Treasury Board of Canada Secretariat
Symbol of the Government of Canada

ARCHIVED - National Defence - Supplementary Tables


Warning This page has been archived.

Archived Content

Information identified as archived on the Web is for reference, research or recordkeeping purposes. It has not been altered or updated after the date of archiving. Web pages that are archived on the Web are not subject to the Government of Canada Web Standards. As per the Communications Policy of the Government of Canada, you can request alternate formats on the "Contact Us" page.

Response to Parliamentary Committees and External Audits


1st Report of the Standing Committee on National Defence, 39th Parliament, 1st Session, "Canadian Forces in Afghanistan" (Adopted by the Committee on June 12, 2007; Presented to the House on June 18, 2007)
Original report
Government response

Recommendation Government Response/Commitment Status
6. The government should recognize the critical and growing work done by the Operational Stress Injury Social Support Network and support it with appropriate funding and other resources, so that it can keep up with the growing need of caring for returning Afghanistan Veterans and their families. The Government recognizes the critical work being done by the Operational Stress Injury Social Support (OSISS) network and has allocated additional resources to support the program's growing needs.

Since the launch of the OSISS network in February 2002, Department of National Defence (DND) funding for OSISS initiatives has increased every year. To meet the rising demand for services, the Government approved a 25% increase in DND's funding for OSISS for fiscal year 2007-2008, bringing the total to $2.6 million. This increased funding will allow OSISS to hire two new peer support coordinators for military members and veterans, six new family peer support coordinators, four regional coordinators, and one speakers' bureau coordinator.

Veterans Affairs Canada (VAC) also contributes $500,000 annually to support ongoing OSISS operations and to contribute to the management and delivery of the program. Furthermore, Budget 2007 provided an additional $1 million annually to VAC to allow OSISS to hire additional family peer support coordinators and support staff, demonstrating the Government's commitment to this worthwhile program.
Since the launch of the OSISS network in February 2002, National Defence funding for OSISS initiatives has increased every year. In 2006, the program launched a Bereavement component to support families who lost a loved one. In fiscal year 2007-2008 alone, the Government approved a 25% increase in the Department's funding for OSISS. DND implemented a regional management structure to the program in March 2009 recognising the importance of supporting front line staff and to create a more robust case management capacity within the program and a new agreement was signed with VAC in 2010 to ensure effective and efficient co-management of the program. A comprehensive strategy has now been developed leveraging the success of OSISS that includes the development of a comprehensive education/prevention initiative to mitigate Operational Stress Injuries as well as general Mental Health problems, decrease stigma, provide tangible tools for leaders to intervene at their levels and remove many of the existing barriers to mental health care.

11th Report of the Standing Committee on Public Accounts, 39th Parliament, 1st Session, "Chapter 2 of the May 2006 Report of the Auditor General of Canada on National Defence - Military Recruiting and Retention" (Adopted by the Committee on November 30, 2006; Presented to the House on December 7, 2006)
Original report
Government response

Recommendation Government Response/Commitment Status
2. That the Department of National Defence report progress in the implementation of its action plan to strengthen the recruitment and retention of military personnel in its annual Departmental Performance Report, beginning with the Report for the period ending 31 March 2007. The Department should also report progress in implementing its national recruiting attractions plan as well as its strategic guidance on national recruiting. In making this information available to Parliament, the Department must make clear reference to the outcomes that are being achieved. The Department of National Defence will ensure that the information identified in this recommendation is included in its annual Departmental Performance Report beginning with the report for the period ending 31 March 2007. The National Attractions Plan is embedded in the CF Recruiting Group's Annual Operations Plan, which has been published for the past four years. Overall recruiting targets for fiscal year 2009-10 were achieved with a total intake of 7522 personnel representing 100.9% of the intake goal. Significantly, of the 19 Priority Occupations (the most distressed occupations assessed as being the most difficult to recruit into) CF Recruiting Group achieved 100% of the intake in 13 occupations and greater than 90% in 4 of the remaining occupations for fiscal year 2009-10. The Strategic Guidance on National Recruiting was published in Feb 2007.
3. That the Department of National Defence establish a formal commitment to process applications for membership in the Canadian Forces within thirty days, ensure that all applicants are made aware of that commitment and report its progress in meeting those goals in its annual Departmental Performance Report. The Government will continue to explore additional opportunities to streamline applicant processing and is progressing with the development of a robust performance measurement system based on the Treasury Board framework for service standards. Progress in meeting the goals identified above will be included in the annual Departmental Performance Report for the Department of National Defence, beginning with the report for the period ending 31 March 2007. Attainment of the goal for applicant processing of 30% completed in 5 days and 70% in 30 days continues to be a significant challenge. Improvements were made in applicant service, eliminating waiting time and in the prioritization of processing. While the Commanding Officers of Recruiting Centres have been given the authority to conduct parallel processing in order to maximize the use of their resources at any given time and ensure concurrent activity, significant delays still exist in resolving three key issues: delays due to difficulties in resolving medical issues discovered during medical fitness evaluations that require additional information from an applicant's civilian medical specialist, delays due to confirmation of pre-security screening requirements and, in many cases, delays waiting for applicants to provide information missing from incomplete applications.
8. The Department of National Defence determine the rate of attrition for female members of the Canadian Forces and, in its exit surveys, seek to establish which factors prompt female members to leave the Forces before full service is completed. The results, along with corrective measures taken to encourage women to complete their full service should be reported in the Department's annual Performance Reports, beginning with the Report for the period ending 31 March 2008. A comprehensive survey analysis that will be conducted in the fall of 2007 will allow the Government to better understand the reasons female members of the Canadian Forces decide to leave the military. Should trends be identified that indicate a need for change, the Government will initiate appropriate corrective measures. The results of this survey analysis, together with any corrective measures undertaken, will be reported in the Departmental Performance Reports, beginning with the report for the period ending 31 March 2008. The CF Retention Strategy approved by AFC in March 2009 with its six lines of operations and 43 initiatives continues to be advanced on a number of fronts (the main lines of operations are Career/Employment Management, Career/Family Balance and Basic Training). CF attrition research has been expanded on and research focussed on female attrition and retention has been completed for naval officer occupations as well as for air force officers in the Pilot and Air Combat Systems Operations occupations. A comprehensive 20 year comparison of overall male and female attrition rates was included in the first Annual Report on Regular Force Attrition (fiscal year 2007-08). Several studies have been undertaken to investigate attrition occurring during the first year of service (YOS) as well as attrition patterns for CF members deployed on Task Force Afghanistan (TFA). In support of the CF Retention Strategy, the CF Retention Survey and CF Exit Survey continue to be administered to gather data on turnover intentions of CF personnel.

Female Attrition Rates for the CF Regular Force
Fiscal Year Officers Non-Commissioned Members
2001-02 4.7% 6.9%
2002-03 6.5% 6.7%
2003-04 6.6% 6.5%
2004-05 5.4% 6.3%
2005-06 6.0% 6.2%
2006-07 5.0% 8.1%
2007-08 6.9% 9.8%
2008-09 6.0% 8.4%
2009-10 7.0% 8.7%

The attrition rates for females in fiscal year 2009-10 were higher than those for men. Female rates had increased over the past year whereas rates for men had decreased from 7.2% in fiscal year 2008-09 to 5.9% in 2009-10 for officers and from 9.6% to 7.5% for NCMs. (Fiscal year 2009-10 rates are preliminary).

