:
We'll begin our meeting now. Other members will arrive. I know there has been some delay due to votes.
We have three witnesses here from Veterans Affairs Canada. I also want to tell you that we'll have some time for business at the end of this meeting. I'm concerned because one of the debates about business will be what we'll use for all the contributions for a gift for the clerk. I wonder how long that will take. We'll suspend at 5:15 for committee business, if that pleases the committee.
Right now we'll go to the officials, Darragh Mogan, Brenda MacCormack, and Doug Clorey, from Veterans Affairs Canada.
Do all of you have opening statements, or just one person? Mr. Mogan, you have an opening statement?
I think you know the tradition of the committee. We give you 10 to 15 minutes for an opening statement, and then we'll go by rotation of party for questions.
You may begin.
:
Thank you very much, Chair and committee members, for having us here.
My colleagues, Brenda and Doug, will provide an introductory briefing on the new Veterans Charter, as you begin your examination of this. The briefing will be about the policy foundation of the charter, its content, the outcomes we've had to date, and possibly the future.
[Translation]
It's a privilege for me to introduce Doug Clorey, Director of Mental Health Policy, and Brenda MacCormack, Director of the New Veterans Charter Program.
[English]
Brenda will give a brief oral overview of the deck material that you have been sent. I hope that's been distributed, Mr. Chair. Then Doug will talk briefly about the mental health aspect of it.
So if I can, Mr. Chair, I'll turn this over to Brenda.
:
Thank you, Mr. Chair and committee members. I appreciate the opportunity to be here today to provide a brief overview of the new Veterans Charter. We will also provide some information on the mental health context, as well as put the programs into context.
I would like to walk you through a bit of the pre-NVC context and some of the issues we were facing at the time. I will talk about the solutions we arrived at and give you a synopsis of some of the facts and figures at present, now that we are three years in, and talk about the mental health context.
To demonstrate how this works for veterans on the ground, we'll provide you with a few veteran profiles so you can understand the nature of the clients who come before us, then we'll finish with some of the challenges and the opportunities.
In terms of the context of the 1990s and into the early 2000 period, we were seeing an increasing number of Canadian Forces veteran clients. Of course, you are aware that there was an increased operational tempo within the Canadian Forces. We also recognized at that time that we did not really do a lot for families in terms of the services that we offered.
The chart on page 4 gives you a little bit of an outline in terms of the changing demographic and provides you with some insight into the types of client groups we were dealing with. While we were seeing the increased operational tempo with the modern-day veterans, we also were seeing a decline in our traditional vets and an increased need with that group. It created a bit of pressure in terms of the varying needs of client groups.
To put the challenges in some categories, we were seeing CF veterans who were not transitioning successfully out of the military, and we knew the families needed support. We didn't have a holistic, comprehensive, integrated kind of approach to how we were managing transition out of the military and the ongoing success of transitioning CF veterans and their families.
Our response in terms of the programming we had at the time was our ability to offer a disability pension and associated treatment benefits, but there was no income stream into the future. There was no rehabilitation, so really the only mechanism that veterans had to get greater assistance was to be more ill and get more money through a disability pension. Of course, at that time the processing times for disability pensions were lengthy as well, so that compounded the problem of getting to people early.
At that time we were really feeling that our response was inadequate. The problems were not being solved and our liability was increasing, so our solution was to create the suite of programs that has become known as the new Veterans Charter. The investment that we made was to focus on wellness. As you'll see as I go through the programs, that represents the multi-faceted response that really changed the nature of government's response to dealing with this particular group.
Were I to summarize it in a particular phrase, I would say that the new Veterans Charter is meant to respond to individual client needs, to provide services and interventions based on needs, and to provide transitioning members and veterans and their families who are out of the military with opportunity and security.
Another key point is that the focus has been and continues to be trying to achieve a seamless transition from the military. As we go through the programs I'll speak about each of the programs individually, but the programs are intended to work in an integrated fashion. The strength of the programs is in the sum of all of them working together and being responsive to needs. At the time the programs came into being in 2006, the government made a commitment to invest $1 billion in these new programs over the first five years.
Rehabilitation is really the cornerstone of the new Veterans Charter in terms of offering that wellness kind of focus. It's a very comprehensive program that is supported by case management, and the design criteria of this program allow quite a bit of scope in terms of what we offer to clients. It focuses holistically on the client and the family, offers medical services and psycho-social types of supports, as well as vocational.
