all our programs stand the test of time, and I know this committee will be an important contributor as we continue to modernize and reform our programs.
[Translation]
I would be delighted to entertain your questions.
[English]
I certainly welcome your insight.
The Chairman: Thank you for a very complete statement.
[Translation]
Your comments will certainly give rise to many questions. On my list is Senator Daly who has some questions for you.
[English]
Senator Day: Welcome to you minister and your colleagues whom I had the opportunity to meet along the way. It is good to see them here and I am glad you brought them along.
On my own behalf, and I believe on behalf of all of my colleagues in the Senate Subcommittee on Veterans Affairs, I would like to say that we have had an extremely good relationship with your department. We find that all of the people working with Veterans Affairs are very dedicated to the service they provide. Their dedication is obvious to us whenever we have a chance to meet with them and we see them on any of our pilgrimages or in the hospitals we have visited. We had the opportunity to visit in Montreal at Ste. Anne's and Sunnybrook in Toronto, and we compliment you on the work you are doing.
You have a very ambitious year in the Year of the Veteran. There is nothing like having a special announcement to help focus on a lot of activities, and I hope we will be able to help move your initiatives along and participate to the extent we can.
I would like to better understand the expanded role of Veterans Affairs to include retired Armed Forces personnel. At one time not that long ago, we were getting comments that there is a definition of ``veteran'' that is different for different circumstances.
Is that something that has been sorted out now, or is there still this difficulty that for certain programs a veteran is someone that has served in a foreign theatre and in another instance a veteran is anyone who has served in the Armed Forces?
Ms. Guarnieri: Thank you for the kind words on behalf of the department. We certainly welcome your generosity of spirit. I have been fond of saying that the individuals I have met that serve in my department have the spirit of volunteers. They do act like they are volunteers.
With respect to your other point of offering your services as we launch the Year of the Veteran, we welcome your participation. It will be an evolving program, so there will be ample opportunity to fine-tune and add more suggestions, so please feel free. We invite commentary and ideas.
With respect to the definition of the word ``veteran,'' eligibility for programs is probably the most important question that you could ask at an estimates session; and because all our estimates hinge on that question, I will ask my officials to answer the definition of the veteran.
Mr. Jack Stagg, Deputy Minister, Veterans Affairs Canada: My understanding is our definition of a ``veteran'' is someone who enlisted, who passed basic training and came out with an honourable discharge. Our definition is as complicated or as simple as that.
There is different eligibility for different programs. We have some programs that are eligible for war-serving veterans, and some programs that are just eligible on the basis of someone's sickness or impairment. However, the basic definition of a ``veteran'' is a person who has been in the department for three or four years. I do not think it is in legislation, but it was announced by Minister Duhamel three or four years ago, and we have stuck with that definition. It seems to us to be a fairly good working definition.
Senator Day: How many veteran programs have different eligibility criteria?
Mr. Stagg: Each of the programs has its own set of eligibility criteria. Priority long-term beds, for instance, are only eligible for those who have served during wartime: the Korean War, the Second World War and the First World War. War veterans' allowances are only available to wartime servers. All of the other programs including long-term care, health care, et cetera, are available, I believe, to most Canadian veterans, if not all.
Ms. Guarnieri: You asked about retired Armed Forces personnel on our advisory committee, and Mr. Stagg participates on that committee.
Mr. Stagg: The advisory committee to which you are referring is one that was set up at the end of the Second World War.
As you recall, General Rohmer chaired an advisory committee that gave us advice on how to plan out events around D-Day. That worked so successfully that we have asked ex-service people to come in and give us a hand to help plan the events for next year.
The events for next year, the 60th anniversary and the Year of the Veteran, involves more than veterans who served in the Second World War, it also involves other veterans.
The minister had asked General Charles Belzile to come and chair the committee, and we also have invited some distinguished Second World War veterans to take part. Smoky Smith is the honorary patron of the committee, Cliff Chadderton is the honorary chair, and we have added Garth Webb from the Juneau Beach Centre. We also have a Second World War air force veteran, who has experience in flight missions over the Netherlands. We have other people from DND, other departments, and some of our own officials.
