BINSKIN, Air Marshal Mark, Vice Chief of the Defence Force, Department of Defence

CAMPBELL, Major General Angus, Deputy Chief of Army, Department of Defence

DOWSE, Air Commodore Andrew, Director General Strategy and Planning, Department of Defence

FOGARTY, Major General Gerard, Head, People Capability, Department of Defence

LEAVY, Commodore Peter James, Director General, Navy People, Department of Defence

WALKER, Rear Admiral Robyn, Commander, Joint Health, and Surgeon General ADF, Department of Defence

Committee met at 17:36

ACTING CHAIR ( Mr Robert ): I declare open the first public hearing of the inquiry into the care of ADF personnel wounded and injured in operations. I welcome representatives of the Department of Defence and the Department of Veterans' Affairs to today's hearing. Although the subcommittee does not require you to give evidence on oath, I should advise you that these hearings are legal proceedings of the parliament and therefore have the same standing as proceedings of the respective houses. The giving of false or misleading evidence is a serious matter and may be regarded as a contempt of parliament. Do you have any comments about the capacity in which you appear today?

Air Marshal Binskin : I am Acting Chief of the Defence Force.

ACTING CHAIR: I invite you to make an opening statement to the subcommittee. I will start with you, Vice Chief, and then if you wish to pass to your respective commands we are happy with that as well.

Air Marshal Binskin : I appreciate the close bipartisan approach you are taking this evening with us. Thank you for having us here. Over the last 14 years the Australian Defence Force has moved from a peacetime organisation to an organisation that is continuously active in warlike peacemaking, peacekeeping, border protection and humanitarian aid operations. Since 1999, ADF personnel have undertaken some 134,000 individual deployments. No doubt many personnel have deployed on numerous occasions.

On operations we expect and demand our personnel to work long and irregular hours under harsh environmental conditions as well as serve in hostile and demanding locations. We have recognised that such service has an increased risk of wounding, injury and illness, both physically and mentally. The ADF has recognised that our peacetime policies, processes and organisational support mechanisms needed to change to deal with the new range of health issues being experienced as a consequence of this move to a more operational footing, and over the past few years we have made these changes.

The provision of health care to ADF personnel is a continuum from enlistment through to transition from the ADF back into civilian life and during all phases of operations: predeployment, on operations and postdeployment. Our wounded and injured receive first-class health support in operational zones from either highly qualified and trained ADF personnel or allied health teams. Our aeromedical evacuation teams are second to none and provide first-class care when bringing our wounded and injured home. Our support systems in Australia are patient focused and patient centric and we are committed to supporting members who are wounded or injured while serving and their families.

We have developed and expanded health and welfare support programs as a direct response to the needs of our people, and these improvements range from changes in policy, such as extending the time our wounded, ill and injured can remain on rehabilitation programs with the express intent of retaining them in the ADF, to changes to the delivery of health and welfare support, with a core component being on-command responsibility, and upskilling our health personnel in the management of complex mental health conditions.

Specific examples of these changes include the implementation of the support coordination programs in each of the services; the early engagement of the Defence Community Organisation to assist the member and their family from the time of wounding; referral of our personnel to the ADF Rehabilitation Program; the development of the Paralympics Sports Program; the development of the Simpson Assistance Program to provide further assistance to the most severely injured; the Support to Wounded, Injured and Ill Program—or the SWIIP—to ensure that any complexity involved in obtaining support is reduced and any gaps in support are closed; the establishment of Army soldier recovery centres to provide command, leadership and management of complex rehabilitation cases; the conduct of the Chief of Army wounded digger forums to listen and learn from our people and their families about how we can do better; the implementation of the recommendations of the Dunt review into mental health; the development of the ADF 2012-15 mental health action plan; and close cooperation with DVA to ensure the transition from ADF managed care and support to DVA managed care and support is seamless. Key to this transition is the establishment of the DVA on-base advisers.

We are of the belief that whilst our current services are good we must continue to review, evaluate and improve these services. We do not want even one member to fall through the cracks or feel unsupported, but we recognise that at times mistakes will be made. We are committed to learning from these mistakes and ensuring that they are not systemic or repeated in the future. We will work hand in hand with DVA to ensure our system and support mechanisms remain relevant, sensitive to members and families, and provide the services our members require, both while in service and following the transition from the services.

We have a team here tonight from each of the services—we are just waiting for Air Force—and from the joint side. We are willing to take any questions that you may put to us.

