SVET Committee Meeting

37th PARLIAMENT, 1st SESSION

Sub-Committee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

EVIDENCE

CONTENTS

Wednesday, March 13, 2002

º

1605

The Chair (Ms. Colleen Beaumier (Brampton West--Mississauga, Lib.))

Mr. Pagtakhan

º

1610

º

1615

º

1620

The Chair

Mr. Roy Bailey (Souris--Moose Mountain, CA)

Mr. Pagtakhan

Mr. Roy Bailey

º

1625

The Chair

Mr. Roy Bailey

Mr. Pagtakhan

Mr. Roy Bailey

The Chair

M. Louis Plamondon (Bas-Richelieu--Nicolet--Bécancour, BQ)

The Chair

M. Godin

M. Pagtakhan

º

1630

M. Godin

M. Pagtakhan

M. Godin

Mr. Pagtakhan

Mr. Brian Ferguson (Assistant Deputy Minister, Veterans Services, Department of Veterans Affairs)

º

1635

Mr. Godin

M. Pagtakhan

Mr. Godin

Mr. Pagtakhan

The Chair

Mr. Bob Wood (Nipissing, Lib.)

Mr. Pagtakhan

º

1640

Mr. Wood

Mr. Rey Pagtakhan

Mr. Larry Murray (Deputy Minister, Department of Veterans Affairs)

Mr. Brian Ferguson

Mr. Bob Wood

Mr. Pagtakhan

Mr. Larry Murray

Mr. Pagtakhan

The Chair

Mr. Larry Murray

º

1645

The Chair

Mrs. Elsie Wayne (Saint John, PC/DR)

Mr. Pagtakhan

Mrs. Elsie Wayne

Mr. Pagtakhan

º

1650

Mrs. Elsie Wayne

Mr. Pagtakhan

The Chair

Mr. Dan McTeague (Pickering--Ajax--Uxbridge, Lib.)

º

1655

Mr. Rey Pagtakhan

Mr. McTeague

Mr. Rey Pagtakhan

The Chair

Mr. Roy Bailey

»

1700

Mr. Pagtakhan

Mr. Larry Murray

Mr. Roy Bailey

The Chair

Mrs. Elsie Wayne

»

1705

Mr. Pagtakhan

Mr. Larry Murray

Mrs. Elsie Wayne

Mr. Pagtakhan

Mr. Larry Murray

Mrs. Elsie Wayne

Mr. Larry Murray

Mrs. Elsie Wayne

The Chair

Mr. Bob Wood

Mr. Pagtakhan

Mr. Bob Wood

Mr. Pagtakhan

Mr. Bob Wood

Mr. Pagtakhan

»

1710

Mr. Bob Wood

Mr. Pagtakhan

Mr. Wood

Mr. Rey Pagtakhan

Mr. Larry Murray

Mr. Bob Wood

Mr. Pagtakhan

Mr. Larry Murray

»

1715

Mr. Bob Wood

The Chair

Mr. Pagtakhan

The Chair

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CANADA

Sub-Committee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs

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NUMBER 005

l

1st SESSION

l

37th PARLIAMENT

---

EVIDENCE

Wednesday, March 13, 2002

[Recorded by Electronic Apparatus]

º  (1605)  

[English]

    The Chair (Ms. Colleen Beaumier (Brampton West--Mississauga, Lib.)): I call to order the Subcommittee on Veterans Affairs of the Standing Committee on National Defence and Veterans Affairs.

    Today we're very pleased to have with us our new minister, who has, I'm sure, spent a great deal of time familiarizing himself. With him are Larry Murray, the deputy minister, Brian Ferguson, the ADM for veterans services, and, Keith Hillier, ADM for corporate services. Welcome.

    Minister, would you like to begin?

    Hon. Rey Pagtakhan (Minister of Veterans Affairs, Lib.): Thank you, Madam Chair and members of the subcommittee.

    Let me start by saying that caring for our veterans is caring for our Canadian nation. Thus I am delighted to join you today to discuss specifically the long-term care of our veterans, your committee's particular area of study at this time, I understand. I realize that you may also want to discuss other matters. Although this is my first meeting with you in my capacity as Minister of Veterans Affairs, I am sure you will find that I share your passion in seeing that our veterans continue to be well served by the Government of Canada. The commitment and energy of your members in this regard are a matter of public record, and for that I commend you all.

    Like any minister in a new portfolio, I spent my first few days and weeks learning the various functions of the department, Veterans Affairs Canada, or VAC, and I will continue to be fully engaged. I visited our head office, for your information, in Charlottetown just last week and met with the staff responsible for advising me on policies and for administering the various programs and benefits we offer. As you may know, I have a keen interest in health care, and I'm notably impressed by the range and calibre of services provided to our veteran clients. I know you too, as members of this committee, are equally interested in health care.

    One of my first activities was a meeting with two of the department's key stakeholder groups. On January 30, about two weeks following my appointment, I had the privilege of sitting down with senior representatives of the Royal Canadian Legion and Army, Navy and Air Force Veterans in Canada to address issues of concern to all of us and to set the stage for on-going dialogue. One of the issues we discussed at length was, in fact, the long-term care of our veterans.

    VAC's approach to quality of care is comprehensive, involving accreditation, monitoring of 10 care outcome standards, and direct resident visits. The residential care strategy, put in place about two years ago now, emphasizes dementia and palliative and respite care. The strategy was a result of recommendations from stakeholder groups and from the Senate subcommittee's 1999 report, Raising the Bar: Creating a New Standard in Veterans Health Care.

