I call this meeting to order.
Welcome to the 25th meeting of the Standing Committee on Veterans Affairs.
Pursuant to Standing Order 108(2) and the motion adopted on Monday, October 3, 2022, the committee is meeting on its study of the impact of the new rehabilitation contract awarded by the Department of Veterans Affairs on the role of the case manager and quality of service delivery.
Today's meeting is taking place in a hybrid format pursuant to the House order of Thursday, June 23rd, 2022. Members are able to attend in person or remotely with the Zoom application.
I will now welcome some colleagues that are here with us today. We have Mr. Peter Julian, who is replacing Ms. Rachel Blaney; Ms. Marilyn Gladu, who is replacing Mr. Fraser Tolmie, and Mr. John Brassard, who is replacing Mr. Terry Dowdall. You should also know that our committee clerk, Ms. Audrée Dallaire, will have the support of Ms. Dancella Boyi, also a clerk.
I will just give a few tips to the witnesses and committee members to ensure that the meeting goes well.
Please wait until I call you before you speak. If you are participating via videoconference, click on the microphone icon to turn your mic on. An interpretation service is also available.
I would remind you that all comments from members and witnesses must go through the chair.
In accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests before today's meeting.
I hope that committee members had a good week and that they were able to attend ceremonies on Remembrance Day.
Now I would like to welcome our witnesses.
From the Union of Veterans' Affairs Employees, we have Virginia Vaillancourt, national president—welcome—and Toufic El-Daher, national executive vice-president. He will be joining us by video conference.
Each of you will have five minutes for your opening remarks. I usually let people know that they only have a minute left or that their time has run out.
Ms. Vaillancourt, you have the floor for the next five minutes.
Thank you for the opportunity to speak with you today. We have the privilege to represent almost 2,800 mostly frontline workers who have the honour to serve our veterans to make sure that they receive proper supports, timely decisions and the benefits they need.
The latest report from Veterans Affairs Canada shows that there are a total of 494 case manager positions on the payroll. Of those, 441 are indeterminate, and there are 53 term positions.
However, positions are not people. From May 3 to August 30, 2022, VAC hired 13 case managers. During the same time period, 24 case managers left the department due to retirement or resignation, or moved to other departments. Yes, VAC hired case managers but still ended up with a net loss of 11 people.
Another 90 case managers are on some form of disability, long-term sick leave or other leave. That means we have fewer than 400 case managers to serve the needs of almost 15,000 veterans and their families. It shouldn't come as any surprise that we have lengthy backlogs, frustrated veterans and psychologically wounded and demoralized staff.
Veterans coming to VAC are often worried or scared, and usually sick and hurting, both physically and mentally. The role of a case manager is to listen to their story and guide them through a complex system when they may be at their most vulnerable. The ultimate goal is to make sure that the veteran's transition to civilian life is as successful as possible.
As you will hear from some case managers next week, this is not just another job. For most of them, it's a calling to serve those who served. Case managers fear that through the new rehab contract, veterans will lose their human, face-to-face contact with someone who will be an ally, an advocate and quite often a trusted friend to them and their families during some pretty dark times.
Under the new contract, the contractor will be the lead in providing advice and guidance to veterans who require rehab services, not the case managers who have built relationships of trust with the veterans. The contractor may find them service providers, but who will answer the questions? Who will sit with them and their families to hear their stories and address their fears? Who will they turn to if things don't work out?
The bigger question is whether we want the face of service to veterans to be a kind, caring and compassionate case manager or a for-profit corporation that serves its shareholders.
I'll turn it over to Toufic.
Thank you very much, Mr. Chair.
The new rehabilitation contract has been problematic from the beginning. Veterans Affairs Canada claims that case managers and the union have been consulted. That is false.
We received a copy of the contract a few days before the contract was awarded. We appointed union representatives to various sub‑committees but they were seldom invited to the planning meetings. None of our questions and none of the questions asked by case managers were answered.
We wrote to the minister to ask that he meet with us and listen to our concerns. He ignored our request twice. The third time, he declined and referred us to the department which still hasn't answered our questions.
The department initially held townhalls where questions were encouraged from employees. Then, when the department couldn't give any satisfactory answers, they shut off the chat function and stopped allowing direct questions. A few weeks ago, the department held another townhall with case managers. Once again, no chat and no questions.
This is not collaboration or consultation.
None of the case managers' questions about their roles and responsibilities or how this contract would actually work have been answered. The case managers have not even been fully trained on how to implement this contract.
Given the situation, we have asked that the implementation of the rehabilitation contract be pushed back, and we hope your committee will consider this possibility.