So the program is not just about getting people back to work, because sometimes that's not possible. It's about improving their quality of life and their functioning at an individual level, community level, and vocational level, if that indeed is appropriate.
There's an accompanying financial benefit package that is part of a dual awards scheme. The financial benefit piece is really about recognizing that there are economic impacts associated with disability, whether they're service-related or career-ending. There's a package of benefits outlined here that's really intended to provide earnings loss benefits for people in rehabilitation, supplementary retirement benefits, and other supports we can perhaps look at in more detail at another briefing.
The disability award is the other part of the economic compensation intended to provide recognition for the impact of service-related disability on the quality of life of the individual. It is a tax-free cash award that's payable based on the level of disability of the individual.
There's also access to health benefits—the public service health care plan—which is really about filling gaps and providing access to that plan for those who would not otherwise be eligible for it.
There's also a job replacement program, which is really a career transition program for folks who are well and who are transitioning out of the military. The package in its entirety is aimed at all of those who are transitioning out of the military, whether they're ill or injured, or whether they choose to leave on their own or they're at a point where they're retiring. So the job placement program is focused on providing career transition types of services that enable them to find employment when they transition to civilian life.
The backdrop of all of this is really case management, which is paramount in helping the client navigate through the system where required, to make sure that the supports are offered at the appropriate time, and to work with the Canadian Forces to ensure that case managers are working in a collaborative fashion as people transition out of the forces, and to continue to work with them as they make that transition.
We've also outlined that there are a number of family supports available through the charter. I won't go into detail on them, but there is a recognition within the charter that the family is paramount in terms of our recognizing their needs and what supports they might require to enable the veteran to make that successful transition, and to maintain that successful transition to civilian life. I've highlighted a few of them on slides 16 and 17.
To date we've assisted close to 13,000 veterans and members and their families. I've outlined some of the program activity pieces, showing how many decisions we've made in particular program areas as well as the favourability rates.
I'll ask Doug now to provide a bit of information on the mental health context, and then we'll just briefly go through a few client scenarios to give you a feel for the program.
:
Good afternoon, everyone.
Although this presentation is on the new Veterans Charter, we felt it was important that you have an understanding of the mental health context in which the new Veterans Charter is provided. As I understand, Mr. Chair, there will be a separate briefing on the full mental health strategy of the department within the next few weeks. Hopefully we'll get into a lot more detail there.
Slide 20 speaks about mental health generally within the Canadian context. Essentially, one out of five Canadians lives with a mental health condition during their lifetime.
The second bullet is interesting as well, because in the Canadian context of those who have need of mental health services, only one-third actually access them, so two-thirds don't. That seems to have some effect also in terms of the specific population we serve. The economic impacts are listed there as well. It's a significant cost to the Canadian economy.
In terms of the extent of need for mental health services, you would be familiar with this, I believe. The increased CF participation in military operations, the combat style of missions, and the more frequent deployment of members of the military with less time to recover and recuperate between deployments have all contributed to increased mental health conditions within the military.
The last bullet on slide 21 speaks to the results of the 2002 Canadian community health survey, on CF members in particular, which identified the four major categories of mental health condition within the military. In order of prevalence, they are depression, alcohol dependency, social phobia, and PTSD. The interesting thing there is that this is the order in which they occur. PTSD, which is obviously very much in the media these days, is actually fourth in the list of the mental health conditions that are experienced.
In terms of clients within the Department of Veterans Affairs who receive disability benefits as a result of a mental health condition, as of the end of March we had 11,888 who have received a favourable decision for disability benefits associated with a psychiatric condition. That breaks down into roughly 63% CF veterans, of whom 12% continue to serve in the military; 24% war service veterans; and 14% RCMP members, of whom 5% are still serving. It is important to note that our strategy on mental health in the department is not just for the CF veterans; it's also for the older veterans. It scans the whole spectrum of mental health conditions, from those related to service at a younger age to those dealing with dementia, Alzheimer's, and all of those related conditions. We've seen an increase in clients of about 8,000 since March 2003. That represents about 1,500 to 1,600 new clients every year with a psychiatric condition who enter our books.