CHAIR: I have a few questions to start off with. There appears to be a common theme developing in some of the major matters that have been disclosed. I will start with the stigma of post-traumatic stress disorder or stress. There certainly appear to be a number of submitters who have indicated there is stigma in Defence, that people are being stigmatised as a result of suffering from PTSD or other forms of stress and also that there is a lack of willingness from someone suffering an illness to come forward and identify themselves as having that condition. What is the department doing about that particular issue?

Air Marshal Binskin : You would have seen over the last few weeks that we are encouraging people who feel that they have a mental illness or PTSD to come forward and it will not be to the detriment of people's careers. In fact, we would prefer to pick this up earlier rather than later and be able to rehabilitate people and get them back to performing their duties as they were before. We can talk a little bit about specifics. I will get Admiral Walker to talk about that in a second, but tomorrow we have our Mental Health Day in Defence. That is across Defence around the nation. So we will be talking about the issues of mental health and helping to educate people about the signs of mental health issues and what we have in place to care for people who have mental health issues, rehabilitate them and get them back into the workforce.

Rear Adm. Walker : In both the civilian community at large and within Defence there is a stigma about mental health disorders. But I think it is important that we are trying to recognise and understand what that stigma means. There is a concern that if you have a recognised mental health disorder one of the key stigmas is that you might be prevented from going on deployment. But from our perspective it is also about our WHS responsibilities. We have to make sure that people are fit to go and do the job they are doing. So it is that line of tyring to identify people and provide appropriate treatment.

There is a difficulty particularly with PTSD. It is to do with when it occurs. It may not happen immediately after an event. In many cases it comes on years after an exposure. So it is a matter of trying to identify people at risk of PTSD. We have developed a program now that is about early intervention—so, with screening of people when they return from operations or by screening them through their medical examinations. If you think you are at risk of PTSD but do not meet the criteria for diagnosis, maybe we can intervene early to prevent you from going on to have PTSD. That course has been developed. It has been developed for a larger group. In fact we have not yet had the numbers for people to do it, so we are trialling it with some individuals to see. We will need to evaluate that.

The mental health prevalence study we conducted in 2010 identified the stigma that people talk about in accessing care and it has identified particular groups. It shows that if you are among the ranks or a non-commissioned officer you perhaps have greater stigma, or different stigma, than if you are an officer. So, we need to target our messages to the different groups and to their particular needs.

We have done some more work evaluating the data set from the mental health prevalence study and we are just getting into what that extra work means. Then it is a matter of formulating a response. It is about improving mental health literacy. I met with the forces commander and the brigade commanders a few weeks ago. It is a question of whether there is some education we can do, particularly for the commanders, and then all through the command at the different leadership levels, about getting people to understand what mental health disorder is.

Probably the first question we should get people to ask is that if someone is not performing well in the workplace we should just not say that they are slack or that it is an administrative problem. In many cases it might be a question of whether they have a medical problem we should be looking at, and not just saying that they are not performing well. So, there is a range of activities underway. It is also about trying to get people to seek treatment early so that we can try to prevent long-term morbidity.

CHAIR: I have a further question on reservists. There appeared to be a perception that they were being treated differently in going through the process. It is possibly a question for DVA, but I will ask the department whether they consider there is any different treatment in respect of an injured reservist compared with a regular soldier.

Rear Adm. Walker : We have some concerns about reservists, because if you come back and you are in the full-time service, or on CFTS, you stay within the fold and you have support mechanisms—you are within your unit and with your colleagues. If you are a reservist and you have gone back into your civilian occupation—and as I said earlier, PTSD, particularly, could occur some time later—it is then about identifying those people and how they access all the support mechanisms that are there with DVA. But, sometimes, for us it is about making sure they are aware of what support mechanisms are there. So, we are continuing to look at the reservist population, particularly the people not on continuous full-time service, because there appears to be a benefit to being in the full-time service, whether it is because of the colleagues, the support or the understanding environment, as opposed to being in the civilian community, where they may not understand what the person has been through.

CHAIR: Could it be more difficult to identify a stress disorder or mental health disorder in a reservist, given that they work, naturally, in other forms of employment, and in the Defence department, as well.

Rear Adm. Walker : It may be a matter of how they feel about the support within their own environment—such as putting your hand up and saying, 'I have a problem', particularly if you have deployed and been away. Your colleagues may have been pulling the load while you had been deployed as a reservist and then if you come back and say you have a problem it may be that within the reservist population there is a feeling of guilt or of not wanting to admit there is a problem. So, we need to do some more work. It is not that there are no support mechanisms available; it is sometimes a matter of marrying people up to them.