We fully support the case managers' recommendations that Veterans Affairs Canada commit to a case ratio of 25:1. This is essential. We also need long‑term funding for this department in order to put an end to temporary or short-term funding. Our veterans are not temporary; they are veterans for life.
Our union and our members are fully committed to serving veterans. They are our friends, our family members, our neighbours and our heroes.
Our veterans deserve better.
I have held my substantive position as a veteran service agent with the Department of Veterans Affairs since 2003. I have been in various positions, but my last position was as a veteran service agent.
I believe that this contract will really hurt veterans and their families.
Since 2006, I have been witness to the privatization of our 15 health programs, which have been transferred to Blue Cross. Initially, the department said that only one health program would be transferred to Blue Cross. In the end, the contract was expanded and all 15 health care programs, including the Veterans Independence Program, which allows veterans to live independently in their homes, are now entirely managed by Blue Cross.
This is why that I'm telling you that even though the department is saying that this is just an administrative change, it is not, because the contract can be changed at any time. It is currently set up for a five‑year period, but it could be extended over many years. The veterans will be the hardest hit, because they will no longer be able to deal directly with their case manager.
Dealing with an insurance company or a private company won't give you the same level of service. Veterans need to be reassured, and there is no way they are going to be reassured by privatizing their care. We saw disasters happen with Blue Cross, and I worry about the other disasters coming with this privatization.
Don't forget that when a veteran can't appeal a decision, the money stays with the Department of Foreign Affairs at the end of the day.
Veterans who have sacrificed their lives so that we may live in peace in a beautiful democratic country do not have access to these services, because someone has decided that the services would be offered by a private company.
We provide services to veterans as public servants. When a claim is denied, we help them to meet the criteria, if necessary. For example, we ask them to provide certain documents and we help them with the process.
I worry that the new company will not show as much empathy.
There is no existing contracting-out clause.
One of the things you mentioned earlier was that the cost associated with outsourcing to this company could in fact work out to a 25% increase in cost. The contract, I note, is for five years and $565 million, which is about $100 million a year.
Realistically, what would it take, if this contract were not to happen, to deal with the current crisis within the case management system within VAC—$100 million, $30 million, $50 million? Would it be less than what this contract will be?
On behalf of the committee and myself, I would like to thank Ms. Vaillancourt, National President of the Union of Veterans' Affairs Employees.
I would also like to thank Mr. Toufic El‑Daher, National Executive Vice‑President of the same union who testified via videoconference.
Thank you for being with us today. I would also like to thank you for the services and the support that you provide to veterans.
Dear colleagues, we will take a two‑minute break in order to bring in the next six witnesses.
We will now resume the meeting with our second group of witnesses.
I will quickly remind you, witnesses, before speaking to please wait until I recognize you by name. If you are on video conference, please click on the microphone icon to unmute yourself.
I would like to remind you, members, to please address your questions through the chair. I would like you also to say who you would like to answer your question, because we have three people here and three on Zoom.
Now I'd like to welcome our witnesses. From the Department of Veterans Affairs, we have Steven Harris, assistant deputy minister, service delivery branch; Jane Hicks, acting director general, service delivery and program management; and Nathalie Pham, senior director, operational and strategic affairs.
On Zoom, from the Partners in Canadian Veterans Rehabilitation Services, we have Monsieur Gilles Chabot, chief operating officer, Lifemark; Ms. Tania Bennett, chief executive officer and executive sponsor, WCG Services; and Ms. Paulette Gardiner Millar, contract manager.
Let's start with the Department of Veterans Affairs. You have five minutes for your introduction, and after that we'll go to Zoom.
Mr. Harris, the floor is yours for five minutes or less.
Thank you for the opportunity to provide this committee with an update on new rehabilitation services and case management services at Veterans Affairs Canada.
The military experience of every veteran is unique. Rehabilitation is a critical component for veterans who need additional support.
The rehabilitation program is designed to support veterans and their families in their transition to civilian life, at home, in their community and at work. The program provides personalized rehabilitation services designed to meet veterans' specific medical, psychosocial and vocational needs. It is one of the programs that provide benefits and services as part of veterans' overall case management plan.
Veterans Affairs case management services support veterans facing complex challenges. It's a collaborative process between the veteran and the case management team to identify needs, set goals, create a plan to help participants and achieve the highest level of independence, health and well-being.
Case management is and remains a core VAC service. In fact, we've made investments over the last two years to reinforce and expand case management practices, including through tools and processes and by reducing caseloads so case managers can meaningfully engage with veterans and their families.