Of all of these clients, 68% have PTSD. Again, I would recall the previous slide, which showed that two-thirds of all of our clients who come forward do so with PTSD. One of the implications there, and we may wish to speak to it at some point in time, is that PTSD seems to be a condition that members of the military and veterans are more open to coming forward with, as opposed to, say, depression.
The third bullet shows the connection with the new Veterans Charter rehabilitation program. We see that 60% of clients coming into rehabilitation--which is a conservative estimate at this point, and it's probably quite a bit more than that--are coming in with a mental health condition as well. That creates a dynamic and a complexity around rehabilitation that is quite significant.
Slide 23 has the breakdown of the numbers more specifically. Of the 2,591 rehabilitation clients within Veterans Affairs, about 1,600 or so have mental health conditions. So it's a significant percentage of clients with mental health conditions that we are trying to rehabilitate into society.
Slide 24 is a very brief summary of our mental health strategy, which is essentially providing access to or in some cases providing within the department a suite of mental health services and benefits that will assist veterans and their families to regain functioning. It's focused on early intervention. The earlier you are able to intervene with these individuals, the more chances of success of recovering and maintaining and retaining full functionality within one's life.
We're also trying to focus on all aspects of life that support mental health and well-being, which we think is unique within the Veterans Affairs mental health programming. It isn't only about health services through psychiatrists and psychologists and other health professionals, but it's also about providing social support, economic support, physical support in the home, and also dealing with individuals on a one-to-one basis based on the World Health Organization's whole-of-person, whole-of-life perspective. We're also building capacity, exercising leadership in the field of mental health, and doing this in partnership with many others.
I won't go into slide 25 in detail, but it's a sampling of some of the services we provide to assist veterans and their families in regaining their mental health and well-being.
:
We've included two or three veteran profiles to demonstrate how the program works on the ground for veterans and demonstrate the needs-based approach in terms of the intervention that's provided. It's very much based on the individual coming forward and what their needs are. You'll see as we go through the profiles that they certainly have varying levels of needs.
The first profile is Justin, who voluntarily released from the military and just needed some career transition, résumé writing type of help. He was able to secure a job he's very pleased with and certainly has provided some very positive feedback in terms of what that program meant to him in transitioning.
The second client, John, was medically released back in 2001. That's five years before the new Veterans Charter came into effect. This particular veteran was quite sick when he came into the program, exhibiting acute symptoms of PTSD, dealing with alcohol, dealing with criminal charges, and marriage stresses, with his wife also being a CF member.
Slide 30 outlines some of the interventions we were able to provide to John in terms of counselling, engaging his family in the plan, providing peer support, and building a trusting relationship. We're beginning to make some headway with this particular client, but I think this demonstrates some of the complexities we're facing. It also demonstrates how clients can come back to the program as many times as they need to. This client would have had some assistance coming out of the military, but he's still struggling, so he will come back and we'll work with him again. At this point, this is a veteran we're continuing to work with. He's still unable to work. We're continuing to help with improving functioning at a family and community level. The marriage certainly remains stressed. Again, that is part of one of the goals we're working on with him, and we'll see over time whether our vocational goals can be achieved.
The last one is Greg. This would be an example of someone who came out of the military with a fairly serious disability back in 1996, being a bilateral amputee, below the knee amputation, but who transitioned well out of the military. He stayed home for a number of years and was the primary caregiver to two young sons. The sons are now in school, and he feels he wants to contribute more to his family situation. We're able to offer those supports to Greg through the programming with some additional prosthesis to allow him to do the work he wants to do and the training that is consistent with what he would like to do in terms of moving forward. He has been very successful and is on his way to a final work term in the marine industry.
Again, this highlights some of the varying levels of need that are presented.
I have a few questions. With regard to trauma and operational stress. Have you developed, through years of research, ways of further preventing operational stress in the people we send on military missions?
With the new charter, we see that you have developed rehabilitation programs to help veterans with operational stress. What results have you achieved?
We're talking about mental health problems. Are there any other mental health problems found among former military members apart from operational stress? What are those types of diseases? In Quebec, how do you cooperate, for example, with the CLSCs, which provide front-line services?
I know very well that stakeholders have expertise with regard to certain mental illnesses, but others have less. Do you provide training for specialists, caseworkers, psychologists through health facilities in Quebec and Canada to enable those professionals to provide services to these people near where they live?
We talk about people in rural areas who often have to travel very far to access services. What are you doing in that regard? Do you have any projects to improve the quality of services for those persons?