Dr JENSEN: Earlier, you were speaking about lessons learnt and how you are going about learning from those lessons and implementing actions to fix those concerns. If I could ask Air Marshal Binskin, and then the different services, because some of these issues will be slightly different from service to service, I would be interested to know what is the biggest lesson you have learnt and what action you have taken as a result of that lesson learnt. I would be interested in hearing from each of the services.

Air Marshal Binskin : I will give you the overview. I think there are a couple of big lessons across the board. One is making sure we have the continuum right—that there are no gaps—and also in the transition to DVA. That is part of it. The follow-on from that is that we are not transitioning people to DVA as early as we used to, because we are rehabilitating within the services—it is predominantly Army—and then bringing them back into service. So their transition to DVA might be a lot later. That is actually bringing costs to us, which we are looking at—how we cover them and how we attribute them. Probably the biggest issue in all of that—it is to do with the continuum—is making sure the families also are taken along on that continuum, because it is not just the member.

Dr JENSEN: That was going to be my next question. I would like you to expand on that.

Air Marshal Binskin : If I pass it down the line, I think that will come out as people discuss some of the programs that are in place. I think you will start to see a bit more of the detail that is coming out, and then they can add a couple of their particular lessons.

Major Gen. Fogarty : Back in 2010, the department undertook a study—it was essentially a gap analysis—into the support we were providing to our injured and ill members. It was a gap analysis against what we were doing now as to what we could ascertain would be best practice. We looked across a number of different nations and what their approach was. A number of lessons came out of that. We identified that we have a very high return to work rate, but there were a number of individuals who were falling through the cracks. One of the principal lessons was that commanders, who ultimately are responsible for the care, support and wellbeing of their people, did not have adequate visibility of the number of their people who were on long-term rehabilitation plans. We need to do something about that straight away.

Secondly, as the Vice Chief has said, we needed to more formally recognise the roles that families played in the support and care given to injured and ill members, and the great weight that many of them were carrying as a result of the stress and the behaviours that were manifesting at home amongst injured and ill members but were not being seen at work.

We also needed to better enunciate what the roles and accountabilities were across the entire system—again, the term the VCDF used—so that we do have a care and support system. But that was not well defined and people did not necessarily know what their particular roles were and how that aligned to a number of other service providers.

We also found that we needed to improve the information flow between Defence and DVA, in particular—again, as referred to by the Vice Chief—and that we did not have a culture of our people claiming for injuries or illness, because in our system you get free medical support regardless of how you acquired the injury or the illness, unlike any other enterprise, where you need a claim first, and then support would follow. We did not want our people leaving the department and then claiming for an injury or an illness that might have happened 20 years earlier, or, worse still, having left the department and, 20 years later, their injury or illness manifesting as something else and then trying to claim to DVA and having the significant difficulty in trying to substantiate the circumstances around the initial injury that occurred 35 years previously.

They were the principal lessons. We found that out in 2010 and then we started an integrated program with the Department of Veterans' Affairs—it now is called the Support for Wounded, Injured and Ill Program—to implement 31 recommendations to provide a much more integrated and member focused system. It is still complex, but the outcome is that you have a dedicated individual who is a coordinating officer, who shields the member who is injured, ill or wounded from that complexity. They are the ones who go to the relevant service provider and support the commander, to ensure that the individual and the individual's family get the support they need, and get it when they need it. They were the principal program lessons across the entire department. The individual services live the day-to-day management of caring and supporting it for their people.

Major Gen. Campbell : I support everything that has been offered thus far. From an Army perspective, building awareness by individuals, by their junior, immediate supervisors and by senior commanders has been critical throughout this experience and will continue to be more so for a decade or more to come. Acknowledging that an army is an organisation that drives by command authority, keeping the management connected to command but respectful of the medical requirements is very important in order to keep energy behind support to our people. There is also the point made about better connecting in families, as we have sought to do. That has been an evolution throughout most of these issues. Also, there is the issue of acknowledging the family as the unit that ultimately is living through and beyond this experience.

The chair mentioned the question of stigma. It is something that clearly arose as an area we still have to keep working on in one of our wounded forums, which was in focus when looking at mental health issues. In that environment we brought together senior Army commanders and persons who were suffering, and their families who were prepared to engage with us. It is a very positive next step leading to initiatives about how we might further advocate and encourage individuals, where they feel comfortable to do so, to be advocates to break down the stigma.