9. The Department of National Defence begin to report the results of the exit surveys it conducts among members of the Canadian Forces in its Departmental Performance Reports beginning with the Report for the period ending 31 March 2007. References to the methodology and scope of the surveys should be included. The Department of National Defence will ensure that the information identified in this recommendation is included in its annual Departmental Performance Report. However, since the comprehensive analysis of survey results will not commence until the fall of 2007, the reporting of these results can only begin with the report for the period ending 31 March 2008. The Exit Survey is given to all Regular Force members who are leaving the CF voluntarily. Survey completion is voluntary. The objective of the analysis of Exit Survey data is to assess departing members' satisfaction (agreement) with several organizational issues as well as determine the extent to which these organizational issues and dissatisfiers influence their decision to leave the CF. Final reports detailing analysis of data collected from 2005 to 2008 will be released by September 2010. Analysis of data collected with the ongoing version, administered since summer 2008, has begun. As well, the CF Retention Survey, which is administered to occupations that are "at-risk" with regards to attrition, is used to explore specific work and non-work related items and their impact on whether an individual intends to stay in or leave the CF in the next five years. Results from the 2008 CF Retention survey are currently being analyzed and published by occupation. The 2010 CF Retention survey is in the field and data analysis will begin later this year. Results of the 2010 Retention survey will provide performance measures to the CF Retention Strategy.
10. That the Department of National Defence establish a target for the maximum acceptable rate of attrition of its trained effective strength and monitor the performance of the package of measures it has instituted to meet that target. The Department should begin to report its progress in its annual Departmental Performance Report beginning with the report ending 31 March 2007. The Government will include data regarding attrition rates in the Department of National Defence annual Departmental Performance Report beginning with the report ending 31 March 2007. However, the data will be based on trend analysis as opposed to pre-determined targets. Due to the number of factors influencing attrition that are beyond the control of the CF, including the state of the Canadian economy, instead of establishing a target for the maximum acceptable rate of attrition of its trained effective strength, the CF closely monitors all aspects of attrition and uses statistical modelling to forecast attrition for each occupation for each fiscal year. These forecasts are used in formal, structured processes to determine the number of personnel who need to be recruited for each occupation for each fiscal year and are published as the Strategic Intake Plan. During the fiscal year, actual recruiting and attrition are monitored on a month-by-month basis and the Strategic Intake Plan is adjusted as required.

While voluntary Regular Force attrition between 2006 and 2008 increased from 4% to 6.9%, this rate increase was manageable in that the CF had the capacity to recruit and train sufficient personnel necessary to replace those who left. However, the additional requirement to recruit and train personnel to meet Force Expansion targets strained both the recruiting and training systems.

During fiscal year 2009 - 2010 the Strategic Intake Plan was set at a higher than traditional level and sought to enrol 7,454 personnel. Actual recruiting exceeded this target, with 7,522 personnel being brought into the Regular Force. Projected attrition was 6,250; however, with the downturn in the economy and a successful CF Retention Strategy, only 5,293 personnel left the Regular Force this past fiscal year. Consequently, with recruiting up and attrition down, the CF grew by 2,229 personnel during this timeframe. The overall strength of the Regular Force as of end-March 2010 was 68,124 personnel and slightly surpassed the 2011-2012 growth target of 68,000.

Now that Force Expansion requirements have been met, the Strategic Intake Plan for the next few years will be reduced to approximately 5,000 new recruits each year. This reduction will alleviate the strain on the recruiting system. However, surge recruiting that occurred during the past few years created a backlog of personnel undergoing basic and initial occupational training. Efforts are being made to increase training capacity and to move these personnel from the Basic Training List to the Trained Effective Strength as quickly as possible; however, due to the length of many technical and professional training programs, it will take a few years before the Trained Effective Strength sees a substantial increase.

15th Report of the Standing Committee on Public Accounts, 39th Parliament, 1st Session, "Chapter 5 - Relocating Members of the Canadian Forces, RCMP, and Federal Public Service of the November 2006 Report of the Auditor General of Canada (Adopted by the Committee on May 16, 2007; Presented to the House on May 29, 2007)
Original report
Government response

Recommendation Government Response/Commitment Status
5. That the Department of National Defence, the Royal Canadian Mounted Police, and Treasury Board Secretariat include, in their annual Departmental Performance Reports, references to the Integrated Relocation-Program as it relates to their employees. Information on the numbers of employees using the Program, the costs, and the extent to which the purposes of the Program are being achieved must be included. This performance information must be included in DPRs beginning with Reports for the period ending 31 March 2008. The Government accepts this recommendation. The purpose of the Integrated Relocation Program (IRP) is to relocate CF personnel and their families in the most efficient fashion and at the most reasonable cost to the public while having a minimum detrimental effect on the employee and family, and on departmental operations.

During fiscal year 2009/10, the CF authorized the service provider, Royal Lepage Relocation Services (RLRS)/ Brookfield Global Relocation Services (GRS), to effect relocations for 16,859 personnel. Of those, 16,653 were activated and it is estimated that as many as 15,900 members actually relocated. Records indicate that the administration fees paid to RLRS/Brookfield GRS for providing relocation services totalled just under $26 million, including GST. The summation of the flow through costs for reimbursements made to CF personnel for relocation benefits were slightly greater than $242 million. All of these figures reflect slight increases over the previous year.

A new IRP contract was awarded to Brookfield Global Relocation Services (GRS) in 2009 and became effective on 1 December. It should be noted that this is the same company that held the previous contract as Royal LePage Relocation Services has simply changed its name to Brookfield GRS. No new CFIRP Manual has been issued this year. Instead the 2009 Manual is still in use in combination with a series of Clarification Bulletins. The Manual and Bulletins are all available on line. The Service Level Agreement between DRBM/DGCB and DGMPRA has changed such that DGMPRA now only collects data for Customer Satisfaction Surveys with analysis now being conducted by DRBM. The most recent data has only just been received in DRBM in June (with an approximately 8% response rate) and has not yet been analysed.


2nd Report of the Standing Committee on National Defence, 40th Parliament, 2nd Session, "Health Services Provided to Canadian Forces Personnel with an Emphasis on Post-Traumatic Stress Disorder" (Adopted by the Committee on June 8, 2009; Presented to the House on June 17, 2009)
Original report
Government response

Recommendation Government Response/Commitment Status
1. The Minister of National Defence and Chief of the Defence Staff to make a joint public announcement to all Canadian Forces ranks, outlining a high-profile effort to pursue a modern, enlightened and unequivocal view of mental health issues in the Canadian Forces. All commanders of commands, formations and units to deliver complementary declarations to their personnel, to reinforce local implementation.

