As you know, I'm Lieutenant-General Lise Bourgon. I'm the acting chief of military personnel and commander of military personnel command.
First this morning, I would like to acknowledge that we are gathered on the traditional unceded territory of the Anishinabe people.
As Acting Chief of Military Personnel, I am responsible for recruitment, training, retention, education, career management, policy, pay and benefits, health services, military career transition, morale and welfare programs, and a host of other corporate and personnel support services. It is a very broad mandate.
I am joined here today by three of my senior commanders.
First, to my right, is Major-General Marc Bilodeau, the surgeon general, who is the medical adviser to the chief of the defence staff and to the . He's also the functional authority for the professional and technical aspects of the medical and the dental care to our members.
I'm also joined by Brigadier-General Scott Malcolm, commander of the health services division, whose responsibility it is to deliver health care to CAF personnel to ensure their readiness and enable CAF operational success through the provision of agile health service capabilities around the world.
To my left is Commodore Daniel Bouchard, Commander of the Canadian Armed Forces Transition Group that provides military career transition services to serving or retired members, including active, retired, healthy, ill and injured members, and families of deceased members.
I would like to thank the committee for its interest in better understanding our military health system, the provision of health services and the transition support to our members. These are indeed important topics, because, first and foremost, we have a duty to take care of our people who put service before self.
Unlike any other institution, the provision of health care to our members is the responsibility of the CAF, and not the province or territory where they reside.
Together, all of us here today are focused on providing the required supports and services to our members through all aspects of their military careers, whether they are healthy, ill or injured, transitioning to civilian status or deployed on operations.
Our priority is the long-term health and wellness of our military members and the provision of high-standard and quality health care to the full diversity of the CAF. This is achieved primarily through the Canadian Forces Health Services Group, which is responsible for the care and well-being of about 64,000 regular forces members as well as our reserve forces members on operations or in full-time service.
Canadian Forces Health Services, or CFHS, is a key enabler to our military missions around the world through pre-hospital, primary, surgical and specialized care.
Here at home, CFHS provides health services through 37 primary care clinics across the country, and 31 of those offer specialized in-house mental health care. The multidisciplinary teams of mental health care providers include social workers, mental health nurses, psychologists, psychiatrists, addiction counsellors and mental health chaplains.
The CAF’s mental health program has been recognized by our NATO allies and civilian organizations for its robust approach to mental health care, stigma reduction initiatives, and mental health research, training and awareness programs.
For example, the road to mental readiness program, launched in 2007, helps promote mental resilience and improves mental health awareness.
We also have a special program called “Resilience Plus” created specifically for military college students.
Given the unique nature of our jobs, sometimes our members become significantly ill and injured. Whether their injury is physical or mental, they may require enhanced support through a return-to-work program or to transition within the CAF or, sadly, to post-military life.
That is one of the reasons why Canada’s 2017 defence policy Strong, Secure, Engaged directed us to create the CAF Transition Group. In close collaboration with Veterans Affairs Canada and other valued partners, we now have 32 transition centres at bases and wings across Canada.
CAF Transition Group staff work to offer the best possible service and support to all CAF personnel and their families to prepare for and, at the appropriate time, complete a seamless and successful transition to civilian life.
It is important to note that transition does not automatically mean leaving the forces. CAF TG—transition group—offers services and programs to support, first and foremost, the return to duty of our members, whether that is by reintegrating them into their home units or helping them transfer their skills and experience to new career paths within the CAF, such as through occupational transfer.
We know we have more work to do to continue to provide quality service to our members. That is also why we are working to improve the spectrum of care that we provide and how it is provided, especially on service and support for women and diverse members.
I think that budget 2022 announced $144 million over five years to expand the CAF health services and physical fitness program to be more responsive to women and gender-diverse members.
We are also taking concrete steps to make our health resources and services more inclusive. For example, we have reviewed our transgender care program to make it more inclusive and comprehensive for our members.
We also continue to work with our women members to offer person-partnered care and to identify gaps and needs in order to act on them.
Whether our personnel are on the road to recovery, rehabilitation, returning to duty in the CAF or transitioning to civilian life, we are committed to assisting them in their journey.
Thank you once again for this opportunity to appear before you today. We welcome questioning from committee members.
Thank you very much, Mr. Chair.