Finally, I have a comment that continues from the question in the Reserve space. That is, we need to attend particularly to those Reserve members who serve as individual embeds, and hence do not have a full-time military unit construct, and their Reserve military construct might not have been deployed on operations. So, it is those who we seek to pay particular attention to, especially if they are living in areas that might be isolated, or they are self-employed. Those kinds of background factors all play to a need to pay particular attention to.

Those are some of the key highlights. There are many learnings in this. I think that the system we have is making advances every day—it is a long way from where it was—and it will continue to do so.

Cdre Leavy : I would reiterate the comments made so far, in particular the last one from General Campbell. By and large, we have quite a good system in place, but there is always more work to do. One of the key things that I think the Navy have found from a number of activities that we have undertaken recently, particularly for mental health—and it is no great surprise, really—is that early intervention is critical. We have had a fairly robust program of peer group training sessions. In fact, we have annual awareness training across the department to try and break down that stigma we spoke about earlier and also to provide our own people, our peers in particular, the tools to recognise potential mental health issues with the people they live and work with. It is quite effective in Navy in particular, where aboard our ships we live in quite a close environment. I can certainly vouch for an increasing number of people coming forward of their own volition over the last few years, but also sailors coming forward thinking that someone they are living or working with closely might have an issue and raising that awareness to command fairly early.

Dr JENSEN: So you are saying, effectively, that that message is getting through.

Cdre Leavy : I believe it is.

Dr JENSEN: because that is one thing—to have the procedures and the policy at an oversight level—but it is vital to actually have the people down at the grassroots level with the understanding and the confidence that stigma is not going to negatively impact on their careers.

Cdre Leavy : Correct. I think we have made significant inroads there. There is a long way to go; there is still an element of stigma, I would suggest. But, personally, I think we have made quite significant inroads in breaking down the barriers that were there even 10 years ago. So I think we are seeing success there. The other thing we have been concentrating on is providing focused, professional help early where we think we need it. In Navy's case in particular, we started a program last year of pre-briefing sailors involved in Operation Resolute, the border protection operation in the north of Australia, and providing dedicated screening of those who have been involved in the operations to try and identify early potential problems where professional help can be brought in early. It is very early days; it has only been running for about a year now, but, again, there are positive signs and we are hoping that throughout their careers we will be able to follow much better those people who were involved in potentially traumatic events in that operation. So there have been a number of positive steps, I think, particularly in the mental health sphere.

In terms of more general management, in April 2002, the Navy started what we call the complex case management system, where we found a number of people who had complex medical issues, often with legal and other social issues associated. Some of those aspects were being dealt with in isolation—there was no real central coordination to look after the wellbeing of the total sailor. So we have had a complex case coordination system in place since April 2010, and that has now been rolled into the program that General Fogarty mentioned, with the member support coordination people we have around Australia, to try and better manage the holistic care of our people rather than doing it in stovepipes. Again, I think I have seen some positive benefits of that, which will only improve over time.

Dr JENSEN: I just want to put something on record—

CHAIR: No, I will come to you later. We only have 12 minutes left. I will go to Mr Robert.

Mr ROBERT: General Campbell, a few months ago Channel 10 did an expose on which a soldier, I think from the 2nd Commando Regiment, was interviewed—with the concurrence of the military; they set it up. He made the point that he was paying for his own acupuncture because the military was not covering it. Is that still the case? Are the alternative therapies that we are not covering?

Rear Adm. Walker : I think it was not actually acupuncture; massage therapy was the treatment.

Mr ROBERT: I am happy to stand corrected.

Rear Adm. Walker : We, as a rule, use evidence based treatment for all that we do, and I stand by that as a treatment principle. We do, however, pay for complementary therapies if there is a case put for it and there is a clinical reason to do so. There needs to be some evidence. What we would do is limit an amount of time because we need to assess the efficacy if there is not a lot of evidence in the literature. I think I would feel better if I had a massage every week, but I do not expect the military to pay for that. What we do need to do—

Mr ROBERT: With the greatest respect, Admiral, you haven't been shot yet either.

Rear Adm. Walker : No, but I have to say that there is no evidence that having a massage improves your clinical rehabilitation or your clinical recovery.

Mr ROBERT: I bet it makes a digger feel better.

Ms BRODTMANN: Let's not go there!

Rear Adm. Walker : I am required to use the public purse wisely. We certainly do pay for complementary treatments, we do expect reports from the providers and we do expect evidence that the continued expenditure is of value to the patient.

Mr ROBERT: Okay.