    Accreditation by the Canadian Council on Health Services Accreditation, or CCHSA, is, in effect, VAC's national standard for long-term care. The department encourages all priority access bed sites, PAB sites for short, to receive this accreditation, and I'm happy to report at this time some 93% of VAC's priority access beds are in accredited facilities. VAC will assist in cases where resources are a barrier to full accreditation.

    You may already be familiar with the Canadian Council on Health Services Accreditation. It is a national, independent, non-profit organization that assists health services organizations across Canada by objectively reviewing the care and quality of service provided to each organization's clients and comparing the findings against a set of national standards. More than 1,800 organizations currently participate in this process, which involves both internal self-assessment and peer review consultations.

    In January of this year VAC signed a contract with CCHSA that will see the organization incorporate VAC's care outcome standards into the accreditation process and provide training to long-term care surveyors and facility staff on these changes. This partnership is an extremely important one, and it allows for participation from the Royal Canadian Legion and other stakeholder groups in the accreditation process.

º  (1610)  

    Since 1998 VAC has been surveying residents and family members on an annual basis, monitoring care quality against 10 care outcome standards, including, among others, safety, security, food, and personal care. Survey results for the year 2000 show a 92% satisfaction rate nationally. In addition, VAC health professionals conduct a comprehensive facility review of our larger PAB sites each year. As a further assurance of quality care, the department has appointed a director of quality care for PAB sites in Ontario. We are monitoring how this pilot project is working.

    At this time I would like to highlight another pilot project that is sure to make a difference in the lives of our veterans. Through our dementia care initiative, VAC has been helping long-term care facilities review their care of dementia patients and is providing funding for training required to ensure the facilities are able to meet the current standards of care in this specialized field. In addition, VAC seeks to encourage and enable PAB facilities to function as centres of excellence for those living in the local community and suffering from dementia.

    Also on the topic of dementia care, in April of last year the Dorothy Macham Home opened at Sunnybrook. VAC's contributions to this project provided for the care of cognitively impaired veterans. The innovative 10-bed unit provides leading-edge patient-focused care for those dementia patients who present unique needs that are best met in a specialized facility with enhanced programming.

    Dementia and other veteran care issues have been discussed at two national conferences sponsored by VAC. Designed as a forum to share best practices in long-term care, these conferences brought together a network of professionals from VAC's contract facilities, enabling smaller long-term care institutions to get insight and knowledge from the larger contract facilities, as well as Ste Anne's Hospital, whose staff have considerable expertise in the specialized clinical care of the elderly. These conferences, the third of which is scheduled for November of this year, demonstrate VAC's commitment to sharing expertise in the care of veterans, particularly in the care of dementia and respite and palliative care. Through these conferences, a network of expertise and professional contacts, both real and virtual, is being developed.

    The department also benefits from the solid advice provided by our gerontological advisory council, in particular the committee of the council that focuses on long-term care. This committee has had a large impact on the development of our residential care strategy and future directions in this regard.

    While still on the topic of long-term care, I would be remiss if I did not thank your committee for taking the time to visit the Perley-Rideau Veterans Health Centre last month. There has been considerable media coverage recently on the funding levels for that particular facility. Currently, the funding for the 250 veterans beds at Perley-Rideau is $162 per day per bed. That figure will be maintained this year, and I am confident that there are sufficient staff providing care for veterans there. In fact, on January 14 this year VAC approved a request from that institution for funding to maintain nursing and personal care funding at the 2001 levels. The most recent survey of residents was conducted in February of this year with 214 veterans or family members. In response to the question, “Overall, are you satisfied with the services provided here?”, the positive response rate was 88%. In addition, I am pleased to report that a VAC nurse has been assigned to the Perley-Rideau Veterans Health Centre to specifically monitor quality of care and address any issues at the facility relating to veterans care.

º  (1615)  

    VAC recognizes the role families play in caring for our veterans, both young and old, and the toll that caregiving can take. In light of that recognition, we place importance on determining the needs not only of the veterans, but also of those who care for them. The department's client-centred service approach provides personalized service that ensures clients are treated as individuals, as members of their family and their community. This approach takes into consideration the family unit, in addition to the individual veteran, when assessing needs. In other words, the assessment and needs of the caregiver are included as part of the overall identification of the needs of the veteran.

    Client needs are assessed in a holistic manner, so that the right service is provided at the right time by the right person. Rather than trying to match clients' needs to the programs and services we have available, there is a greater emphasis in determining all of the client's needs, and then using all our programs and services, as well as those of other agencies, to meet those needs.

    This consideration of the family unit is also quite evident in VAC's efforts to meet the needs of our younger clients, the Canadian Forces veterans. As you know, the Canadian Forces represent a growing client group for Veterans Affairs Canada. Many Canadian Forces members return from deployment with post-traumatic stress disorder and other operational stress injuries, injuries that take a toll not only on the member, but on his family unit as well.

    The department has done a great deal of work in identifying and meeting the broader needs of Canadian Forces members and veterans. My focus today is primarily on long-term care, but I will be happy to come back another day to talk about the wide variety of Canadian Forces-related initiatives under way at VAC. In fact, I have with me a compendium of corporate Canadian Forces initiatives for your information, should you wish to have a copy.

    Allow me very briefly to mention, before I conclude my presentation, that VAC provided briefings to all CF personnel going to Afghanistan before they left to fight the war on terrorism to ensure that they're aware of the benefits and services for which they may be eligible as a result of their service. In fact, we made sure that our “In Service to the Canadian Forces” brochures were available to the personnel aboard each ship and aircraft.

    One of the issues I would like to seek your views on in the near future is how we can strike a balance between our ability to provide quality care to our war era clients and our ability to meet the rehabilitation and transition needs of our younger Canadian Forces veterans. Indeed, your input will continue to be valuable as we address these and other important issues.