Senator Day: Is that separate from the Federal Advisory Council on Remembrance referred to during the presentation?
Mr. Stagg: That is a committee that I chair and it is separate. It is internal to government, with 13 deputy ministers from 13 separate departments.
Senator Day: My final question is with respect to the issue of eligibility. I congratulate you on the announcement you made yesterday to expand the program. As parliamentarians, we receive a lot of calls from either surviving spouses of veterans or from the Legion organizations in our areas.
As I understand the Veterans Independence Program, sometimes referred to as VIP, started in 1981 and went forward, and when the veteran died that was the end of the program. In 1990, it was amended somewhat to allow for a one-year extension for the surviving spouse. In 2003, the definition ``primary caregiver'' was added and you picked up those individuals for continuous support as long as the death of the person they were caring for was from 1990 and afterwards. Am I correct?
Ms. Guarnieri: As you can imagine, this program has evolved over time. It is appropriately named VIP, because our veterans certainly deserve VIP treatment.
The program was initially designed to provide benefits to the veterans. Eventually, spouses were included in this program. We found the method and the mechanism to go back to 1981 and include all the primary caregivers dating back to the inception of the program.
This is a forward-looking program. I notice that there was a word ``retroactive.'' Some people misinterpreted when we said we were going back to 1981 to gather those caregivers that had been excluded by the 1990 change to which you referred.
Senator Day: I understand that there is no retroactive pay out.
Ms. Guarnieri: You cannot give grounds keeping and laundry service retroactively.
Senator Day: I understand. My concern is that the criterion you have listed here is that the person who applies for this is the surviving caregiver, who must be assessed within one year after the death of the veteran. Will that criterion not exclude many people?
Mr. Stagg: This is an assessment that we make. It is normally made by virtue of us asking the caregiver whether or not they were able to take care of themselves once the veteran had passed on. In some cases, there might be some medical evidence to say that they needed some additional care. We do not press hard for proof. If a veteran passes on, we assume that the spouse will need of the program. The spouse or the caregiver that we will pick up now, will be allowed to continue lawns or grounds keeping if the primary veteran who passed away had passed away with those programs.
Ms. Guarnieri: Are you saying that if the veteran was receiving the VIP service, the spouse would automatically get it?
Mr. Stagg: That is correct. I will let Mr. Ferguson speak to the application of this program. He is much more aware of the program.
Senator Day: The problem is that we may be asked to explain this.
Mr. Brian Ferguson, Assistant Deputy Minister, Corporate Services, Veterans Affairs Canada: When the application is made for the elderly caregivers, it will be automatic and they will be put into pay. We will do an assessment but it will be of the kind that would be done in that circumstance.
It provides us with the other option. If the caregiver happens to be a younger individual, say 40 years old, quite capable of doing their own grounds keeping, that gives us the option of assessing their need. That is what the intent was there.
Ms. Guarnieri: Am I right that they can also add to an expansion of services, in the assessment period?
Mr. Ferguson: They are only eligible for what the veteran was receiving at the time. It is intended more for the case, to ensure that they actually need the service. As the deputy indicated earlier, this will be handled rather expeditiously for the older veterans and would be there for the application if we have some younger individuals in need.
Senator Day: If the veteran was receiving snow removal and the surviving caregiver finds that she also needs house care, she cannot get that because the veteran was not getting that because she had been taking care of it.
Mr. Ferguson: That is correct.
Senator Day: The second point I have not got clarified yet, and maybe you want to think about this and get back to the committee. What causes me concern is that one year from the date of the veteran's death she must be assessed or she will be ineligible.
Mr. Ferguson: No, what I am saying to you, senator, is that for the aging veteran population, they will automatically be put into pay and put into their services.
Senator Day: That is going forward. What about the veteran who died a few years ago? What about the woman who was caring for that VIP veteran who was not eligible then but is now? What is the situation with her when she has not been assessed within a year of his death? Will she be ineligible?
Mr. Ferguson: We will clarify, but the intent is not to make them be reassessed within a year.
Senator Day: It would be very good if you could clarify that for everyone.
Mr. Ferguson: In that case, it was meant for the new cases of death.