:
I will start. There are many questions here.
In terms of preventing operational stress injuries, your first question, one of the findings in research is that the best way to prevent, if you can prevent, is to build resilience so you have an opportunity to be more prepared for what you are going to deal with. Very often where we find ourselves in Veterans Affairs is very much downstream, where the opportunity to prevent the operational stress injury is not there because it has already occurred. I cannot speak for the Department of National Defence, but I know they are working very hard at trying to build resilience in the members of the military so they are better prepared to deal with what they have to deal with and hence to avoid some of the operational stress injuries that occur, we hope.
The other area of prevention is education. Here we are doing quite a lot in terms of building awareness, as are the Canadian Forces, to reduce stigma, to get across the idea that a mental health injury is an injury, just like a physical injury, and it needs to be approached in a very similar way in terms of approaching various agencies for services, treatment, and whatever benefits are required.
The second question, on success in terms of rehabilitation, Brenda may wish to speak to. The approach we take in Veterans Affairs is that recovery is possible and that recovery should be the norm. So we approach the delivery of services as if there will be a recovery at the end.
Our statistics are really not that sound at this point, in terms of lifetime projections. How successful have we been over the lifetime of an individual? That's really hard to tell. But the approach we use is that the individual will be able to recover, and we work toward that end.
In terms of other mental health problems, yes, what we see in veterans is reflective of the general Canadian population. We will see all kinds of mental health problems, some of which are related to operations and some of which are not. So it's not unusual for us to see that.
In terms of collaborating with local agencies, as in the province of Quebec, we very much try to do that, primarily with our district offices. We also work very closely with our operational stress injury clinics to reach out to these agencies to provide education awareness training. In fact, there are four functions of the operational stress injury clinics that may be of interest. The first is to provide a comprehensive assessment to individuals; the second is to treat, where it's appropriate; the third is to reach out to providers in the local communities, like the ones you've mentioned; and the fourth is to conduct research.
It's very important for us to reach out to service providers in the community, because these operational stress injury clinics provide only a temporary service. Eventually the individuals will return home, return to the local community, and will need to rely on local service providers in the community. So part of the job is to reach out to them so they are able to provide the kinds of services that are required.
Have I addressed most of your questions?
Would you have a figure on how many people have applied and been turned down a first time? Of course on the letter it says you always have an appeal, but they may not appeal, because they're of the generation that understands that if the government says no the first time, they figure there's no hope. Do you have a figure for how many of those people wouldn't have appealed in that process?
Also, the Royal Canadian Legion has written all of us and has indicated concerns on the living charter in terms of the lump sum payment. That possibly could be looked at. Some veterans are asking for a lifelong pension instead. I wonder if you could address that issue.
Also, I have two people in my riding--in Dartmouth, actually--who went through psychiatric treatment. They were both determined to be cleared, but their children were denied further assistance because the parents were no longer receiving psychiatric help. Since the parents were no longer receiving psychiatric help, that help was cut off for their children. We've heard in testimony that PTSD and symptoms of that nature could be transferrable, but unfortunately their children were denied further assistance in that regard.
The other concern I'm getting in fair numbers relates to asbestos on ships. I have about a dozen cases on my desk from across the country of people who were denied asbestosis claims. We know now that there was asbestos on the ships in the 1940s and 1950s.
There is also the matter of hearing loss. As you know, after the court case a few years ago, DVA was forced to go back and contact all those people who had claimed hearing loss and were denied. I wonder if you can tell us how that process is going and whether it is almost finished.
Last but not least are the hospitals. As you know, the hospitals under DVA--which are now provincially run, except for Ste. Anne's--are for World War II and Korean veterans. What are the plans for those hospitals when the vast majority of those individuals have passed on? Do you plan to open them up for more modern-day veterans, or what would be the proposed plan in that regard?
Thank you very much. I have more, but I'll be cut off very soon. Thank you.
:
That's understood? All right.
With regard to the lump sum versus the annuity or the return of the pension, to an extent it depends on who is asking, because some people want the lump sum paid out as an annuity, which is a possibility if it's invested properly, but you've got to be careful when you're investing these days, as we all know.