    In closing, Madam Chair, let me draw to your attention the palpable commitment and hard work I experienced first hand as I interacted with staff during my visit last week in Charlottetown. We can take pride. They're making a real difference in the lives of our veterans, and this type of dedication is one that is shared by my staff here in Ottawa, as well as across the country.

    I would like to thank you for giving me the opportunity to appear before your committee so soon after my appointment, and I look forward to your support and guidance as we move forward in addressing the ever-increasing needs, particularly the long-term care needs, of our most distinguished citizens, our veterans.

    Merci beaucoup.

º  (1620)  

    The Chair: Thank you.

    Mr. Bailey.

    Mr. Roy Bailey (Souris--Moose Mountain, Canadian Alliance): Thank you, Madam Chair.

    Thank you, Mr. Minister, for your report and for including in that report a commitment to come back to this committee, because I'm quite sure that with the late start we had today, we're not going to get around to all the questions my colleagues on both side of the table would have for you.

    I'm pleased to see you deal at length with long-term care for veterans. I will maybe get back to that a little later, but today the Ontario Court of Appeal ruled that the government has responsibility to invest or pay interest on the money it managed on behalf of the disabled veterans and that it has breached that responsibility. Mr. Minister, we had two years ago still three outstanding items, you might say. We had the merchant marines, and we still have an issue with native veterans, but this issue, to me, is as big an issue as either one of the others, despite the fact that if you go back to 1970, the staff at Veterans Affairs warned the government that it could be held liable on the holding of this, as did the Auditor General in 1985 and 1986, and so it goes on. It's been a long time. Justice Brockenshire of the Ontario Supreme Court ruled on October 11, 2000, that the government was liable, and today the Ontario Court of Appeal upheld that judgment. My calculations tell me that every week that goes by, the interest incurred with the debt owing is something like $2 million.

    So, Mr. Minister, although there hasn't been a decision by the government as to whether they will appeal or not, would you agree that the government has a legal and a moral responsibility to resolve this matter now, rather than have it go on building up a debt of some $2 million each week?

    Mr. Rey Pagtakhan: I thank you for your question. It is a very complex issue, and a number of legal issues have been raised. The court, as you rightly pointed out, has made its ruling. The department lawyers and the justice department are now reviewing the ruling and will be making known their advice to us in due time. Let me just add that since 1990 we have been paying interest on the trust accounts, so the issue really relates to the retroactive interest. That's precisely the point that is being reviewed by the lawyers, and since it is under review, I would not like to prejudge the decision that may emanate from that review.

    Mr. Roy Bailey: Thank you, I agree. My understanding is that it's under review and that decision as to whether the government has to take it to the Supreme Court is pending. So I shall not question it further, except to say that being a little bit older than others, I happen to know some of these people who would benefit by this. It's a personal thing with me. I've looked at it for the last 25 years or more, and I think there is a debt owing. I had to express that.

    How much time do I have left?

º  (1625)  

    The Chair: You have plenty of time. You're only halfway through.

    Mr. Roy Bailey: I want to get to the Veterans Review and Appeal Board. This is probably the one area that causes members of Parliament the most concern. When a veteran wishes to appeal a decision that has been made, most often you have a nice 8 1/2 x 11 sheet of paper with one sentence: “Your appeal has been denied.” That's it, period. I don't think that's sufficient. From my dealings with veterans who come to my office--and I'm sure my colleagues around this table would agree with me--surely, they are deserving of more than that one basic sentence. Do you not think there is something seriously wrong with the Veterans Review and Appeal Board? We just don't get the answers, and the veterans who are going through the process of appealing are not satisfied with the response from the department.

    Mr. Rey Pagtakhan: To put it into context, the Veterans Review and Appeal Board, of course, is an independent quasi-judicial tribunal. Therefore, it would be inappropriate for the minister to comment on the rulings made by that tribunal at any time. That is an ethical principle of law that we should adopt. With respect to your question about appeals being denied in a simple sentence, whether that is appropriate or not. I'm a little worried that if I comment on that type of approach now, it might be construed as trying to impugn the credibility of the tribunal. So at this point, I hope you will understand, I will not make any comment, for fear that it might be construed as trying to pass judgment on the credibility of the tribunal, which is one of the assets of Canada. We have an independent quasi-judicial tribunal to which veterans appeal, and the veterans are accompanied by their pension advocates. Therefore, we have a very nice kind of process.

    Mr. Roy Bailey: I'll leave it there. Thank you, Mr. Minister. I'll maybe get a round with the second questions, with my other colleagues coming in.

    The Chair: Thank you.

    Monsieur Plamondon.

[Translation]

    M. Louis Plamondon (Bas-Richelieu--Nicolet--Bécancour, BQ): That is fine. I will come back later on. Thank you.

    The Chair: Mr. Godin.

    Mr. Yvon Godin (Acadie--Bathurst, NDP): Thank you, Madam Chair.

    First of all, I would like to thank the Minister for being here with us today. Perhaps you could give me some clarifications on a couple of issues.

    In my riding, there are many veterans. I would like to know what your intentions are for the future, what course of action you intend to follow. Veterans are getting older and they need health care or even hospital care. They make requests to be allowed to stay in their community. In the Acadian peninsula or in the Bathurst area, they are absolutely not interested in going to live in Moncton, for example. That is completely outside of their community. Visits from their parents would be rare and so on. So they are making requests in order to be able to--

    Recently, there was even a petition in my region to ask for some beds in Caraquet, for example. Whether the bed is in Moncton or in Caraquet, I do not think that it would make any difference in terms of the cost. Why not accomodate people in their own community in order to give our veterans who have served our country the chance and the opportunity to spend their old days with their family and in their own region? I would like to have an answer on that issue.