Senator Day: That is not clear from your material but thank you for the clarification.
The Chairman: Could you send a letter to clarify that, Mr. Ferguson?
Mr. Stagg: We certainly will.
Ms. Guarnieri: That was an important clarification, thank you.
Senator Forrestall: Thank you for breakfast yesterday morning, minister. Keep that up and will you have a great time with us.
Ms. Guarnieri: We will have chubby people.
Senator Forrestall: I am being facetious although we enjoyed ourselves.
When we were last at Ste. Anne's, we talked privately and a little bit in committee with Dr. Paquette. In my humble estimation, he is one of the great current figures in veterans' medicine, not just in Canada but in North America.
We talked about his hopes for research and how much work is left to be done and the different nature of veterans' illnesses. Things that we understand today require forms of treatment that we did not envision 25 or 50 years ago.
I want to talk a little about money for research and current programs. Dr. Paquette had two or three pet programs underway. I laud him for his persistence in pursuing these projects.
I hope that when our people call the United States' research centres, our people are calling to chat and exchange information, not just calling for advice. We should be able to provide our own people. It should work like Dr. Paquette has suggested.
Ms. Guarnieri: You have certainly flagged a crucial issue that is very important to Canada's veterans. Certainly, Mr. Ferguson is our resident expert when it comes to dealing with our established clinics across the country to provide specialized care. This is very different than fixing an arm or a leg. There is no quick fix. You may have been given one of the most difficult tasks here, Mr. Ferguson.
Mr. Ferguson: In response to your question, Ste. Anne's is at the centre of a wide range of research activities that they conduct on their own. We have benefited from their research.
Based on its own research, Ste. Anne's has instituted a pain management clinic. Chronic pain is an important life inhibitor for veterans both young and old. In a second area of research Ste. Anne's has introduced a dysphagia program. This program will encourage those who have difficulty swallowing to eat and maintain their viability. In these two areas Ste. Anne's has done remarkable work. They are now in the process of strengthening their research capacity.
As the minister mentioned in her opening remarks, Ste. Anne's is basically a showcase institution. It has the lead role in the networks of excellence for mental health reports to our Canadian Forces veterans and is strengthening, as we speak, its capacity to do research. It does its research in close consultation with other countries, in particular the United States and Australia. They do a lot of research in operational stress injuries that we can take advantage of without having to reinvent the wheel.
Dr. Paquette is correct in saying that we need to invest more in research and we are doing so. We have quite aggressive plans to institute further developments in that area.
Senator Forrestall: I would be most supportive of any additional funds that can be directed to Dr. Paquette and the other doctors throughout the service, because it is very worthwhile work.
Senator Atkins: I am thinking primarily of veterans of the Second World War. When Second World War veterans returned to Canada, many were anxious to get out of the service and, as a result, waived any complaints they might have had that would have been recorded on their medical records. Now that all of those veterans are over 80 and they have disabilities with hearing, eyesight, et cetera, how are they being treated?
Are these veterans referred back to the original medical records, or is there a program that accommodates them regardless of their complaint?
Ms. Guarnieri: As you can imagine, senator, it is difficult for us to correct all of the errors that may have been committed in the past. I can certainly tell you that our department goes that extra mile to give the veterans the benefit of the doubt. When they come forward, our people exhaust every possibility and explore every avenue to address the veteran's needs.
Mr. Stagg: We try and use whatever medical records are available. Some of the common problems that afflict older people now in their 70s or 80s are problems that show a pattern which relate back to war service.
For instance, one of the problems is around hearing; audiology. There is a pattern of audiology that will follow you for the rest of your life if you were subject to very loud noises and trauma anytime in your life. Our doctors can tell from the audiology graphs whether or not someone had lost their hearing over time not related to service, or whether it was a traumatic event that happened to them during their service. That is only one example.
As the minister said, in almost every instance where we look at medical records, if no medical record exists, the benefit of the doubt is given to the veteran. There are some complaints, but in just about every instance we satisfy the veteran by going that extra mile to accommodate what is wrong with them, and certainly allow ourselves to relate that back to an individual service.
Senator Downe: Minister, thank you very much for your detailed overview. In my opinion, you have the best job in government.