The JPSU, as you said, was stood up in 2009 to assist our ill and injured in their transition and their support. In 2017, we stood up “Strong, Secure, Engaged”, recognizing the requirement to increase the support to our members who are transitioning. In 2018 my organization, the Canadian Armed Forces transition group, was stood up in order to provide that support.
We have developed a process for military to civilian transition. All regular force—and soon reserve force members—will be transitioning through our organization to civilian life.
Our primary focus also is on retention. As General Bourgon was saying, we have stood up 32 transition centres in nine regions to support the process of transition.
Thank you, General Bourgon.
Mr. Chair, that gap in the women's health data and research is not unique to the military. It exists in society. Most of the research in health care, unfortunately, historically, has focused on males, and there's very little data on many conditions related to women. Obviously we're impacted by that in the military, which means that more research is required in order to inform better care for women.
That goes from preventing injury and diseases to managing health conditions in a military environment, which is the area that is unique to us and one that we need to study more.
We're doing an honest job regarding women's health. In our screening for breast cancer and our data on cervical cancer, for example, we're on par with Canadian society. That being said, we can do a lot better. That's why we're very fortunate to have been funded through the last budget with a significant amount of money to build a women's health program. That program will be based on four pillars, one of which is improving the health care that we provide to our women. That speaks to the quality of the care but also to the spectrum of care itself, because there are some items currently not covered that women would benefit from having covered.
We're looking at injury prevention, and for that we're in partnership with our partners, the directors general of morale and welfare services, who are, basically, our fitness providers.
With respect to research and engagement, I spoke about research. There are lots of gaps there. We are going to engage with our research partners in order to fill those gaps from a research perspective and have better data to be able to monitor the health of women as well as the efficacy of our preventive measures and treatment measures.
Finally, we need to measure what we do. We need to have better quality and performance measurements regarding the health of our women. We lack data, and we need to build that data in order to make sure that what we do ultimately leads to improvement and better results.
To carry on, in Canada proper, including our clinic in Geilenkirchen, Germany, and in Belgium, we have 37 clients. We would characterize those as enhanced primary care, meaning that you don't just have access to doctors, nurses, physician's assistants and nurse practitioners; in most of those clinics you also have access to a pharmacist and, in some of our larger centres, to X-rays, and in some of our largest centres, a CT scan.
You also have access to labs, and in 31 of 37, you also have access to mental health services, which could include psychiatrists, psychologists, social workers and mental health nurses. That's why I would say it's more of an enhanced primary care.
In our overseas deployments, currently in Kuwait, Latvia, Poland and the Indo-Pacific on our ships, we have integral medical support, meaning it is provided by our folks. Both overseas and in Canada, as was alluded to by Lieutenant-General Bourgon, if there's a service that's required that's not immediately available or is not of the right type, we're able to refer members out, whether it's in Canada to our civilian partners or overseas to validate—
It is always a pleasure to have you here. Thank you for being with us today.
I want to follow up on the discussion started by Ms. O’Connell about the status of women. I also want to touch on the sharing of information by the CAF with other entities. Yesterday at the Standing Committee on Veterans Affairs, it was said that data gathered by the CAF were not necessarily adequately shared with other organizations, such as Veterans Affairs Canada.
We know that many female members are released from the armed forces for medical reasons. For instance, military equipment is not always adapted for women, even if things are improving in that regard. Veterans Affairs Canada, in that sense, is sort of like an insurance company that only considers symptoms while ignoring root causes. There is no feedback loop.
Are you aware of this problem? How can that situation be handled?
I'd like to pursue the same line of questioning.
There seem to be two problems with the transfer of medical records to the provinces. The first is that the first two years are the most critical part of any transition, but the provinces are short on doctors and it isn't unusual for new veterans to not be able to find one. The second issue is that, even when they have access to the medical records, some doctors believe that their code of ethics requires them to start the process over from the beginning.
Are there any initiatives that would allow new veterans to keep having access to Canadian Forces health services for a year or two to ease the transition? Are such avenues being considered?
Is it a human resources issue or more of a financial issue?
Some people have explained to us that they have expertise as physician assistants in the armed forces but can't work as civilians because their credentials aren't recognized. And yet, they could work for the federal government and help our troops in their transition.
I'd like to hear your opinion on this. Are these realistic solutions?
Thank you for the question, Ms. Normandin.
It's true that the transfer of care during the transition to civilian life can be problematic due to the issues with the civilian health care system. As you're no doubt aware, the system is unable to meet current needs.