The Government is dedicated to pursuing a modern, enlightened and unequivocal view of mental health issues in the CF and has already taken steps to implement the Committee's recommendation. On 25 June 2009, the Chief of the Defence Staff (CDS) made a public announcement to launch the CF Mental Health Awareness Campaign, themed "Be the Difference," which has the dual aim of educating CF personnel on mental health issues, and building a culture of understanding. In his speech, the CDS communicated the idea that all personnel can make a difference to those affected by mental health issues. He also highlighted the success of two CF non-clinical programs: the Mental Health and Operational Stress Injury Joint Speakers Bureau, established in 2007 to educate the military community on mental health issues; and the Operational Stress Injury Social Support network, an innovative peer-based intervention program established in 2001.

CF efforts to date have had success in raising awareness and understanding of mental health issues among the leadership cadre. However, much remains to be done at the lower rank levels to ensure that they too understand that mental illness is a genuine illness and not a personal failing. As part of the CF Mental Health Awareness Campaign, commanders of commands, formations and units will also be encouraged to deliver complementary declarations to their personnel to reinforce implementation at the local level.

This has been completed. It is continuing with the role-out of the "Be The Difference" campaign across the CF. As this is non-clinical mental health it falls more under the responsibility of CMP. This campaign launch was accompanied by the distribution of print and audio-visual materials to all units across the CF, and a general message was issued to the CF population. A follow-up awareness campaign is also being implemented at major bases across Canada with the support and participation of local leadership.
2. The Department of National Defence to cause an independent audit to be conducted of military patient case management practices, to determine the extent to which a gap exists between expressed Canadian Forces policy and the actual practices applied to the continuing treatment and care of injured Canadian Forces personnel. Once defined, appropriate measures should be taken, throughout the chain of command, to eliminate the gap and improve patient care. Several authorities external to the CF have recently reviewed these issues, including the Office of the Auditor General, the CF Chief Review Services, the CF Ombudsman, the Mental Health Advisory Committee - a civil-military body with participation from DND, VAC, the RCMP and academics - to examine and make recommendations regarding mental health issues. Accreditation Canada, a not-for-profit, independent organization that is recognized as the national authority for the establishment and assessment of health care standards and the accreditation of health care institutions, also specifically assesses concordance between policy and practice. Gaps and action plans are well defined and further reviews are planned, such as Accreditation Canada's audit of the entire CF health system and the Mental Health Advisory Committee's ongoing reviews. In addition, an international panel of experts, led by the Deputy Surgeon General and including military and civilian experts from Canada, the United States, the United Kingdom, Australia and the Netherlands, will be reviewing and discussing each nation's experience with suicide prevention/education, as well as current literature and evidence-based best practices, this fall (22-23 September 2009). The Government looks forward to the outcome of all of these studies and will make every effort to implement recommended measures to eliminate the policy-implementation gap and further improve patient care. Accreditation Canada's audit of the CF Healthcare System continues. As per initial Government response, if and when any gaps that exist between expressed Canadian Forces' policy and the actual practices applied to the continuing treatment and care of injured Canadian Forces personnel, appropriate measures are taken, throughout the chain of command, to eliminate the gap and improve patient care. This item should be considered complete.
9 . The Canadian Forces to ensure that members and their families are provided with information about the risk of domestic violence that is associated with OSI and PTSD, and to provide services to family members who are at risk of or suffering from domestic violence as a result of OSI or PTSD. The Government has already taken actions to address this issue. A CF directive has been issued outlining the steps to be followed when an incident of family violence occurs. It explains the CF policy on family violence, establishes a framework for management/implementation of the policy at both national and unit levels and assigns responsibility/authority for the various elements of the policy. The CF has also adopted an interdisciplinary team including health care providers, chaplains, Military Police and Military Family Resource Centre staff who assist in educating the CF on the prevention of family violence as well as responding to incidents. Moreover, the newly formed Mental Health & OSI Joint Speakers Bureau is currently developing new mental health educational curriculum, which will include information about the risk of domestic violence associated with OSI and PTSD, and coordinating its delivery. While the new curriculum is being developed, the focus within the CF is on how to motivate CF members to encourage their families to attend information sessions where the link between domestic violence and OSI is discussed. Families have access to social support through trained Family Peer support coordinators within the OSISS program. The Mental Health & OSI Joint Speakers Bureau has developed new mental health educational curriculum that is specific to families and deployment which includes information about potential negative behaviours associated with OSI and PTSD. New curriculum for families is also under development regarding mental health in general which will which will include information about the risk of domestic violence associated with OSI and PTSD, and a web-based delivery of this curriculum is being explored to render it accessible to all families. While the new curriculum is being developed, the focus within the CF is on how to motivate CF members to encourage their families to attend information sessions where the link between domestic violence and OSI is discussed. The CF continues to take a proactive stance in preventing family violence through education and awareness. The CF Family Violence Prevention and Awareness Campaign "Take a Stand Against Family Violence" was launched in 2007 and runs the second week of October each year. The campaign is intended to encourage open and frank dialogue on the prevention of family violence. The campaign includes posters, brochures, and family fact sheets, distribution of briefings and a resource database for use by responders/service providers, and localized base/wing activities. The CF Family Violence Prevention and Awareness Campaign is implemented locally through Base/Wing Family Crisis Teams, Military Family Resource Centres or the Strengthening the Forces Health Promotion Office.
10. The Canadian Forces to develop a formal outreach program to educate contracted health care professionals about the unique nature of military experiences encountered on international missions, particularly those involving any degree of combat. The Government is currently working in this direction. Local level initiatives, such as the collective clinical training offered at CFB Gagetown and Valcartier for all health care professionals, are already well underway to develop such an understanding among both Public Service and contracted health care professionals, but there would be benefit in a more formal approach. To this end, the CF Health Services Group recently began developing a civilian personnel orientation package geared initially to Public Servants and civilian contractors. The package is expected to include information on the military culture, organization, terminology and domestic and international operations, including those involving combat, as well as occupational health aspects of the military. It could be completed as early as November 2009. Local initiatives continue to be developed that include information not only for healthcare providers but family members of CF Personnel. Work also continues on developing a civilian personnel orientation guide. This guide was not completed by November 2009 as initially anticipated and a new completion date has not been determined at this time.
11. The Canadian Forces to formally recognize the requirement to include, where appropriate, selected family members in the treatment regime of psychologically injured personnel and take measures to ensure they are consulted and included in treatment plans, to the extent it is helpful to do so. The Government fully recognizes the value-added of family members in the treatment of personnel injured either physically or psychologically. The inclusion of family members, where relevant to the health care of CF patients, is a long-established practice. The CF has issued an instruction on Member Focused Family Care which formally recognizes the importance of family inclusion in the care of the member and provides the opportunity for family members to be seen in CF clinics in support of the member and to participate in psycho-education programs. These programs are conducted at the regional centres. Families are brought into the clinic for an intensive one week training program to educate them about the CF members' condition and their involvement in the care and support to the member. Completed.
12. Where injured Canadian Forces members require continuing assistance in navigating an administratively complex programme of treatment and care, the Canadian Forces to facilitate the use of a designated advocate chosen by the member and provide an appropriate level of cooperation with such advocate. Canadian Forces members to be advised of their right to an advocate. Given the concerns of additional stresses on family members, potential advocates to include retired members of the Canadian Forces and other professionals (e.g. medical doctors, psychologists, spiritual/religious advisors). The Government recognizes the need to assist CF members in navigating the sometimes complex administration of treatment and care. The last thing injured personnel and their families want is an additional source of stress. There are already many professionals/entities responsible for advocating on the injured member's behalf, including Case Managers, Peer Counsellors, Veterans Affairs Advocates, the Integrated Personnel Support Centres (IPSC) and the chain of command. There has been an increased focus on identifying and correcting the deficiencies in the current system, including through the stand-up of the new Joint Personnel Support Unit (JPSU) that provides a one-stop shop for ill and injured members. Services offered by the JPSU include advocacy on a variety of issues such as the administration of health care. To bolster the implementation of the JPSU/IPSCs, two services targeted at supporting the families of the ill and injured were introduced:
  • Family Liaison Officer: Dedicated support to the families of CF personnel with an illness, injury, or special need; and
  • Casualty Support Child Care: Child care services for the families of the ill and injured and the families of the fallen.
13. The Canadian Forces to give primary consideration to the continuity of quality care for recovering soldiers, over career development options. The Government agrees that the health of our recovering men and women in uniform should always come first and that CF personnel should not be moved from one location to the other if such a move has the potential to adversely affect their recovery. This is particularly important in the case of mental health issues such as operational stress injuries and PTSD where the stability of the relationship between a patient and his/her mental health professional is crucial to ensure the success of the treatment and the full recovery of the member. While medical officers assign military employment limitations to patients in need of particular care or treatment when necessary to ensure that appropriate continuity of care is achieved, it may not always be clear to career managers that they should avoid posting a member away from his/her unit. The Government recognizes that this is an issue and the CF is committed to look into ways of improving its record in this area. In doing so, the CF will reach for a delicate balance between continuity of care and professional development, one that will put the health of our men and women in uniform first, while avoiding being an obstacle to career progression - which could make members reluctant to report the symptoms of mental health illnesses. Director General Military Careers will continue to work with the other agencies within Defence that are charged with the care of the ill and injured to ensure that ill and injured members are treated with compassion. However, the boundaries imposed by the principle of universality of service and the National Defence Act must also be considered. To this end, a special board has been stood up, chaired by Chief Military Personnel with senior membership from the environmental commands, to ensure that decisions on the future employment of members wounded in action receive consideration at the highest level possible. Likewise, policy has been put in place to allow for the retention of ill and injured personnel who breech the terms of Universality of Service, but are employable 5 days a week during normal working hours for a transition period of up to 3 years. On completion of this period, the Director of Casualty Support Management, in cooperation with the staffs of the Joint Personnel Support Unit (JPSU) and Veterans Affairs Canada will ensure that the member receives the support required to transition to a civilian career, and ensure that they receive all of the pension/medical benefits associated with their condition. For those members whose condition does not allow them to be employed, they will be retained for a period of up to 6 months during which time the Director of Casualty Support Management, working with the agencies mentioned above will ensure a smooth transition plan into civilian life.
14. The Canadian Forces to monitor the mental health of its members for five years after deployment on operational missions, to ensure effective treatment and tracking of mental health issues. The Government supports the need for sustained tracking of CF members' mental health. In fact, the CF monitors the mental health of its members not just for five years after an operational tour of duty, but throughout their entire career. The mechanisms for doing this include opportunities to self-report concerns through a mandatory end of deployment report and during Third Location Decompression, a mandatory enhanced post-deployment medical and psycho-social/mental health screening a few months post-deployment, an ongoing systematic program of Periodic Health Assessments for the duration of the member's career, the opportunity to self-identify and self-present for care at any time, and a final pre-release health assessment. Supervisors also have the responsibility to monitor the well-being of their subordinates and refer them to help if necessary. Completed.
15. The Canadian Forces to recognize there still exists a certain culture, perhaps even a prejudice, regarding how mental illness is perceived among its rank and file.