Furthermore, the Government of Canada earlier this month confirmed $43 million in funding over three years to support these services. This funding will maintain the total number of frontline and back staff, including case managers, and will help improve the case manager-to-veteran ratio and the tools they use.
We also oversee the implementation of long-term initiatives, including the rehabilitation services and vocational assistance program and the renewal of case management, which will help reduce the workload for managers, particularly the administrative duties related to case management.
Currently, vocational rehabilitation is administered under one contract, while medical and psychosocial rehabilitation services are delivered through multiple providers through a second contract with Medavie Blue Cross. The expiry of the vocational rehabilitation services contract in December 2022 provided the department with an opportunity to improve upon the rehabilitation program and the way we deliver it.
Veterans Affairs Canada consulted the case managers, veterans and their families, industry experts and the Union of Veterans Affairs Employees throughout the renewal and contract implementation process. Their opinions, concerns and viewpoints helped us define the new provider's rehabilitation services delivery method.
Case managers and veterans have told us how they would like rehabilitation services to be delivered, and we have listened.
The current program delivery, with two distinct contracts, places a heavy administrative burden on case managers. Time is spent finding multiple providers for each veteran, educating them on the program, gathering reports and scheduling appointments. Case managers have identified that spending more time directly working with veterans and their families is a priority. A 2019 survey from the audit and evaluation of case management services reports that approximately 73% of case managers spend 50% or more of their time working on administrative tasks.
This new rehabilitation contract was awarded on June 30, 2021, to Partners in Canadian Veterans Rehabilitation Services, or PCVRS. It is a partnership between WCG International and Lifemark Health Group, which coordinates the administration of medical, psychosocial and vocational services to veterans and other eligible participants of the Veterans Affairs Canada rehabilitation program.
Having a single service provider means having rehabilitation-focused services that are coordinated, nationally consistent, quality-assured, performance-measured and include advanced technological supports.
These enhancements will improve the veteran experience and their well-being by offering a more holistic rehabilitation program wherein veterans have the best chance to achieve their goals and adapt successfully to life after service.
For the first time, veterans will be able to consult and print out a copy of their rehabilitation plan. They will also be able to submit requests for payment online, see the list of their upcoming rehabilitation meetings, and use a secure messaging system to communicate with their rehabilitation services specialist.
The new national contract aims to reduce the time case managers spend on administrative work. Case managers can instead spend time engaging with veterans on other supports that they may also need as part of their overall well-being.
Case management services and resources will continue as an essential service delivered to veterans and their families by case managers.
There is no job loss as a result of this contract. In fact, the commitment to case management is key for the , including his recent announcement of $43 million of additional funding for case managers.
I'd be happy to take your questions.
I am Tania Bennett, executive sponsor for Partners in Canadian Veterans Rehabilitation Services, or PCVRS. Joining me are my PCVRS colleagues: Gilles Chabot, who is a member of the PCVRS executive team, and Paulette Gardiner Millar, who is our dedicated contract manager. We're extremely pleased to be here today to share information related to this very important topic.
Partners in Canadian Veterans Rehabilitation Services is an innovative partnership, joining long-serving organizations in Canadian rehabilitation and vocational services. In fact, our partnership was created for one specific purpose, and that's to deliver high-quality rehabilitative care for veterans through services contracted by Veterans Affairs Canada in the rehabilitation services and vocational assistance program.
Our organization and our qualified health and vocational professionals from across Canada bring the knowledge and expertise to meet VAC's requirements for the program.
I'd like to tell you a little bit more about who we are. Our team has many years of experience providing a comprehensive range of evidence-based medical, psychosocial and vocational rehabilitation assessments and services across the country. We have deep experience working with veterans and we have developed tried and tested methods to deliver high-quality assessments and rehabilitation services that will help veterans transition to post-service life.
PCVRS is a mission-driven team with shared culture and values. We are committed to enabling veterans to live better lives through effective, personalized rehabilitative and vocational care. Our focus is on helping veterans and their families successfully transition to post-service life and to achieve their potential in all areas of well-being. We're on a mission to ensure that participants of the program achieve optimal levels of health, functioning and participation at home, at work and in their communities.
There are four key values for our foundation of care for veterans and their families. The values in our C-A-R-E or CARE model are compassion, access, respect and excellence.
Our approach puts veterans first. We show compassion for those we serve and build trusting relationships based on integrity and kindness. We remove barriers to access to services by providing a wide variety of in-person and virtual services in both English and French, and accessibility is embedded in our technology and our service delivery approaches.
PCVRS provides Canada-wide coast-to-coast coverage through a network of thousands of medical, psychosocial and vocational rehabilitation services professionals who provide services through in-person care as well as virtual options.