Whether we would return to paying out pensions, which by their very nature grow if you can demonstrate a greater illness, apart from a policy point of view, that can and does, I think, run counter to the wellness approach. So I'm not optimistic that there is going to be revision back to the old pension days, but I am quite convinced that there is a ministerial commitment that improvements in the charter are going to be considered as soon as possible.
Mr. Chair, Mr. Stoffer asked about the children of veterans who were receiving psychiatric help, and the veterans recovered and the children didn't. We'd have to look at those cases. I think we have the authority to continue to help those children, so maybe I could get names at the break. We'll have a look at that.
With regard to asbestosis on ships, we're aware of that concern and we're looking into it. I can't give a progress update now, but I can submit one if you wish.
With regard to hearing loss, we certainly are trying to revise our policy in line with the Federal Court of Appeal decision. We are looking back to provide disability benefit decisions in line with the court decision. That policy should be released quite soon.
:
If you had asked me that several years ago, I would have probably told you that it's much more prevalent in CF veterans. I'm not so sure that's the case any more. It's interesting to see, as war service veterans reach a certain point in their lives, that they start to reflect back on their lives, as we probably all will do at some point, and it seems that as they do that, they start bringing up some of the traumas that occurred when they were younger and that have been repressed for up to 60-plus years.
In fact, there was a study in Australia on Korean veterans. It was really quite astonishing how many Korean veterans, 60 years after the fact, who had apparently lived very successful lives, what one would call very stable lives, and had families, reached a point in their lives where they started to reflect back, and suddenly all these symptoms started to show up and they became clinically diagnosed with PTSD.
So I'm not sure, to answer your question, but I do think what is happening is that there is greater data now, which shows that PTSD, within the military, can show up at any time, either very early on or 60-plus years later.
:
It may be less a matter of frequency, although if you look at the original Veterans Charter between 1946 and 1953, I think there were three separate periods when that was amended and changed. By the time of the Korean War, there was a statute passed called the Veterans Benefit Act, which added to the World War II Veterans Charter.
To answer your question, though, we try to focus on the wellness and the successful transition to civilian life, with the benefits and services that are there, and allow experience, plus a formal evaluation that we're now undergoing for the new Veterans Charter, to identify gaps. We've already identified some gaps in family support. We're doing this with a large advisory group called the New Veterans Charter Advisory Group, which we just met with today.
On the degree of economic support while someone's on rehabilitation, the question may be, for instance, is it adequate to ask a family of four to survive on 75% of a private's salary for two years while a private is going through rehabilitation? It's better than what was there pre-charter, but it may not be a reasonable thing to ask someone to do. In other words, you may be setting individuals up for failure by not providing an adequate amount of income support while they're going through rehabilitation.
The other area, then, in addition to family services, is the mental health area. We've made extensive progress within existing authority, but I think it's pretty imperative to look at gaps in that area.
As to timing, when we have the information that's there and when the government of the day is satisfied that it's ready to move and has the resources, that's when the movement will be there. We want to build, as I think anybody would want to build, a fairly strong consensus among modern veterans that we've identified where the gaps are. The foundation of the new Veterans Charter is solid, but we've identified where the key gaps are and we can fill them in a timely fashion.
:
Rehabilitation, by its very nature, is about working with an individual and their family, and certainly recognizing that the family needs to be part and parcel of any kind of rehabilitation moving forward.
Case management provides that kind of stabilizing influence, that one point of contact, where the case manager can work with their client, work with external community resources, work with professionals involved in the care of the veteran and the family, and help them navigate through the system, advocate for them in times when that is necessary, help them establish goals, and help them determine what kinds of intervention need to be in place to get them help. That personal relationship with the case manager is paramount.
In terms of working with the family, it's certainly recognized that when we have some of the complex veterans health needs we see before us, families--children and spouses--will be impacted because of the very nature, in particular, of the mental health types of impacts.
To achieve that comprehensive, integrated kind of approach that the rehabilitation program provides, case management is the means by which we do that.
I thank the witnesses for coming.
I have to apologize. I had a previous meeting, so I missed part of your presentation. I do apologize.
I'm quite interested in veterans affairs. I served in the RCMP for 18 years and I retired as a sergeant.
There are a lot of RCMP veterans now who have served overseas. They serve their country. They serve in their homeland. I've seen a lot of members suffer from post-traumatic stress disorder. For the NCO, say, in charge of a detachment, the onus was on the detachment commander or an NCO to make recommendations to the appropriate health services to look at possible symptoms if a member was dealing with post-traumatic stress disorder.