The CF recognizes the stigma attached to mental health and is very pro-active in addressing this issue. The newly formed Joint Speakers Bureau, which includes mental health clinicians and OSI veterans, has been actively educating CF members and the chain of command at all stages of a member's career on mental health and the importance of creating a supportive environment so members can come forward early for mental health care. More recently, the CDS campaign raised the importance of mental health as a leadership issue. There is evidence that these efforts to decrease stigma have been successful in that members are seeking help much earlier when mental issues arise, indicating a significant reduction in stigma as a barrier to care. Moreover, the Global Business and Economic Roundtable on Addiction and Mental Health recently "praised the military for its success in taking some of the stigma out of mental illness." Mr. Bill Wilkerson, the Chairman of the Roundtable, stated that "the military and paramilitary have crossed the Rubicon in recognizing that mental illness is a real expression of ill health and not weak character."

Information on mental health and OSI is already included in all Basic Military Qualification Training for commissioned and non-commissioned members, as well as Primary Leadership Qualification and Advanced Leadership Qualification. However, the CF is currently reviewing the detailed descriptions of the knowledge, skills, and other attributes required for all members of the CF for both officers and non commissioned personnel. This review is expected to result in the addition of OSI information to a greater number of courses. As of 1 October 2009, there will also be a standardized mental health and OSI pre-deployment education for all CF members, including leaders at all levels. This pre-deployment education will include recognition of behaviours often associated with mental health conditions, possible interventions, as well as information about available resources.

Information on Mental Health (MH) and Operational Stress Injuries (OSI) is currently taught during eight 40-minute periods throughout the Basic Military Officer Qualification (BMOQ) and Basic Military Qualification (BMQ) courses for commissioned and non-commissioned CF members, respectively. Additional content on the subjects are also provided on the other courses later during a member's career on the Primary Leadership Qualification (ten 45-minute periods), the Intermediate Leadership Qualification (two 45-minute periods) and the Advanced Leadership Qualification (eight 45-minute periods). The CF continuously reviews the training to update or add new knowledge and course content. The intent of future reviews on MH/OSI training is to add knowledge to courses where no training currently exists or to improve existing training. In the fall of 2009, preparations were made to provide a standardized MH/OSI pre-deployment education for all CF members, including leaders, at all levels. This pre-deployment education includes recognition of behaviours often associated with mental health conditions, possible interventions, as well as information about available resources. The pilot course was delivered in December 2009. Implementation of the training is scheduled for Task Force 3-10 in June 2010 in Valcartier, with 2,500 personnel to be trained. There is an additional phase of this training which involves family members of those being deployed, with on-site training on two bases for now, and also via Webinar for those who are not in close geographic proximity to a base, wing or Military Family Resource Centre. For the basic military qualification courses, a working group met in April 2010 to completely review the content and prepare for delivery of a three-phase building block process to teach and coach the members' skills throughout their career and deployment cycles. The training will be implemented starting in January 2011 and involves a three-phase approach based on three specific time periods within the basic military qualification courses (around 2nd week, 7th week and 13th week) when guest speakers from Health Services Group/Joint Speakers Bureau introduce MH/OSI topics as follows:

Phase 1 - First Teaching Block: definitions, coping skills;
Phase 2 - Middle Teaching Block: skill reaffirmation such as what do you remember, how have you applied what you learned so far, goal setting; and
Phase 3 - Last Teaching Block- resilience, getting help, types of resources, demystifying MH, fears of stigma, resource barriers, suicide and addictions.