[English]

    Mr. Rey Pagtakhan: This is a very vital question indeed, because it highlights the importance of the department's residential care strategy. As I noted in my presentation, we have the long-term care beds, we have priority access beds, but from time to time in a given local community there may not be the bed that is essentially needed by the particular veteran. So what the department has done now is this. Eligible veterans, when they need the services, should be able to get them very promptly. So when a bed is not accessible, because of availability or distance, we would provide the family with assistance, so that should they wish, and if the care can be given at home, they will have that necessary assistance. In fact, I'm glad you asked the question. Our response from the families is precisely what you have inferred more or less. Families would like the veteran to stay with them in their homes, provided the services are there from Veterans Affairs Canada to assist them. So that is part of our residential care strategy.

º  (1630)  

[Translation]

    Mr. Yvon Godin: Okay, but that is fine for residential care. There comes a time when you need hospitals. I refer to the time when a veteran is too sick to stay home and must be hospitalized. It seems to me that having to drive 280 kilometers from home is somewhat of a long journey, especially when the person could be located only one kilometer or even half a kilometer from home. There are hospitals in the regions.

    I appreciate what you are saying, Mr. Minister, when you talk about giving care directly at home. I believe that is now being done with everybody. They are trying to give more care at home than in the hospital, but I am talking about people who must be hospitalized.

[English]

    Mr. Rey Pagtakhan: Hospital care, of course, is required by the nature of the health condition. Let us assume for a moment that a given farther place has more beds not fully occupied, and we have another hospital nearer to this particular veteran where we have identified a greater need. Then the flexibility on the part of the department is there to transfer some of these access beds to that local hospital, nearer to where the demand is. The essence is, as you said, that we should be able to have the flexibility, so that when acute care is needed in a hospital, it is provided in a hospital with speed, and when a case can be handled at home, as agreed to, it is handled at home.

[Translation]

    Mr. Yvon Godin: Madam Chair, veterans have another complaint. I don't know whether the issue has been settled, but there were veterans in some regions who were seeing a doctor in a neighbouring village, perhaps 20 minutes away from their home. However, since there was a doctor 5 or 10 minutes away in the other direction, their mileage reimbursement rate has been reduced if they drive to go see the doctor of their choice. In some cases, they had been seeing that very same doctor for the past 30 years. They are now being told that they can't see that physician that they have been seeing for the past 25 or 30 years, that they must go where they are told to go. Otherwise, their mileage reimbursement rate is reduced.

    I do not know whether you have an answer to that question or whether you agree with me that some changes have been made, but I can tell you that it hurt veterans. It is like withdrawing a service from someone who is used to receiving that service. That is something that gave rise to a lot of complaints among veterans in my area. They said that it did not make sense, that it was unfair to deprive them of their doctor.

[English]

    Mr. Rey Pagtakhan: You have raised a very interesting point in respect of health care, that the patient must have confidence in the physician. I have not been confronted with this particular issue, and I would ask the ADM of veterans services whether we have the flexibility to allow it. There is indeed the principle that if you have no confidence in your physician, it will be very difficult to relate as a patient to the doctor.

    Mr. Brian Ferguson (Assistant Deputy Minister, Veterans Services, Department of Veterans Affairs): Generally, the position and the policy of the department is to seek medical services as close as possible to the veteran, so we pay for the veteran to go to the nearest facility to them. There can sometimes be exceptions to that, if the doctor is not available or if there's some specialized care assessment required that may not be possible for the local GP. But the general rule is that we do pay the veteran to go to the closest available facility.

º  (1635)  

    Mr. Yvon Godin: I could come back later on, but when you have done it for the last 25 years and you just changed it two years ago, it hurts very much. He's used to a doctor for 25 years, and you now say, you no longer have your doctor, because we changed our policy.

    Mr. Rey Pagtakhan: Of course, if the distance between the doctor and the patient has increased--

    Mr. Yvon Godin: No, I mean when it stays the same.

    Mr. Rey Pagtakhan: Sometimes too--and I'm speaking here as a physician--if the travel could be too much for the patient, a doctor in a given facility would also advise and say, okay, I will take care of you and establish a rapport. It is not infrequent that they're able to relate to the particular new physician. But if you have a particular case to offer, I would be glad to receive that in the office and look at it more carefully, because there are certain principles here, patient confidence in the doctor and caring for the veteran. As Mr. Ferguson has said, the idea is to ensure that people find quality care, and if the issue is confidence, flexibility is there, exceptions are made.

    The Chair: Thank you.

    Mr. Wood.

    Mr. Bob Wood (Nipissing, Lib.): Thank you, Madam Chair.

    Mr. Minister, you mentioned early in your presentation today that you had met with the Royal Canadian Legion and the Army, Navy and Air Force Veterans to address issues of concern, but what you didn't mention is how these talks are going and if Veterans Affairs Canada was able to satisfactorily address some of the concerns on the care of veterans. Maybe you could update us on how that's going.

    Mr. Rey Pagtakhan: As you may know--it is public record--there was a period of discomfort between the veterans organizations and the department, and I think they have legitimate concerns. My task was to proceed with the meeting of January 13, two weeks after my appointment. I called each one of them and asked their permission to proceed with the meeting as already scheduled. I was glad that they were very understanding. A couple of them said, we will understand if you would like to postpone the meeting, but I did say that with their permission, I would like to proceed. Of course, they all agreed.