We've implemented a process by which our members can stay in uniform longer to ensure a safe transition. This is something that we manage in partnership with the transition group. We're ensuring that our members have access to all of the health care and support they need. That allows us to bridge the gap, so to speak, in light of the resource availability issues on the outside.
We're looking at a number of initiatives with Veterans Affairs Canada with the goal of improving access to family physicians when our members leave the Canadian Forces. For instance, in partnership with the College of Family Physicians of Canada, we've put together a document to help family physicians understand what life is like for veterans and to encourage them to take patients that were released from the armed forces into their care.
We're obviously looking into the options you mentioned, like utilizing professionals with varying backgrounds. Physician assistants are increasingly popular in Canada. The majority of provinces agree on the issue of allowing physician assistants to practise. Those that haven't quite come around yet are getting in touch with us to get the benefit of our experience in the matter. The Canadian Forces have been employing physician assistants for 50 years now. It's a profession we understand well, and we know that physician assistants can help improve access to primary health care and reduce the backlog in the health care system.
Thank you very much, Ma'am, and Mr. Chair.
Yes, OSISS, the operational stress injury social support, is a partnership program that we do with Veterans Affairs Canada. It's a group of 70 managers/coordinators and 70 volunteers. They have lived experience. They are also on their own journeys in assisting our members through this difficult process. It's a one-on-one peer support group that provides these volunteers. It can be done virtually and in person. It can be done on the base. It can also be done at a civilian establishment off the base, which is sometimes required in order to have that further discussion.
On average, we'll support about 2,000 peers. That's divided by peers. It's also with their families. The families are invited to these support systems. Twenty per cent will be serving members: 11% are the members themselves, with 9% being their families. The other 80% are veterans: 55% are the veterans themselves, and 25% are the families who accompany them on these services. On average, we have 2,000 peer interactions to support these individuals throughout, and again, it's in partnership with Veterans Affairs Canada.
Thank you to our witnesses for being here with us today.
This was a study that I put forward, and the main reason I put it forward is that when I sat on the veterans affairs committee several years back, there were clear concerns that I had that have been raised here already. However, I do want to push a little bit and see if there's more information that we can gather here today.
At the time, officials from Veterans Affairs were saying that they're very limited in terms of the information they receive about these veterans' medical histories within the forces. It was very much up to the veteran to go and seek help. There wasn't anybody reaching out to them. There wasn't a database of people who should be checked on every couple of years. It was very much up to the veteran to reach out for help.
Clearly, there's a lot of work that needs to be done there. One of the recommendations that we made in that study, which only went to Veterans Affairs—it did not go to National Defence—was to have a consent form signed to allow their medical information to be transferred to Veterans Affairs when they're signing other forms as they are being released.
First off, I would like to know if you think that would make a difference and if you think that could be a recommendation that we have in this committee for this particular study that would go to National Defence.
Second, I know that you've been speaking, Monsieur Bouchard, about a recent program, a transition program. I'm wondering if you can explain a little bit further. Specifically, what in the last couple of years has been done in order to merge these two departments together in order to better offer services to our people?
The fact is that we've always used telemedicine. In the past, services were mainly provided over the phone. Military members could call a doctor to get a prescription renewed, for example. Of course, when the pandemic hit, we had to quickly find new ways to apply technology to telemedicine, among other things through the use of video conference.
The things that were implemented were implemented because we didn't have any other choice. We acted out of necessity, especially in the first few months of the pandemic, when everything was closed. We understood that was the only way for us to keep seeing our patients and giving them the care they need.
The challenge involves the fact that our current telemedicine system isn't fully integrated with our electronic health records system. It's a real problem, mainly in terms of coordination and logistics. These problems should be resolved within a few years, with the modernization of our various systems.
That said, telemedicine certainly has added value, because some of our members are deployed in places where there are no military clinics nearby. Telemedicine also allows us to provide greater support to our members deployed abroad, for instance when they need to consult a specialist. A lot of issues can be resolved through video conference. In-person consultations aren't always needed. The same can be said for most mental health issues.
Telemedicine allows us to provide our members with more specialized care. There's no doubt that telemedicine adds a lot of value—
Thank you, Mr. May, for the effort and for co-chairing Seamless Canada, because it is very important.
Again, when we look at the military, the strength behind our uniforms is our families. We are all tracking the recruitment and the retention.