18. The Department of National Defence and the Canadian Forces to move to co-locate all medical facilities on military bases, in a manner that supports the concept that all injuries and ailments will be treated with equal respect and that works to eliminate any lingering stigma associated with mental health issues. The Government adheres to this concept and has made every effort to co-locate all medical facilities on military bases. While challenges remain, these are due to infrastructure limitations rather than a lack of desire to co-locate. As new clinics are built as part of the Canadian Forces Health Services (CFHS) Infrastructure Recapitalization Project, all services will be integrated in one facility. This project will ensure that all CF clinics meet health care standards and that they provide appropriate layout and space for staff to operate effectively. The current Canadian Forces Health Services Infrastructure Plan takes in to account this recommendation and will ensure collocation of all medical facilities on military bases. This item should be considered complete.
19. The Department of National Defence to ensure that adequate resources are allocated to the establishment of a sufficient number of the Joint Personnel Support Units and Integrated Personnel Support Centres to provide this level of support and service nation-wide. DND continually strives to improve the resources, both financial and human, to support establishments throughout the country. Up to now, there is one Joint Personnel Support Unit with 19 Integrated Personnel Support Centres in its chain of command across Canada. Work is ongoing with the CF to assess the need for additional centres. The implementation of the full scope of the new capability is expected during fiscal year 2010-11.
20. Reserve unit chains of command to be intimately and proactively involved in ensuring their returning personnel complete the post-deployment process on time, including all necessary administration, interviews and medical appointments. Where individual Reservists are undergoing continuing care and treatment after full-time service, Reserve unit chains of command to remain in regular contact with CFHS case managers and to take an active interest in the soldier's treatment programme.

The Government agrees that the military chain of command must be fully engaged in the health of their returning personnel. To ensure that returning Reservists complete all the necessary administration, interviews and medical appointments, DND has implemented a program known as the Reserve Medical Link Team whereby all returning Reservists are contacted and tracked to ensure that post-deployment screening is completed. To date, 90% of Primary Reserve members who participated in ROTO 5 of the CF mission in Afghanistan have been contacted, with final contact taking place 12 months after their return to Canada. Approximately 80% of Primary Reservists participating in ROTO 6 have now had initial contact. The Reserve Medical Link Team also liaises regularly with CF Case Managers and the situations of all Primary Reserve members requiring care are discussed in case conferences that review individual health care needs and management plans.

The Government has already taken steps to address the issue covered by this recommendation. The Reserve Medical Link Team has implemented a program that provides annual briefings on health benefits, entitlements, access to care, post-deployment screening and contact information. These annual briefings are mandatory for all members of a Reserve unit, with frequent additional briefings to the units' command elements, and include information on the recognition of the signs and symptoms of OSIs, as well as information on how to access treatment. This program covers a very broad range of mental health illnesses (including PTSD, anxiety, depression, sleep and other disorders, etc.) attributable to operations and each of these illnesses has its specific treatment regime.

In this program's first year of operations, 90% of target Army Reserve units were briefed. During its second year, Air and Naval Reserve units will be included. All remaining Reservists will be included in the third year of operations. In addition, the newly formed Joint Speakers Bureau which includes mental health clinicians and OSI veterans has been actively educating CF members and the chain of command at all stages of a member's career on mental health and the importance of creating a supportive environment so members can come forward early for care.

The Reserve Medical Link Team process has continued since its inception approximately 2 years ago. The process involves information briefings on entitlements to all Reserve stakeholders and staged contacts with deployed Reservists ending one year post return to Canada. To date, Primary Reserve members who participated in ROTO 5 of the CF mission in Afghanistan have been contacted a minimum of 3 or more times. The initial screening of this ROTO is considered complete. To note, there are individual cases of soldiers who, while initially self-reporting as well, have now reported concerns related to reintegration (i.e. sleeping problems, nightmares, family issues, and increased alcohol consumption). All of these members are being tracked and referred to appropriate agencies both internal and external to Defence. Initial screening of ROTO 6 has also been largely completed with approximately 77 % having responded to second contact at the 6 month point. ROTO 7 is still in progress with approximately 65% of the members having responded to initial contact. The Reserve Medical Link Team has recently begun contacting those members deploying in smaller numbers to other international operations which are on-going.
22. The Minister of National Defence and the Canadian Forces to continue to strive for the compassionate application of existing regulations regarding universality of service and minimum operational standards, to allow the continued employment of recovering soldiers, as long as such employment contributes to Canadian Forces operational requirements. DND and the CF always strive to treat their members with compassion, while also respecting the boundaries imposed by the principle of universality of service and the National Defence Act. There are currently a number of existing and planned policies designed to retain recovering CF personnel. For example, the CF is authorized to retain personnel who are unable to meet the full requirements of universality of service for a limited period of time as long as they are employable. In addition, there are opportunities available for personnel to serve in a Reserve Force component, which is not subject to the same condition of universality as the Regular and Primary Reserve Forces. Treating our injured men or women in uniform with compassion is the least we can do in respect for the sacrifice they are willing to make for their country.

Policy - Director General Military Careers will continue to work with the other agencies within Defence that are charged with the care of the ill and injured to ensure that ill and injured members are treated with compassion. However, the boundaries imposed by the principle of universality of service and the National Defence Act must also be considered. To this end, a special board has been stood up, chaired by Chief Military Personnel with senior membership from the environmental commands, to ensure that decisions on the future employment of members wounded in action receive consideration at the highest level possible. Likewise, policy has been put in place to allow for the retention of ill and injured personnel who breech the terms of Universality of Service, but are employable 5 days a week during normal working hours for a transition period of up to 3 years. On completion of this period, the Director of Casualty Support Management, in cooperation with the staffs of the JPSU and VA will ensure that the member receives the support required to transition to a civilian career, and ensure that they receive all of the pension/medical benefits associated with their condition. For those members whose condition does not allow them to be employed, they will be retained for a period of up to 6 months during which time the Director of Casualty Support Management, working with the agencies mentioned above will ensure a smooth transition plan into civilian life.

Career management - a cell of 3 dedicated career managers has been set up to manage the careers of the ill and injured. Once a CF member is posted to the SPHL, the management of their careers is turned over from their occupation CM to one of the 3 Ill and Injured CMs. These individuals will facilitate all necessary moves for the members' rehabilitation, they liaise with all of the other CF care providers on the members' behalf, they personally meet (either in person or through electronic means) with each of the ill and injured, they conduct annual briefings and interviews with the individuals and their CoCs, and they ensure, whenever possible, that career coursing continues if the individual's medical situation allows. Once the member has recovered, the CM for the Ill and Injured will then ensure that the member is transitioned back into his environment, and his or her career management is transitioned back to the environmental CM.