    We discussed long-term care, the compensation issue with prisoners of war, and the extension of the VIP program. I must say, the discussions are actively ongoing now, and I am confident progress has been made. But no final decision has been made between the organizations and the department. So in respect to them, with your permission, I will decline to specify the level of progress, but I can assure you that progress has been made. In due time I will report to the committee, even by way of writing, if not in an appearance. I wish they were here, so I could ask them whether I can tell you.

º  (1640)  

    Mr. Bob Wood: Yes, so do I.

    You referred to the 10-bed unit at Sunnybrook that provides special care for dementia patients. With the steadily growing number of cases of Alzheimer's and other dementias, are there any plans for expansion of the program, either at Sunnybrook or at any other VAC-sponsored facility?

    Mr. Rey Pagtakhan: If the need continues to be there, we have to provide the necessary expansion. But at the same time, I was just told this morning by Madam Sharon Carstairs, the government leader in the Senate, that they just had a very successful conference on palliative care, which is part of this issue, in Winnipeg, and a report would be forthcoming from that. My plan is to speak with her and see how palliative care, Alzheimer's, and the other issues could perhaps be put together. But in principle, I suppose, where facilities are needed, we have to respond as a government.

    I would like the others to comment.

    Mr. Larry Murray (Deputy Minister, Department of Veterans Affairs): I'll start, Minister.

    We do have a number of initiatives under way. In the minister's address he indicated that we have launched, we think, quite a successful initiative on dementia care, and we're actually trying it out in both the larger and the smaller facilities, two in Cape Breton and two of the larger facilities across the country. There are a number of other facilities across the country, besides Sunnybrook, where we have made capital investments to enhance their dementia care facilities. We would be pleased to provide that information to the committee.

    I don't know, Brian, whether there's additional information.

    Mr. Brian Ferguson: Nothing in addition to the details you have provided. We would be pleased to make them available to the committee. Certainly, the dementia care issue is front and centre in the department. As the minister outlined, where necessary, we will take steps to add additional capacity.

    Mr. Bob Wood: Fine.

    Minister, the armed forces are going through a thing right now with post-traumatic stress disorder. Veterans Affairs is quite concerned about that, I would imagine. With Canada now in the process of playing an increasing role in world peace spots, the number of cases of the disorder is likely to increase. You seem to indicate that this is a short-term care situation. So there are really two parts to my question. What's being done to actually deal with cases of post-traumatic stress disorder, and, second, is this not likely to become a long-term care situation in some cases?

    Mr. Rey Pagtakhan: It is too early to predict whether it would require long-term care. We will continue to learn about the nature of the injury. Once that care is needed in the long term, it will, of course, be provided.

    As for what has been done, I think we have four or five centres around the country.

    Mr. Larry Murray: That correct, Minister, five centres.

    Mr. Rey Pagtakhan: I may tell the committee that this issue has seized my particular interest, and I'm wondering if we could expand the centres of excellence. We are currently engaged on this very issue in the department, how we can even further ensure that the type of the service needed will be provided across the country, that we will continue to learn about the disorder, and that we will be able to take more proactive steps. At the present we have provided counselling services, because we believe this disorder affects not only the individual, but also the family, and even the community and the co-employees, if they have to go to work, when the disorder is of a minor nature.

    So it is very early to say, Mr. Wood, whether it will be long-term at this time, but that's precisely one of the questions. That is why I would like to put in place a structure that will enable us to continue to learn about the disorder itself, so that we can respond more appropriately in the future.

    The Chair: Mr. Murray.

    Mr. Larry Murray: The minister made it very clear in his meeting with us last week that this is the top priority, the handling of these cases. People have been frustrated at the speed with which we've dealt with them, and because of the level of knowledge and the amount of expertise in this area, debate among medical authorities of one sort or another, we changed our approach to the protocol. We put together a small team who are experts in this, starting in February 2000. Since then we've had 88% positive responses to PTSD claims, very quickly and very effectively. As the minister indicated, we are working very closely with DND to provide support. The minister has directed that we press on with the clinic we've set up in Ste Anne's hospital.

    It's to some extent about information as well, and in addition to the brochure on the Canadian Forces initiative, which would give you some insight on this, we've also provided a brochure on PTSD that we're distributing right across the country to Legions, to individuals, to Forces' bases; it lays out in layman's terms what PTSD isall about, what the treatments are, and so on.

º  (1645)  

    The Chair: Thank you.

    Mrs. Wayne.

    Mrs. Elsie Wayne (Saint John, PC/DR): Thank you very much, Madam Chair.

    First, I want to welcome the new minister here today.

    Also, as you're all aware, Ossie MacLean has passed away, the merchant navy man. I had the privilege and honour of speaking at his funeral. His wife asked me, Larry, to pass on her best wishes to you and to all our people in the Department of Veterans Affairs. Bob Wood got a bottle of rum from Ossie, none of the rest of us did. I have to say it was a very special day. She wanted me also, as did he before he passed away, to be sure to recognize George Baker, as well as Senator Duhamel, who was minister at the time. So I thank all of you for the work you did on behalf of the merchant navy men.

    I understand, Mr. Minister, that before I came through that door, one of my colleagues asked a question with regard to what has taken place with the Ontario Court of Appeal decision that was delivered today. That was why I was late, I was doing an interview on that. I know you have to await the advice of the government lawyers about whether to appeal it again, but I'm wondering how you yourself feel, whether or not you believe that the government should appeal this once again.

    Mr. Rey Pagtakhan: Because the process of review has started, I think it would be most appropriate for me to wait for the results of that review. I think it would be very inappropriate for me to now comment on that. It's a very complex legal issue. I would like to add that there is indeed urgency on the issue, but I would not like to comment on the direction that may or may not be taken by the government as a result of this review, in respect to the process of review.