Now, I'm just curious. In regard to the Department of Veterans Affairs and its policy, when did the RCMP become included in the mandate for post-traumatic stress disorder, or just basically added to Veterans Affairs?
:
I have three questions, actually. The first one is on the hospitals. What is the long-term plan for the hospitals when the vast majority of World War II and Korean veterans have passed on?
Also, in Nova Scotia, the 1-866 number for veterans shuts down at 4:30 and they are told to call back the next day. I wonder if that can all be changed and transferred over to handle calls across the country. It's frustrating. The people who answer the phones during the regular business hours are very good, but the problem is that if you call after a certain time, you're told to call back.
The other issue is that you had indicated—and we're quite aware of this, Doug—the fact that there are many people within DND collecting a DVA pension. Could you please tell us how many of them could be doing so, and are they part of this statistical information that you've given us? If you don't have the number, maybe you could send it to us later. It seems rather ironic that they're not veterans, which is understandable, but they do receive the DVA pension. So it would be interesting to know how many of them are, and are they part of your statistical information?
That should do it for now. I have many more questions, but the chair will cut me off, I'm sure.
:
I'll answer the first two, and maybe Doug can answer the third for Mr. Stoffer.
On the long-term-care plan for our hospitals, Veterans Affairs created these hospitals in the absence of any alternative in the community. Right now there are about 250,000 to 260,000 nursing home beds in Canada that weren't there at the end of World War II. The long-term-care response at the end of World War II was a stop-gap measure--and a very important one, by the way.
Now the older veterans are sort of voting with their feet and wanting more and more to stay in the community. Our long-term plan for these facilities—even for the modern veteran, because it's so important for long-term care to be close to family and home—is to emphasize and support individuals staying close to home in existing Canadian nursing homes. Over time, our plan is to specialize the care and services offered in the contract beds we now have for the older veterans that they can't get in the community--primarily respite care, and then geriatric care.
I think we could give the committee a longer briefing on our long-term-care strategy, but in summary that's the direction in which we're proposing to go. Even the traditional veterans want to stay close to the community. For instance, they don't want to go to Sunnybrook Hospital if they live in Barrie, Ontario, because they'll never see their families again.
Adding eligibility for Canadian Forces veterans is a political decision that will have to be considered in time.
Regarding the 1-800 number, I'll have to check about the availability. It seems to me those service hours are meant to be longer, but we'll have to get back to the committee on that.
:
That's a fair question.
In terms of getting the evidence base for the conversion, as it were, from an entitlement to a needs-based or a wellness approach, we started the first studies in 1999. We did a study of the needs of Canadian Forces veterans themselves, and we asked them what their requirements were, and it was no surprise. We also began to look at what was happening with the anecdotal evidence and the increase in our pension claims and what the outcomes were for these individuals.
It became quite apparent when we started talking to the experts—and we had what was called a Canadian Forces Advisory Council, whose members were academics and practitioners. When we put the scenarios and the research we had gathered to them, they said, “Listen, you're inadvertently encouraging illness here with your sole response from a pension program. You don't mean to, and the veterans themselves don't mean to do that, but the only way you can create an income stream is to have more pension, so you get reassessed and get higher and higher rates, and what's happening is you're not investing early enough and you're not investing in wellness with a rehabilitation program.”
That's a summary version of where we went. That took about four and a half years of research to get the case to put to government. And all parties agreed with the evidence and all parties agreed with the response, which is very heartening for us. But there was quite a lead-up, in terms of research, in terms of getting the evidentiary base that justified the change and justified a rather large investment of almost $1 billion over five years in the front end.
:
I can speak to the tele-mental-health side of things, which is what you may be referring to.
The Chair: Yes.
Mr. Doug Clorey: We're still early days in this. In the department we've conducted three pilot projects, at this point, to ensure that we know what we're getting into when we enter the tele-mental-health field.
It is a field that is available in all the provinces of Canada, but it is tricky. You need to be able to create all of the safeguards around the intervention in an environment where the individuals are not physically present.
We did conduct a pilot project in Newfoundland, one in Calgary, and one recently in Fredericton, to develop the protocols to ensure that when we implement this fully across the department, we have the assurances that the interventions will unfold as they should, with the appropriate safeguards at both ends.