23. The Department of National Defence to immediately provide enhanced transportation resources (such as modern multi-passenger vans or highway cruiser buses and drivers) to isolated military bases to ensure that military personnel and family members have adequate transportation for access to out-of-town health care services and medical appointments. DND is currently looking at ways for ill and injured members, and the members of their families who are involved in their treatment, to have access to transportation to access out-of-town health care services, if required. In some locations, Base Commanders have also expended funds to secure accessible transport to enable those requiring assistance to attend appointments with health care providers. Ongoing. Vehicles are acquired as needed.
24. The Canadian Forces to remind personnel that they have an obligation to keep their families fully informed of medical and social support services available to them. The Canadian Forces to continue to encourage military families to engage those medical and social support services. The Government recognizes the important role families play in enabling the operational effectiveness of the CF and appreciates the unique nature of military life. Every effort is being made to encourage CF members and their families to use the support resources that are made available to them. In 2008, DND's Chief Military Personnel initiated a transformation initiative, specifically targeting the enhancement of support to military families. Throughout 2008 and 2009, extensive, broad-based consultations with CF leadership, families and service providers revealed deficiencies in the family support system, and recommended solutions to close the gap between identified family requirements and available services. The CF is examining these solutions and will consider making necessary adjustments to the services currently provided by the Military Family Resources Centres to ensure military families are aware of, and have access to, available medical and social support services in their community.

In response to Chief Military Personnel's transformation initiative, a CF family service enhancement strategy was developed to address family support deficiencies in the following key:

  • Child Care;
  • Transition Services (Education, Employment, Access to Health Care);
  • Family Separation and Reunion; and
  • Mental Health and Social Support.

Twenty-one projects were piloted, generating numerous recommendations on family program, service and policy additions, expansions and revisions. Based on the successful results of several of the pilot projects, the following initiatives were implemented:

  • Family Information Line: A staffed 1-800 line to support families' navigation of existing policy, information and services;
  • FamilyForce.ca: A web-based portal connecting CF families to local, national and international information, services and resources;
  • National Military Family Council: A volunteer advisory council to provide a voice for military families to Armed Forces Council;
  • Community Wellness Index: A standardized assessment of the health of each CF community;
  • Family Liaison Officer: Dedicated support to the families of CF personnel with an illness, injury, or special need; and
  • Casualty Support Child Care: Child care services for the families of the ill and injured and the families of the fallen.
25. In conjunction with other Federal Healthcare Partnership stakeholders, the Department of National Defence, Veterans Affairs Canada and the Canadian Forces to hold an annual national conference on best practices and advancements in military health care overall, with special emphasis on mental health care. The Government has begun exploring ways of increasing the interest of Canadian mental health professionals in CF and Veterans issues. In this spirit, a joint VAC-DND Mental Health Information Exchange Symposium, featuring mental health experts was held on 22 January 2009, in Ottawa with participants from DND, VAC, the RCMP and other Government departments. In addition, staff from VAC, as well as from VAC-funded OSI clinics, present in major conferences in relation to operational stress injuries, such as those of the Canadian Psychology Association, the International Society for Traumatic Stress Studies, and the Canadian Centre on Substance Abuse. The Government of Canada will be providing further opportunities for the sharing of best practices and advancements in mental health care by organizing a symposium on psychological trauma and operational stress to be held in 2011 in partnership with the International Society for Traumatic Stress Studies. The Government will also continue to leverage regional education events/conferences that build upon the work already carried out by the CF Health Services Civilian-Military Co-operation Team, with the "Care to the Wounded Soldier Initiative." This initiative involved a series of educational events that brought health care providers and senior health care administrators within geographical regions together to participate in briefings on the health needs of the CF ill and injured soldiers, including mental health care needs, and proved very successful as a forum for information sharing. Completed, although by its nature this will be a process that is continually ongoing.
32. The Canadian Forces to regularly review the composition of the Operational Trauma Stress Support Centre multi-disciplinary teams and remain open to the addition or use of clinical professionals not traditionally found in the military health care system, such as registered marriage and family therapists and that the services thereof be added to the dependents' Extended Health Care schedule of covered benefits. The Government has already taken action in this direction. The present teams are composed of the following professionals who are members of a professional regulatory organization with the accompanying provincial statutory authority: family physicians, psychiatrists, social workers, mental health nurses and psychologists. Presently registered marriage and family therapists are regulated only in Quebec and are seeking regulatory status in other provinces. Once they are regulated the CF will assess their potential contribution to the care of CF members and their families, as well as their potential addition to the dependents' Extended Health Care schedule of covered benefits.

As part of their mandate, the Operational Trauma and Stress Support Centre programs review national and international literature on trauma, with a focus on issues related to post-traumatic stress disorder. The Canadian Forces utilizes evidence-based best practices as endorsed by organizations such as the International Society for Traumatic Stress Studies. Before considering a treatment or technique, it must be supported by objective evidence of its efficacy which normally requires randomized controlled trials published in peer reviewed journals.

Progressive action has been and continues to be taken in the areas of both treatment and of prevention of mental illness and operational stress injuries such as post-traumatic stress disorder.

33. The Canadian Forces to provide this Committee, the Auditor General of Canada and the Department of National Defence and Canadian Forces Ombudsman with a full, unclassified update of the status of the Canadian Forces Health Information System, along with a meaningful explanation of when it will reach full operational capacity.

34. The federal government to move immediately to provide the necessary resources to reach full operational capability of the Canadian Forces Health Information Systems project, with the assistance of a database.

The CF Health Services Group would be pleased to provide additional briefings on the Canadian Forces Health Information System (CFHIS) and its future needs. As such, the CF Health Services Group will develop a presentation and make arrangements to set up briefings for the Committee, the Auditor General and the CF Ombudsman as outlined in recommendation 33. These briefings could take place this fall. A revised schedule and costing should be available this fall and will be shared with the Committee, the Auditor General and the CF Ombudsman as part of the briefings.

The CFHIS will improve the management of health information that is created within CF facilities. However, CF members also receive care from the public health care system. Accordingly, full operational capability of the CFHIS will not be realized until the CFHIS is rolled out to each CF Clinic and then connected to the emerging pan-Canadian Electronic Health Record. This will then allow care providers in both the CF and the public health care system to have complete health information. As recommended, the CF, as a member of the FHP, is collaborating with other federal organizations with similar needs in a whole of government effort towards identifying the requirements for federal participation in the pan-Canadian Electronic Health Record.

The Canadian Forces Health Information System (CFHIS) Project continues to be on budget and during the reporting period sought TB approval for a 23-month extension to allow the roll-out of the system to all CF clinics and ships. CFHIS has also been identified by the TB Secretariat Chief Information Officer (CIO) as a model for other departments with health care delivery responsibilities. Federal Healthcare Partnership (FHP) continues to progress the development of an interface that will allow the relevant federal departments to link with civilian electronic health records systems.

35. The federal government to initiate cooperative programs with provincial and territorial governments, to offer incentives to qualified professional health care workers, to provide their services to Canadian Forces personnel and their families, in locations where there is a shortage of such services.

36. The federal government to continue to work in cooperation with provincial and territorial governments to enhance relationships between local community health and social services to enhance and Canadian Forces health care services.