    Mrs. Elsie Wayne: I just have to say that I think each and every one of us has to look at the sacrifices made by all those veterans in World War I and World War II, and their families as well. If the bank had their money and didn't pay any interest, they'd be in big trouble and the government would be taking them to task, so I think they have to take a look in the mirror on this one.

    It was brought to our attention that in the 1960s, Mr. Minister, all our veterans hospitals, with the exception of one, the one in Montreal, Ste Anne's, were turned over to the provinces, and the provinces were to look after them. We've been told by the Legion that the Ste Anne's Hospital is at a very high standard and they highly approve of it. They don't want it lowered, but they want all the other veterans hospitals brought up to the same standard as that. We are looking at this and we've been discussing this.

    Could you tell me, Mr. Minister, and inform our committee here, have you had an opportunity.... I know you haven't been there too long, but I know Larry has been around for a long time and Keith and Brian, so they certainly can tell us. How do you see this? Because I'll tell you, when I was told in my hospital back home they were going to fly the bacon and eggs in for those men in the morning from Toronto and we had to lay off our chef, I said I was stepping down as MP and going out there to cook the bacon and eggs. So we kept our chef, I don't know about the rest of them. I'd like to know how you feel about this.

    Mr. Rey Pagtakhan: I think it's very important that we ensure a national standard of care across the country. That is why, in my meeting with the two major organizations, the Royal Canadian Legion and ANAVETS, we provided them with the list of the 10 criteria of care and quality, which can be summed up as relating to their physical, emotional, spiritual, and recreational needs. This has been approved in principle by them. Part of the process, of course, is to ensure that we have accreditation across the country based on these outcome criteria upon which we now have agreement. I'm glad to say, as I indicated in my presentation, that 93% of our facilities are accredited. So it would be relatively easy for them to respond to these outcome criteria.

    Because accreditation happens during cycles of time, we have to put in place a mechanism for ongoing monitoring. One example, of course, is at the Perley-Rideau Centre. There is a VAC nurse monitoring the concerns and issues that may be there from the veteran clients. These are the things that we are having an ongoing look at. I think you can expect to see a much better approach to national standardization of care.

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    Mrs. Elsie Wayne: As you know, I'm sure, we had quite a large DVA hospital in Saint John. It was beautiful, but it was torn down, and then a small one was built. Then we had to expand on it. I believe the new beds in the expansion are now open. But the last word I got was that we still have another 100 veterans in need of hospital beds in my area. I'm not sure, but that was given to me in the past two months. We've taken them and put them in the hospitals. They've taken a wing of the St. Joseph's Hospital and put them in there, and a wing of the Atlantic Health Sciences Corporation Hospital and put them in there, because we don't have enough room in our veterans hospitals.

    I had a veteran, Minister, whose family called me. They were told that in order for their father to get into that veterans hospital when there was a vacant bed, they had to first go through going into a bed in St. Joseph's Hospital, and then they would be listed for being moved out of that into the veterans hospital. They said, we don't want to do that with dad, because when he goes to St. Joseph's Hospital, let's face it, he's there by himself. This man had a lot of problems he couldn't deal with.

    It's a very serious situation and one we have to deal with. We have to make sure those men and women who put their lives on the line so you and I can sit here today are looked after now. They tell me we have a lot of them, and I know that, because I've gone to St. Joseph's Hospital. They're all in wheelchairs or in beds, but they're waiting for beds in our new wing, and there aren't enough there for them.

    Mr. Rey Pagtakhan: We have about 10,000 priority access beds in the country, and we have the flexibility to move available beds from one area to another where there is an identified need. But if you encounter individual cases, I would certainly appreciate hearing from you, because then each case will form part of a consensus of assessment upon which we can then take other measures, should they be deemed necessary. I will attend to that, it will be one of my objectives.

    The Chair: Mr. McTeague.

    Mr. Dan McTeague (Pickering--Ajax--Uxbridge, Lib.): Thank you, Madam Chair.

    Minister, welcome, and I offer you congratulations on your elevation to this portfolio. It's certainly not one that loses interest, and from time to time issues keep coming back. We hope you'll be able to put a fresh stamp on this portfolio, particularly given that some of these issues that have been raised by my other colleagues here on the committee have been raised time and time again.

    I have essentially two questions. One follows up on the question of the national standard you alluded to. ANAVETS and the Royal Canadian Legion were here on January 31 and had a number of concerns with the question of accreditation and the national standard based on outcomes, something I was directly involved in with Minister Baker some three or four years ago now. I guess there's an over-arching feeling that the department should retain responsibility for care and ensure that there's a guarantee of a common standard. Given these negotiations, are you prepared to make that commitment, notwithstanding the provincial involvement? The outcomes themselves are something where some of us think there ought to be an underlying guarantee from the federal government. Are we continuing in the belief that we should be prepared to support and to ensure that standard exists right across the country, outside of Ste Anne's?

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    Mr. Rey Pagtakhan: Yes, indeed, I am committed to that, and if there is any--and I hope not--hesitancy on the part of provincial facilities, I will apply my persuasion to them. The outcome standards are very reasonable, ones I am confident all health care facilities would agree to. If there is the possibility that some facilities may not be able to comply with these standards, and if there are some barriers we are able to identify, I will also challenge myself and the department to see how we can remove those barriers, so that all facilities for our veterans do meet the 10 outcome standards.

    I should also tell you that as part of the dialogue they have started, the organizations have agreed to re-engage themselves with the two advisory councils, the gerontological and the Canadian Forces councils. So I think we're all working together in partnership again, and I am sure we can achieve far better.