Ms. Guarnieri: I think so, too.
Senator Downe: I think some of the ministers who used to have the job would agree with you. When they moved on, they missed it even more.
I thought your report was very detailed. The department is doing tremendous work, as they have done in the past. I think they are adjusting to the new realities of having younger veterans.
My question pertains to your budget. As you are aware, the government has an expenditure review exercise under way where they intend to reallocate $12 billion over five years from low priorities to high priorities. Given the support Canadians have shown for benefits for our veterans and our Canadian Forces troops, is your department exempt from that exercise?
Ms. Guarnieri: No, we are undergoing the exercise too. I can say, quite forthrightly, that it is a good exercise to go through. We are seeking efficiencies as we move forward.
Mr. Stagg can elaborate further. It is not an exercise that we see as menacing. Departments that have shown a willingness to do their part and look for efficiencies are actually being rewarded. We have not suffered as a result of reallocation of funds.
Mr. Stagg: As the minister said, senator, we are part of the exercise. What we are doing is trying to find a way of looking for efficiencies and savings in the system. Last time, for instance, we contributed somewhere in the neighbourhood of $4 million by virtue of us being able to save money on medical services and medical goods such as oxygen. What came to realize that we could find considerable savings through consolidation of our oxygen accounts and as a result saved almost $4 million dollars. We are looking at finding ways of contributing and not have a negative impact on the veterans' services. That is our goal and we think we can probably achieve that goal.
Senator Downe: I accept what you said in the last exercise. My concern arises from a comment and statement the Auditor General gave before the National Finance Committee where she said that at $12 billion, programs would likely have to be eliminated. The last exercise you are referring to was, I believe, a $1 billion reallocation. This is a much more significant amount.
The point I stress is that I hope that if there are program cuts this department is exempted because of the important work that you do, not only for the veterans but their dependents. If you need any assistance in that area, I will volunteer and I am sure others will as well.
Ms. Guarnieri: I think I can safely assure you that no essential service will ever be cut. I argue that we will explore ways to enhance services to veterans. You can rest assured that with all of you jealously guarding the purse for this ministry, I do not think we will fare badly on it.
The Chairman: My information is that Mr. Marchand's Veterans Review and Appeal Board aims to deal with matters that come before it within 30 days. While in 2000-01 you were up over 40 days, you now have the average length of time down to 34 days. I am hoping that you will be able to tell me that you are getting ever closer to your objective of 30 days.
After that, could you elaborate on what you see as the greatest challenges facing the board — for instance, the changing demographic of your clientele — and how you are moving to meet that challenge?
Mr. Victor Marchand, Chair, Veterans Review and Appeal Board, Veterans Affairs Canada: Honourable senators, as far as turnaround times are concerned, we have done even slightly better in 2003-04. Our turnaround time on appeal is 22 days and turnaround time on reviews is 28 days. That is the average time it takes between the actual hearing and when the decision is put out. We are very proud of that performance.
As far as the change and the challenges that are faced by the board, I think the biggest is the change in client mix, from the conventional World War II or Korean campaign vet, we are now faced with a younger, much more assertive generation, and the legal issues and medical conditions brought forward are more complex and require more research and hearing time. It is simply more complex work that requires more rigour and more time. That is the biggest challenge these days, and for the years to come it will be the complexity of medical conditions and legal submissions.
Senator Atkins: I am curious to know, on average, what is the most prominent complaint that you get?
Mr. Marchand: Post-traumatic stress disorder claims are the most complex and far-reaching, both with a view to a rigorous assessment of the event that caused the trauma as well as the extent of the damage, psychological or otherwise, that was caused. We are called upon to assess both the event and the extent of the psychological damage. Those cases require a significant amount of work.
Orthopaedic injuries are still numerous at many levels and they also require up-to-date medical information.
Senator Forrestall: The subject has already been raised by Senator Day and others in similar circumstances, and it has to do with our definition of the ``war zone.'' The timing of those definitions, directly affect people.