One of the main reasons people leave the military is the impact of service on their families. From a point of view of health care access, by the time you get on the list to have access to a doctor, you're moving again. It's the same thing for child care. It's very difficult to find child care every time you move.
There's also spousal employment. Again, when one of our members is posted, their spouse needs to find a new job in the new location. Usually they end up at the bottom of the list again, with the lowest salary.
Those three lines of effort are the core of Seamless Canada. If the provinces can work on those three lines of efforts and on finding.... It's not going to be magic. There are small victories that we have to achieve through the years to facilitate those three areas of friction when our members are moving across the country.
For me, that's the core. I'm a mother. My husband was in the military. Raising two kids and having to wait for child care access when you're deployed and when you're working crazy hours is so stressful. If I had a magic wand, I would use it for access to child care.
It's great if we can look at subsidized child care. That's great for our members, but having access is absolutely essential for our service members to be able to do their jobs and to be operationally effective because they don't have to worry about what's going to happen to their kids.
I landed a Sea King in Halifax in a parking lot. It was quarter to six, and my husband was deployed. I was like, “Oh my God, who's going to go get the children, because the MFRC closes at six? What are they going to do?” We didn't have family members because we were not posted where we had family members.
That access to child care, for me, would be critical. We're working very hard, but if I had one wish, it would be that one.
We're hiring in 19 different health care occupations. Obviously, we need to have a targeted approach for each of those. They are not trained in the same types of schools. They're not trained in the same environment or in the same locations in the country. We're trying to have a very targeted approach for each.
For example, for physicians, we're putting advertisements in medical journals. We're going to med schools to do presentations on what it is to be a military doctor. Usually, we bring somebody in uniform to talk to the med students as well, so that they understand the environment, the conditions, the benefits and everything we offer them as an exciting career.
We're also doing this through a network of specialist recruiters who are specialized in recruiting health care professionals. There are people working full time for us in different areas of the country where the main focus is really to recruit health care professionals on our behalf.
Obviously, we're recruiting a lot of people, but a lot of people are leaving after their obligatory service because they've decided to do something else with their lives, so retention becomes a challenge for us. We need to do better from a retention perspective and try to make sure that we keep them excited while they're serving so that they are willing to serve. We need to create that sense of identity, as well, that General Bourgon was talking about, and that sense of purpose.
There's a challenge currently in health care, not only in the military but also in the country overall, as you know. There's an increase in demand overall for health care, especially mental health services, that is challenging the system overall. There are just not enough mental health care providers in the country currently to meet the demand. Obviously that is impacting us as well, because our members are a sample of Canadian society, so that demand for health care has increased also.
That trend started, by the way, before the pandemic, and it was just exacerbated during the pandemic. I think there's a new set of stigmas that are not as present as before from a health care perspective, which is good. I think it's going to bring more people into care earlier, which probably will improve the overall outcome of all those people who are suffering with mental health issues, but this need is currently creating a lot of pressure on our systems.
We're obviously still trying to recruit as much as we can to have our piece of it, if you will, from the perspective of mental health care providers. We currently have 50 active hiring processes going on through our contractor, Calian, to bring in additional mental health professionals. It's not easy, because we're in competition, obviously, with our colleagues from the provinces, and we can't afford to steal everything from them either. We need to share in some ways.
What we're doing, although internally, is trying to re-look at our program and at the way we deliver mental health care to see if we can become more efficient, if we can “responsibilize” more patients and if we can stick to our patients less than we are currently. All of that is part of what we're doing.
There are lots of applications online now, for example, to do some mental health treatment, if you will. We need to capitalize on that. I think that would save resources for us and allow us to treat more people if we do that. However, it's an ongoing challenge that we're working on actively.
Actually, the beauty of our system is that it involves the maintenance of pan-Canadian electronic health records. All of the information related to the care that's provided to patients is recorded in these files, which are accessible from anywhere. That way, when a member is transferred or temporarily assigned to another base for operational reasons, access to care is much easier.
As for the therapeutic bonds that exist with our members, I agree with you that it plays a major role not only in terms of the quality of care, but also in terms of the support we can offer our members.
Furthermore, the advantage of telemedicine is that it allows us to ensure follow-up with a professional even when a member moves around. That said, this only happens on occasion, since the majority of our members don't get transferred when they're very sick. It remains an option we can use when we need to, however.
We also occasionally authorize our members to travel to meet a health care professional. That only happens in exceptional circumstances since the majority of mental health care services can be provided through telemedicine.