    Mr. Dan McTeague: Minister, my second question deals with perhaps spending a bit more money to save a bit of money. It centres on the question of the veterans independence program. It has been brought to my attention by a number of Legions in my riding and throughout the Toronto region that a number of veterans have complained bitterly and have not been successful in getting across, either to the Legion or the VAC, their concern about the limitations of the income qualification clause. I'm wondering if, given the alternative of having to institutionalize people or to put certain veterans in a position where they are treated unequally, consideration could be given to removing the entire qualification clause.

    Obviously, there are fewer and fewer veterans for whom there is an expenditure, but to my understanding, it's more of a philosophical question. When veterans were enlisted, they certainly were enlisted with the notion that they somehow would have some kind of means test applied with the income qualification clause. I'm wondering if you would give any thought to the idea of removing it entirely for those of us who are concerned about giving rich veterans an opportunity to receive something that wouldn't be available to others. There's always a means by which we can claw that back for taxable benefits, but it strikes me as passing strange and, to a great extent, unfair that we would use this only for people who make up to $1,438 a month. I realize there may be some tinkering around with that number to make it more relevant to inflation, but perhaps you could consider removing it in its entirety, for the sake of fairness and the sake of the commitment the veterans made in the first place.

    Mr. Rey Pagtakhan: I have always believed in principle in quality assurance, and quality assurance means we are prepared to review any existing program. I will admit that I have not discussed this with my department, but you have raised it now, and we will look at it.

    The Chair: Thank you.

    Mr. Bailey.

    Mr. Roy Bailey: Mr. Minister, I want to make one comment before I get to the real question. I want to briefly go back to the Veterans Review and Appeal Board. The Royal Canadian Legion was forced to set aside $30,000 of its own money for a court challenge against the review board, and it was, again, on the refusal to issue interpretations for the decisions the board makes. The veterans come and very pointedly say, who is responsible for the Veterans Review and Appeal Board? You've answered that it's a separate body, but they will say, are they an island unto themselves? Don't they have a mandate to issue interpretations for decisions? I'd like you, sir, to think about that, because I really believe--and it's not in the form of a question--it's a big enough issue for you and your department to look at.

    This is an up-to-date question. Our soldiers presently serving in Afghanistan may well be asking the same question that was asked by the Gulf War veterans, and that is this: If I am injured and require a long-term care bed, will I have access to a veterans bed in a veterans facility? I think the answer is, no. My understanding is that only veterans from World War I, World War II, and the Korean conflict have access to long-term beds paid for by the Department of Veterans Affairs. If this is true, we have created a double standard. Why wouldn't we give the same treatment to these soldiers who are putting their lives on the line, certainly over in Afghanistan today, as to World War I and World War II veterans?

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    Mr. Rey Pagtakhan: On the Veterans Review and Appeal Board, I will look into it. Just to comment, though, that while the regular courts of law regularly give reasons for their decisions, there are also occasions when they do not. But you have raised the question, and I will look into it from the administrative point of view.

    As to the question of those needing long-term care in the Canadian Forces and whether we have a differential policy, I would ask the deputy minister to enlighten us on this.

    Mr. Larry Murray: You are correct that if you are not a World War I, World War II, or Korean veteran, you do not have access to a long-term care bed. Long-term care beds are specifically designed for aged veterans, and the average age of our Canadian Forces veterans at the moment is 55. We have, in the context of recent efforts to deal more holistically and more effectively with Canadian Forces veterans, undertaken a number of initiatives, which include providing them with access to the veterans independence program, seeing whether they were injured in a special duty area or outside a special duty area, and that actually gives them access to community beds if they are out of the forces and need treatment for medical conditions resulting from their service to Canada.

    I think the broader issue is how and whether we're dealing with those veterans who have a different set of needs and expectations from those of the veterans who are 80 years old. There is a whole range of initiatives, as the minister indicated, and it would really be worthwhile to come back and give you that whole range.

    At some point this issue of long-term care beds for Canadian Forces veterans will need to be addressed, but as I say, at the moment, because of the age of those veterans and the nature of the care provided in a long-term care bed, namely, gerontological care, I don't think it's at the heart of the more critical medical issues confronting those veterans now. That doesn't mean it's an issue that doesn't need to be looked into at some stage of the game.

    Mr. Roy Bailey: Thank you very much.

    The Chair: Mrs. Wayne.

    Mrs. Elsie Wayne: I had the honour and the privilege of going to Vimy to bring back the remains of the unknown soldier some time ago. Larry and others were there as well. I would just like to know if you could give us an update on the state of the repairs of the Vimy memorial. I understand they're finding a problem getting the stones, but where are we, and do you have any idea how long it will take to restore the Vimy memorial in Vimy, France?

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    Mr. Rey Pagtakhan: The department has a series of phases. I met with the staff in charge of searching for the stones. I would like, again, the deputy to give us a full update on this, if he would.

    Mr. Larry Murray: The project has been created, the full funding has been approved by the government, and we're now moving forward towards an implementation plan that would take five years and coincide with the anniversary of the battle itself. We have found the stone. It's in Croatia, on the Dalmatian coast near Split. There are some technical problems with the company that owns the quarry and just went bankrupt. In any case, we're working our way through that, and we're confident that we will be able to do that. We're doing a number of pilots to make sure we get it right, because part of the problem previously was that with the best of intentions, the type of mortar being used and so on actually created, to some extent, more difficulties.

    I'd say it's well in hand, and the committee might well be interested in a 45-minute presentation we provided in Charlottetown to the Senate subcommittee on veterans affairs last Thursday. We'd be delighted at any time to have the team come in and give you this presentation, which would give you a much more eloquent and complete answer to your question.