In fact, much of the mechanics to facilitate such cooperation are already in place. As indicated in Recommendations 5 and 25, forums for discussions with Provinces and Territories and regional and local health authorities are in place. These include, but are not limited to, the Advisory Committee on Health Delivery and Human Resources, the Health Human Resources Partnership and Planning Sub-Committee, and the activities led by the CF Health Services Group. In Ontario, Memoranda of Understanding between the CF and the Local Health Integration Networks are being developed to facilitate access to community health services. As previously mentioned, the FHP Partners have also instituted the Office of Health Human Resources to build health services capacity within the federal government enabling the CF, for example, to better service its members, including families. The FHP, appreciating the value of further developing the relationships with Provinces and Territories, has invited one of the Co-Chairs of the Advisory Committee on Health Delivery and Human Resources to attend FHP Executive Committee meetings. This provides a vehicle to keep the FHP partner organizations up to date on activities with Provinces and Territories and a forum through which the FHP partners can raise issues they are facing and on which they would like to work collaboratively with Provinces and Territories to address. With respect to service members, the actions outlined in the Government response have been completed and liaison/cooperation with the various partners is ongoing at the national and local levels. Responsibility for actions relating to dependents does not lie with the CF.


20th Report of the Standing Committee on Public Accounts, 40th Parliament, 2nd Session, "Chapter 5, Financial Management and Control - National Defence of the Spring 2009 Report of the Auditor General of Canada" (Adopted by the Committee on November 18, 2009; Presented to the House on December 3, 2009)
Original report
Government response

Recommendation Government Response/Commitment Status
1. National Defence to provide the Public Accounts Committee with a report by 31 December 2010 on the progress in implementing the recommendations made in Chapter 5 of the Auditor General's Spring 2009 Report. The Government accepts this recommendation. Following the release of the Auditor General's 2009 Report, DND developed an action plan to chart its progress on implementing the recommendations made by the Auditor General. This action plan was presented to the Public Accounts Committee on September 28th, 2009. Some of the progress already underway includes the development of a new corporate strategy that will help establish clearer links between day-to-day activities of the Department and overall Government Direction, as outlined in the Canada First Defence Strategy; the development of a Program Activity Architecture that demonstrates how Defence programs achieve strategic outcomes; and the implementation of a new financial management governance structure with the appointment of DND's first Chief Financial Officer and the establishment of the Defence Finance Committee and the Defence Strategic Executive Committee. DND will continue to follow through on the action plan and will provide a progress report to the Committee by December 31st, 2010. See "Response to the Auditor General".


1st Report of the Standing Committee on Public Accounts, 40th Parliament, 2nd Session, "Chapter 4, Military Health Care - National Defence of the October 2007 Report of the Auditor General of Canada" (Adopted by the Committee on February 12, 2009; Presented to the House on February 25, 2009)
Original report
Government response

Recommendation Government Response/Commitment Status
1. National Defence to provide the Public Accounts Committee with a detailed progress report by 31 October 2008 on the implementation of its plan to address deficiencies identified by the Office of the Auditor General in its audit on Military Health Care. The Government accepts this recommendation, with the necessary revision to the timeline. The Government has developed an action plan intended to address the recommendations contained in the Auditor General's report on military health care. This action plan was presented to the Public Accounts Committee on 31 January 2008. An updated action plan was provided to the Auditor General in spring 2009. DND intends to provide the Committee with a copy of this updated action plan, which includes details on progress to date, by the end of June 2009. Progress towards achievement of these recommendations will be provided to the Auditor General on a regular basis. Copies of these reports will be provided to the Committee as they become available. Updates are forwarded through Chief Military Personnel to Chief Review Services and updates should be provided to OAG through appropriate channels. Defence agreed to provide this same update to SCOPA but has not done so.
2. National Defence to provide information in its annual Departmental Performance Report on the aggregate costs of the military health care system, as well as the number of physicians, nurses, pharmacists, medical technicians, and physician's assistants employed in that system. The Government accepts this recommendation. DND will report this information in the Fiscal Year 2009/10 Departmental Performance Report. In future years, DND will also look for other ways to make this information available to the public. Currently, in the military health care system the CF employs 169 physicians (including specialists);182 nurses (excluding 60 in the process of completing mandatory preceptorship); 40 pharmacists; 29 social workers; 1299 med techs; and 139 physician assistants. In September 2009, the CF Health Services commissioned an independent, external costing review of the delivery of health care to CF members. This study, conducted by Public Works and Government Services Canada (PWGSC) Consulting Services, sought to determine the relative cost per capita of health services delivered to CF members compared to services provided to an equivalent Canadian population and to determine the reasons for any differences. The study identified the aggregate cost of the CF Health System to be $684M and found that the CF Health Services delivered the equivalent services at a lower cost than the Canadian health care system.
3. National Defence to conduct a comprehensive survey by 30 June 2009 of the state of mental health of CF members and the quality of mental health care services they and their families receive, with a special emphasis on those returning from overseas operations. The Government accepts the intent of this recommendation and has already been working towards its implementation. Two surveys are currently underway as a part of a regular program to determine areas of personnel support in need of updating. The first survey, Canadian Forces Health and Lifestyle Information Survey (2008), will help determine the state of mental health in the CF, as well as develop a picture of the overall health and fitness of CF personnel. The survey contains significant emphasis on mental health issues including questions on depression, mental distress, post traumatic stress disorder and suicide. In addition there is a large section on the utilization of mental health services and patient satisfaction. The survey is sent to a random selection of CF members and will be compared to previous surveys. The survey was sent out in three cycles to take into account seasonal variations in factors such as physical activity. The first cycle was sent out in the fall of 2008. While the results of all three phases will not be ready to analyze until fall 2009, preliminary mental health results could be available by July 2009. The second survey (entitled Your Say) measures the attitudes of CF personnel and their families towards the CF and its quality of life programs. The next version of the survey will be sent to CF members in June 2009 and will contain questions to measure the availability of mental health resources for CF members and their families. Capturing the views of those returning from overseas operations is particularly important to ensuring the CF health system meets the needs of members. In addition to the two surveys, on completion of lengthy deployments, CF members receive briefings on mental health issues and have an opportunity to discuss, in private, any personal concerns with a mental health provider, including concerns related to the availability of services. Ninety to 180 days after returning to Canada, members are required to complete a detailed health questionnaire and an in-depth interview with a mental health professional to discuss any outstanding issues. The first of the two surveys identified in the Government response, The CFHLIS (2008) has been completed and analysed. The resulting report has been produced and is going through the staffing process. Release of the final report is anticipated no later than end summer 2010.
4. National Defence to report in its annual Departmental Performance Report on the status and implementation of the Canadian Forces Health Information System, including whether the system is on budget and on time. The Government accepts this recommendation. DND will report this information in the Fiscal Year 2009/10 Departmental Performance Report. In future years, DND will also look for other ways to make this information available to the public. The CFHIS Project continues to be on budget and during the reporting period sought Treasury Board approval for a 23-month extension to allow the roll-out of the system to all CF clinics and ships.
5. National Defence to confirm in its annual performance report that all physicians, nurses, dentists and pharmacists are licensed to practice and that all medical technicians and physician assistants are certified. National Defence also to confirm the number of practitioners who take advantage of the Maintenance of Clinical Skills program. The Government accepts this recommendation. DND will report this information in the Fiscal Year 2009/10 Departmental Performance Report. In future years, DND will also look for other ways to make this information available to the public. Licenses- The National Credentialing Cell maintains a database of licensed/certified CF clinical practitioners. Maintenance of Clinical Skills Program (MCSP)- Since 2009, the MCSP Cell has instituted a detailed accounting of clinical practitioners who participated in nationally funded MCSP activities. In fiscal year 2009-10, the following participated in MCSP - Regular Force: nurses- 56 (24%); generalist physicians- 144 (78%); physician assistants-80 ( 52%); medical technicians- 152 (14%), dentists- 8 (80% of dentists in non-clinical positions). The majority of CF generalist medical officers, physiotherapists, pharmacists, social workers, dentists and dental technicians, operating room, laboratory and radiology technicians are employed in CF clinical positions where they obtain clinical practice daily. All physician specialists and most new nurse graduates work in civilian institutions and are in full-time clinical positions. Many Regular Force clinicians also participate in MCSP locally where no funding is required and these numbers are not presently captured by the National MCSP Cell. However, a MCSP Activity Evaluation Survey was implemented 1 April 2010 which all Regular and Reserve Force CF clinicians are required to complete when participating in any MCSP activity. This data will be captured in a national database to provide a true representation of MCSP participation. In preparation for deployment, all CF clinicians are required to participate in MCSP; however, their numbers are not captured under the normal MCSP due to their Operations category. Reservist clinicians normally work in their clinical environments in their civilian jobs and therefore usually only require some clinical time in a CF clinical-related environment each year to maintain military competencies for which we had 95 participants in fiscal year 2009-10. Reserve medical technicians also have a robust Unit MCSP training program in which participation is mandatory on a regular basis.
6. National Defence to develop a governance framework for its military health care system that involves senior leadership, health care providers, and Canadian Forces members using the system. The Government accepts this recommendation. The CF is continually seeking new ways to involve members in the administration of programs. The CF will review the current CF Health System governance structure to identify possible areas for improvement, with a particular focus on the need for user and healthcare provider input. The CF has begun to address the Committee's concerns with the military health care governance system. For example, the Spectrum of Care Committee is now chaired by the Assistant Chief Military Personnel and reports to the Chief of the Defence Staff. This committee is responsible for determining the medical procedures and benefits to be made available to CF personnel. It is made up of senior leaders from Canada Command, Canadian Expeditionary Forces Command, and Canadian Special Operations Forces Command, as well as health services providers and senior leaders from Military Personnel Command. CF members in the system are represented on the Committee by their senior officers. Their views are also communicated to the Committee through the results of the Canadian Forces Health and Lifestyle Information Survey and the Your Say survey. As a result of the Spectrum of Care Committee's membership, and by raising the approval level to the Chief of the Defence Staff, the CF can now ensure that the medical system reacts to the needs of its senior leadership in implementation of Government policies and directions. Canadian Forces Health Services is firmly embedded in a well-defined and robust command and governance structure, which is horizontally linked and vertically connected to all Defence organizations. With respect to Health Care and service to our CF members, Canadian Forces Health Services Group (CF H Svcs Gp) manages the Canadian Forces Spectrum of Care (SoC). The CF H Svcs Gp has a direct reporting function for command and control, governance, as well as business planning to CMP, recognizing and respecting the uniqueness of the CF Health Care system. Even though health services is clearly one of Defence's main lines of operation, there are also other intricate relationships for the CF H Svcs Gp within the CF framework at large, Defence and other government departments. One such example is the Surgeon General's direct linkage to the Minister of National Defence and the Chief of the Defence Staff. The CF H Svcs Gp is Canada's fourteenth healthcare system and is the life-blood of the CF, providing excellent health care to all CF members, wherever they serve.