We provide and nurture an inclusive environment that is free from discrimination and that is respectful and considerate of the unique experience of each veteran, spouse, common-law partner or survivor. We have embedded gender-based analysis-plus principles into all aspects of our service to advance equality and inclusion for veterans of all backgrounds. We provide training for our team members to support specific veteran communities, including the indigenous veteran population.
We strive for excellence in all we do, and we'll collaborate as a partner to continuously improve the participant experience and to enhance rehabilitative outcomes.
Our Partners in Canadian Veterans Rehabilitation Services team has been created to achieve our mission to enable better lives for veterans. We take a “team around the participant” approach and we look forward to collaborating with VAC case managers to deliver our contracted services for the rehabilitation program. This is important, as we understand that case managers are the delegated VAC decision-makers for rehabilitation plans.
In closing, we are honoured to deliver a professional and supportive rehabilitation service for Canadian veterans. Veterans and their families deserve high-quality, accessible and inclusive health and well-being services, and that is what PCVRS is committed to delivering.
Thank you, Mr. Chair.
Thank you. If you could get those to the clerk, we would appreciate it.
Now I'll go to the issue that we're dealing with today.
In this process, I see there being three key people here. Obviously, veterans and their families, first and foremost, are clearly the priority here, but I think we also were talking about those who work for the department now and are going to see some changes to what happens with their roles. Also, I think service providers obviously could be impacted in this changeover as well.
I wanted to get from you a sense of what has occurred in terms of communication between the department and each of those three key stakeholders particularly, starting with the veterans.
Yes. There's been consultation.
First of all, as we started the implementation period, we set up a series of working groups that had members from the union from various groups, and they've been involved in forming the implementation process. We've also have six town halls.
Most recently, we had six Q-and-A sessions for case managers with about 450 participants in the week of October 31 to share information and provide feedback.
We've also set up a portal for case managers to answer any of their questions. We've had over 300 questions responded to that they've shared with us over the past 12 months.
That gives you a sense of some of the consultation.
Thank you very much, Mr. Chair.
We have in excess of 9,000 practitioners across the country who have experience in providing rehabilitation services. Some of these clinicians who work with us directly include physiotherapists, occupational therapists, psychologists, physicians, chiropractors, massage therapists, kinesiologists, social workers, clinical counsellors and vocational professionals.
We have over 20 years of experience in providing comprehensive rehabilitation services to Canadians, including veterans, across Canada.
We also have over 600 physical locations to help support and provide access for our veterans. We have an extensive affiliate network as well.
I think I can take that question.
After the VAC case manager confirms eligibility, then the referral would come over to PCVRS at that point. The veteran will be assigned an RSS, a rehabilitation service specialist. We'll do the initial assessment to determine what the barriers are and what the needs are, and then the participant, the VAC case manager and the RSS will work together to build the rehabilitation plan.
If there are any consultations required in order to do that—medical assessments, vocational assessments and so on—those will be provided and then worked into the decision-making in terms of moving forward. At that point, if everybody agrees on the rehabilitation plan, then the care will be provided to the veteran.
Thank you very much, Mr. Chair.
I'm going to start off with a notice of motion for our next meeting:
That Veterans Affairs Canada (VAC) provide to the Committee a copy of the contract for rehabilitation services between VAC and Partners in Canadian Veterans Rehabilitation Services by November 25, 2022.
That's a notice of motion. I will be giving you a copy of that for our next meeting, Mr. Chair.
I'm really concerned when, in testimony we've heard, I see $14 million a year provided to Veterans Affairs Canada and over $100 million a year going into this contract. It strikes me, particularly given the lack of preparation for the transition that takes place in 120 hours, that we are showing profound disrespect to our veterans.
The government has not prepared the grounds on this, and the government obviously has money for engaging private firms. That money should be invested in Veterans Affairs, and they deserve—all our veterans deserve—the highest quality of service possible.
This panel has finished.
On my behalf and on behalf of the committee members, I would like to thank the witnesses for being here.
From Veterans Affairs, we had Mr. Steven Harris, assistant deputy minister, service delivery branch, Ms. Jane Hicks, acting director general, service delivery and program management, and Ms. Nathalie Pham, senior director, operational and strategic affairs.
By video conference, we were also joined by representatives of the Partners in Canadian Veterans Rehabilitation Services, Ms. Tania Bennett, chief executive officer and executive sponsor, WCG Services, Mr. Gilles Chabot, chief operating officer, Lifemark, and Ms. Paulette Gardiner Millar, contract manager.
We will now suspend and go in camera. I invite the members participating remotely to use the new link sent to them.
The meeting is suspended.
[Proceedings continue in camera]