    Mrs. Elsie Wayne: Yes, I hope we could have that presentation some time in the near future, because that would update us, as Larry has stated.

    I just have one other question. Mr. Minister, you indicated that the feedback your department received from clients and family surveys was extremely positive, and we're pleased to hear this. Could you and your department be a little more specific as to the regional or provincial breakdown for these surveys, showing which hospitals and so on? I'd like to know about New Brunswick, how it came out there.

    Mr. Rey Pagtakhan: We have figures for the provincial breakdown, I think across the country.

    Mr. Larry Murray: I think so, Minister. We could share the whole thing.

    Mrs. Elsie Wayne: That would be good for all of us.

    Mr. Larry Murray: We might have to look at names, but I think we could provide, within the privacy laws, the whole thing. We have a number of surveys.

    Mrs. Elsie Wayne: Thank you very much, Madam Chair.

    The Chair: Thank you.

    Mr. Wood.

    Mr. Bob Wood: Thank you, Madam Chair.

    Mr. Minister, you talked about the Canadian Council on Health Services Accreditation. You're saying you're about to do a survey on the health care facilities. Why would you do that? Isn't there information already available now? You must have ongoing surveys done. Isn't there information available now that you could look at? And if the survey is really necessary--maybe it is, I don't know--how long is it going to take?

    Mr. Rey Pagtakhan: Did I say a survey?

    Mr. Bob Wood: Yes, you did--accreditation, its effect on the department. I think you did, didn't you?

    Mr. Rey Pagtakhan: No, we would like them to have continuing monitoring as part of the ongoing accreditation process. I said the cycle of accreditation is every three years or so, depending on the particular facility.

    Mr. Bob Wood: You signed a contract with these people in January.

    Mr. Rey Pagtakhan: Yes. I do not know the specific time cycle, but the way accreditation works, as you may know, is that you make policy, say, every three years, and then you do that survey. That is really a part of the process to ensure that there has not been any lapse in the level of standard and to assure quality. But part of the submission of the Royal Canadian Legion is that in fact, there has been a lapse. That is why I thought there had to be also a mechanism for monitoring from time to time in-between accreditation visits. There is no need for a formal survey every now and then. We know the standards, and they have agreed to look to these standards.

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    Mr. Bob Wood: Good.

    Something that always bugs me about Veterans Affairs Canada is the fact that with the independent review tribunal, so I'm led to believe, there is a great backlog of cases that haven't been dealt with in maybe one or two years. I know there's a guy, but I forget what his name is--Chambers, or something like that--who's the chair of this. Hopefully, that's not right. There can't be that large a backlog of veterans who want an upgrade or whatever in hearings, so they can have maybe a few extra bucks. I know it's very hard to get to the bottom of it or find out where that hearing deterioration came from, but is there a tremendous backlog of these particular cases, where veterans are left to hang in there for a number of years? Maybe it goes right back to what my friend Mr. Bailey said when he was here, that they just say it's been refused, with no explanation. Is that happening?

    Mr. Rey Pagtakhan: The load before the board, as I understand it, has been significantly reduced, the backlog and the waiting time for the hearing of cases. Is that what you are referring to?

    Mr. Bob Wood: Yes.

    Mr. Rey Pagtakhan: That has decreased. I suppose it depends on the complexity. I believe that undue delay is justice denied, so we cannot allow undue delay and will continue to provide the resources.

    Do you have any take as to the average waiting time now?

    Mr. Larry Murray: I think it would really be better to provide the information specifically. From our perspective, we did have some delays when we were incorporating the new computer system. That's back under control, and we think, at a departmental level, we're well back within the turnaround times that were established in pension reform, and we're now at a 70-plus% “yes” rate on first applications. But I wouldn't want to speculate on the whole thing. I think it would be better if we gave you a response that indicates where we're at. It is something we monitor continuously, so it's not hard for us to give you the data.

    Mr. Bob Wood: We were led to believe, from the Legion's point of view anyway, that it was a rather unfortunate way to come up with an answer, whether people are refused, or they're not refused, or they have to go to an appeal board, or whatever.

    Mr. Rey Pagtakhan: The processing of cases before the department is one aspect, of course. Only when that has been disallowed, does it go to the appeal board. At the departmental level, the processing time has become significantly better. I also have the clear understanding that the backlog has been significantly reduced, I just do not have the exact figures at this time. We will provide the committee with those figures, because I think you are raising a very important question. If the delay is significant, a recommendation may be forthcoming from the committee. Do we need more members of the appeal board, or to improve the support staff, or to improve the technology? So I think you have raised a very important question, Mr. Wood. We will provide you with the specific statistics.

    Mr. Larry Murray: Yes, I think that's the best way. I just want to be clear, though, that VRAB, to some extent, uses our computer systems, and there was a lot of heat and light around delays a few months ago, as we were trying to get the system lined up. I don't know where it's at right now, but I wouldn't want to leave the impression that it's all VRAB, if there's a problem. I suspect it's departmental as well, but we'll provide the statistics.

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    Mr. Bob Wood: It was two or three months ago when they were here, so maybe it is cleared up. Let's hope it is.

    The Chair: Is everyone satisfied that the minister has answered all our questions?

    It was very nice of you to be here, especially so early in your mandate. We appreciate the opportunity to have you and your departmental officials here.

    We're going to try to approve a budget for travel to Ste Anne's, and we hope you will approve of our going there, Minister.

    Mr. Rey Pagtakhan: Thank you so much, Madam Chair, and again, it's been a pleasure.

    The Chair: Thank you.

    Meeting adjourned.