PACP Committee Report

The audit found that National Defence does not adequately monitor its health care practitioners to ensure that they maintain their licenses or certification. National Defence estimated in 2006 that as many as 20 percent of practitioners may have not been licensed.^[13] The OAG could only confirm that 69 percent of physicians and 75 percent of nurses were licensed. Not all medical technicians pursued certification following their training because it was not mandatory, and a large portion of physician assistants have not been certified to the new standards.

Additionally, many practitioners do not get exposure to a full scope of practice. The audit found that some physicians were not licensed in the province in which they practiced and thus could not take advantage of opportunities to work in civilian facilities to gain experience for maintaining the full scope of their skills. While the Department has implemented a Maintenance of Clinical Skills Program, few take advantage of the mandatory program because they believe they cannot be spared from their regular duties.

Major General Semianiw told the Committee that the Department has taken steps to document the status of its health care providers:

As part of the Rx2000 reforms, it was decided to reinstitute external accreditation of CF health services. As part of this process, a Canadian Forces national credentialing cell was recreated in mid-2007. To date the cell has achieved license verification for 100% of physicians and dentists, 96.7% of pharmacists, and 79.9% of nurses. A new Canadian Forces credentialing policy is set for release in February 2008.^[14]

However, this does not specify whether or not these licenses are in the provinces in which they are practicing, nor does it address the issues with medical technicians and physician assistants.

In response to the OAG’s recommendation to ensure that gaps in the clinical skills are identified and closed in a timely manner, National Defence responded that, “attainment of the required levels of skills maintenance remains problematic due in large measure to the current operational tempo and shortages of clinicians.”^[15]Indeed, Brigadier General Jaeger confirmed that National Defence continues to have difficulties with staffing:

We don't have enough uniformed bodies to really make the program work the way it was intended to—we have focused on identifying those people who are coming to deployment in the next year or so and pulling out all the stops we can to make sure that they get brought up to speed in time for their deployment. That has resulted in relatively less effort for those who stay behind.^[16]

As the Committee believes that it is very important that National Defence ensures that its health care practitioners are licensed and maintain their skills, the Committee would like to have ongoing information about the department’s progress in this area. Consequently, the Committee recommends that:

Recommendation 5

National Defence confirm in its annual performance report that all physicians, nurses, dentists and pharmicists are licensed to practice, and that all medical technicians and physician assistants are certified. National Defence should also report the number of practitioners who take advantage of the Maintenance of Clinical Skills Program.

The audit found that there is little oversight of the military health care system to ensure that patient needs are met and services are provided in a cost-effective manner.^[17] There is no mechanism to monitor the system’s ability to deliver services or means for users to challenge the quality and nature of the services available.

           

Major General Semianiw told the Committee that he has raised the level of the review committee which makes health care entitlement decisions. He said:

CHaving the Armed Forces Council, the leadership of the Canadian Forces—the Chief of Defence Staff, the Vice-Chief of Defence Staff, the Chief of the Air Staff, the Chief of the Maritime Staff, and the Chief of the Land Staff—make decisions about Canadian Forces personnel health care entitlements will help Canadian Forces health services ensure that costs incurred are indeed related to patient requirements and operational needs.^[18]

While the Committee agrees that the involvement of senior leadership is vital in making decisions about the military health care system, National Defence also needs to have input from Canadian Force members using the services, as well as health care providers delivering the services. National Defence needs to have a mechanism to bring together these three groups to provide the necessary oversight, guidance, and accountability to the military health care system. Thus, the Committee recommends that:

Recommendation 6

National Defence develop a governance framework for its military health care system that involves senior leadership, health care providers, and Canadian Forces members using the system.

On April 3, 2008, the Interim Ombudsman for the Department of National Defence and the Canadian Forces released a special report entitled “Reserve Care: An Investigation into the Treatment of Injured Reservists.” According to the report, Ombudsman investigators found that Canadian Forces Reservists who are injured in the course of their duties face a host of challenges in accessing timely, adequate and ongoing medical care that Regular Force members do not. The Ombudsman concluded that the Canadian Forces regulations and policies relating to the health care entitlements of reservists are obscure, complex and confusing.

The Committee is quite concerned by the inconsistent and unpredictable standards of care provided to Canadian Forces Reservists who should be treated fairly and equitably. The Committee trusts that the Department of National Defence will take the report of the Ombudsman very seriously and seek to ensure that Reservists receive quality health care in a timely manner.

Members of the Canadian Forces serve their country honourably by being willing to put their lives at risk, and many are currently doing so on a daily basis on deployment in Afghanistan. In return for their willingness to sacrifice their health and safety, they have a reasonable expectation that they will receive quality health care services. Consequently, the Department of National Defence must have the systems and practices in place to ensure that the military health care system is providing quality services. However, the audit by the Office of the Auditor General found that the Department does not have the information available to provide that assurance. National Defence is working to fix the deficiencies identified by the audit and developed an action plan in order to demonstrate its commitment. The Committee believes that it is necessary to hold the Department to account to fulfilling those commitments by having the Department provide a progress report and by publicly reporting information in its departmental performance report. Providing such information will help assure Canadians and Regular Forces members that the military health care system is meeting its goals.