I can think of men and women who were involved in the Cuban missile crisis, which is getting to be many years ago now. In a general way and not getting into specific cases, men and women served in what was obviously a war zone, under any criteria that we use today. Anybody who participated in that sea coastal defence zone area that was proscribed in that initial 24 to 48 hours, are not entitled, no matter what their health condition, to the benefits of being among their brothers in veterans' hospitals. They have to go off and be on their own; where care is required, they cannot stay in their own homes. That puts an awful burden on the families.
I like George Hees's admonition: ``If you have a doubt, for Christ's sake resolve it in favour of the veteran. There are not that many of them left.''
Could we not review those people who joined the forces in defence of Canada, who served at the direction of their masters and who were deprived of opportunities, no matter what they might have wanted to do?
I will give you the example of a dentist who spent his career in Halifax identifying remains from dental records, who never served overseas, was never in a war zone, wanted to be, but was not.
There cannot be that many people, really. Can we not find in their favour? Can we not do something to help them out a little bit?
Ms. Guarnieri: Are you talking about disabled individuals or broken spirits?
Senator Forrestall: Yes.
Ms. Guarnieri: Perhaps Mr. Stagg would like to elaborate and offer some insights.
Mr. Stagg: We have veterans' care hospitals for World War II veterans, as you know, senator, and for those who served in Korea. We also have community beds available for those who served afterwards.
The only two programs that are not available for those people who served after the Korean War and were not involved in wartime service is the war veterans' allowance, which is the basic provision for people who have very low incomes, and a priority access bed. Most of those priority access beds occur in veterans' wings of hospitals. Those are the only two programs that are not available to those people who served afterwards. Disability pensions VIP and all of those services are available to every one of those people, whether they went overseas or not.
Senator Forrestall: Do we have vacant beds?
Mr. Stagg: In fact, we do.
Mr. Ferguson: We do in a couple of isolated areas. I think, for example, in Parkwood, there are some beds that are not being used in the hospital. When we have a situation like that, we will move those beds to areas of higher needs in the community facilities. We keep an active inventory of where there are beds, but there are not many areas like that, senator. Most of the areas are fully occupied.
In some cases we have wait lists. It is interesting that where we have had the wait lists in the priority access beds, we introduced a pilot program that is now a national program to allow those overseas service veterans who had access to those beds to stay at home with enhanced home care under the VIP program in order to give them care in their home that would equate to being in the hospital.
We found that in Halifax, Victoria and in Camp Hill when we applied that pilot program, when the bed became available, over 90 per cent of those individuals said, ``Could we stay where we are please rather than go into that hospital.''
Senator Forrestall: I was talking about individuals. That is why I said there are probably very few of them who, for one reason or another, need virtually palliative care.
Ms. Guarnieri: I know you are supposed to be asking the questions, but have you come across individuals that had specific needs?
Senator Forrestall: Yes, I certainly have. I have been around here for 38 years going on 39. Yes, believe me.
Ms. Guarnieri: Well, bring them forward.
Senator Forrestall: As a matter of fact, I used to work for your department.
Ms. Guarnieri: I know you know this department, so you know that if you bring them forward to the department, they will certainly explore all possibilities to assist.
Senator Forrestall: Madam Minister, I am appealing to your newness and your wonderful nature.
The Chairman: Hard to resist, senator, but regrettably we only have two minutes left and Senator Downe, who is a welcome guest at our committee meetings, has a short question that will elicit, I know, a very short answer.
Senator Downe: As a supplementary to a question that the chairman asked, the government has been criticized in some quarters for not making timely appointments. As I recall, the Veterans Review and Appeal Board used to allow up to 26 or 29 permanent members and unlimited temporaries.
Are there many vacancies on that board, or do you have enough members to do the work?
Mr. Marchand: I will always need more board members. Board members love the job they do and would like to review and look at every file with the depth that they require. We have a magic number that is in the legislation, and that auditing has revealed to be correct, of 29 board members full-time. At present, we are hovering at 27, 24 permanent and three part-time.
[Translation]
The Chairman: We would like to thank the minister's associates for being here today and for fielding questions. Let me also thank you, Madam Minister, on behalf of the committee, for your presence and your comments. We had an excellent discussion and we are prepared to work with you and your department to address all outstanding issues.
The committee adjourned.