Response to the Auditor General (including to the Commissioner of the Environment and Sustainable Development)

Office of the Auditor General (OAG)
During the reporting period the Auditor General (AG) and the Commissioner of the Environment and Sustainable Development tabled two audit reports in Parliament focused specifically on National Defence-Chapter 5 of the May 09 tabling titled "Financial Management and Control" and Chapter 5 of the November 09 tabling titled "Acquiring Military Vehicles for Use in Afghanistan".

In the Chapter on "Financial Management and Control" the AG concluded that although the Department had taken steps to strengthen financial management and control, the Department could not demonstrate that these support the financial management of resources, corporate planning and decision making, especially for the medium to long term; that the implementation of Integrated Risk Management in the Department has been slow; and that the existing governance structure is not focussed on financial management.

In the Chapter on "Acquiring Military Vehicles for Use in Afghanistan", for the four vehicles examined, the AG concluded that National Defence was able to quickly provide three of these vehicles to address operational needs, although not always with all required capabilities. The AG reported that one of the vehicles was two years behind schedule and that the numbers of this vehicle available for operations had been affected by an underestimation of the vehicles needed for training. The AG reported that the Department's Project Approval Guide was consistent with TB's project management policies, but that the four large, urgent projects were not managed in accordance with this Guide.

These two Chapters, including departmental responses to the Auditor General's recommendations, can be accessed on the Auditor General's website at the following link: OAG Latest Audit Reports

In May 09 the Auditor General also tabled "Health and Safety Issues in Federal Office Buildings". This report focused primarily on Public Works and Government Services Canada, but, in the portion of the report dealing with fire safety, also included three recommendations directed at National Defence and a number of other departments and agencies. These can also be viewed at the above web link. In November 09 the AG tabled a Chapter focused on Public Safety Canada and titled, "Emergency Management". Although DND was included in the audit along with other federal departments and agencies, no recommendations were directed at the Department. Chapter 1 of the November 09 Commissioner of the Environment and Sustainable Development report was addressed to the Canadian Environmental Assessment Agency (the Agency) and entitled, "Applying the Canadian Environmental Assessment Act". Aside from the Agency, the audit scope involved twelve other entities, including National Defence, but all recommendations were addressed at the Agency.

During the reporting period, in response to the annual request by the Auditor General, National Defence provided updates on the status of all OAG audit recommendations tabled in Parliament during the five-year period 2004-05 to 2008-09.


External Audits (Note: These refer to other external audits conducted by the Public Service Commission of Canada or the Office of the Commissioner of Official Languages)

The Office of the Commissioner of Official Languages (OCOL) conducted an audit on language of instruction (LOI) in the CF and on the training management framework to determine whether the CF promotes and delivers training in the official language (OL) of its members' choice. The Commissioner made public the final report on 2 June 2010. It consists of his recommendations, the CF action plan and his response to the action. This report, including recommendations and responses, is available on the OCOL website.

The OCOL had looked at the CF periodically over the past years, and certain issues linger. These include, but are not restricted to, deficiencies in strategic and operational planning leading to IT&E plans, framework and delivery of courses (courses not available in both OLs, material not available in both OLs, and a lack of bilingual instructors), and lack of integration of OLs as a vital component of career management. This audit took a comprehensive look at the LOI for all CF individual training provided to officers and non-commissioned members from all Training Authorities. The findings and recommendations that will emanate from the OCOL's final audit report will assist in improving CF OLA compliance and, ultimately, in offering all CF members the possibility of being trained in their OL of choice.

Sources: Assistant Deputy Minister (Policy) Group; Chief Military Personnel Group; Chief Review Services Group