Senator FAWCETT: One of the really encouraging initiatives that this committee has had a look at over the last six months or so are the soldier recovery centres around Australia. I think that is a real feather in the cap of your brigade commanders, what they are doing there. It is fairly clear, though, that capacity-wise—and understanding that some of them are fairly new—they have identified that they are meeting perhaps a 10th of the identified need, given that they are looking at not just the wounded but also people who have been injured in sport or training or whatever else. I am just wondering whether you can, from your evidence base, validate the efficacy of the approach and then also provide some funding so that the capacity can be expanded, because my understanding is that it is out of hide at the moment. They are to be commended for what they are achieving with that. But assuming it is effective—and, certainly, the initial feedback appears to be that it is—what plans do you have to expand the capacity of those to provide that command environment for soldiers who have a long-term rehabilitation need?

Major Gen. Campbell : I would say that we will find a way to fund it, to sustain it and, as the evidence base demonstrates its value, to provide for the need. I agree; it looks like it is a good system. The longest running centre has now been up and running for about 18 months. We have relatively modest numbers under care in those centres, ranging from 40 down to about 18 in the three locations—Darwin, Townsville and Brisbane. So we are going to learn from it, it is not going away, and we will work out how to move forward on it.

Senator FAWCETT: Air Marshal Binskin, this is probably a question for you. Those centres obviously have a large Army presence, so the brigade commander is very much the senior officer, with some clout in the area. In places where there are reservists and Air Force, Navy and Army people who do not have a brigade commander providing that centre of gravity for the activity, what kinds of central initiatives are being pushed to encourage local commands to look at that need? I am specifically talking here about RAAF Base Edinburgh, where 7RAR is based. They have their farewell parade this coming weekend, so in six to seven months time the unfortunate fact is that we may have a number of people coming back who need that support. From a Canberra perspective, what initiatives do you have to put those kinds of resources into and focus on other areas that may have more of a tri-service approach?

Air Marshal Binskin : We do have a number of rehabilitation programs out there. This is a good Army initiative that is running, and I would think that they would probably have something in place for when 7RAR get back. The interesting bit about the cost—and this is the bit that does take time—is that, for every soldier we rehabilitate and put back in the workplace, there is one less soldier to train. So there are going to be offsets there that will have benefits over time, and there is one less soldier going to DVA. So there are benefits there, but you cannot put your finger on the exact dollar value at the moment. But it is something we are going to have to look at more.

It is a good Army initiative. Air Force have similar, smaller initiatives, and I know Navy do as well. It is not on the same scale, and that is simply because of the size of the forces deploying. But I would not like to centralise it too much at the moment, because there are good initiatives along the three service lines where the three service chiefs actually do demonstrate their commitment to their people.

Rear Adm. Walker : It is a continuum. We have the ADF rehabilitation program, on which the majority of our people can be managed. That is a command engagement activity, so it is the health provider, the rehab provider and command. We have the soldier recovery centres and the Navy personnel support units—where we again interact with command and medical, and we will have the establishment of the intensive rehabilitation programs, with two centres to be opened early next year in Holsworthy and at Lavarack for the severely injured. So there is a continuum of care and we need to look along that continuum at where people fit into that continuum.

The figures that we have in terms of why the intensive recovery programs are going into Townsville and Holsworthy are around the numbers of people. It does not mean that people in other areas that do not have the same critical mass of numbers are not being managed under the rehabilitation program.

Major Gen. Campbell : Could I just add that that modest nature keeps it as part of a continuum. And its location keeps it connected to the command structure and the support mechanisms of the habitual home bases. So, as the Vice mentioned, avoiding the enthusiasm to centralise or to disproportionately grow within that continuum and become a competition to the continuum are things that we have to be careful of as we develop this.

CHAIR: We are going to go to Ms Brodtmann next because we only have about five minutes left and two more people have indicated that they have questions.

Ms BRODTMANN: I am looking at the PTSD cases and the mental health cases and I am interested to know where they present. Is it individually initiated or is it initiated by a concerned family member or by a commander? I am just trying to get a sense of how deep that self-awareness or that cultural change is at this point in time in the ADF.

Air Marshal Binskin : In general, we use are all the ways that you mentioned. That is probably testament to the education program that we have going on at the moment. We will go through a bit of the detail of what we do post operations, noting that not all PTSD or mental health issues are coming from operations. But this will give you an idea of what we have in place.

Rear Adm. Walker : Any avenue gets you into treatment, whether it be through a colleague alerting either the medical staff or command or yourself initiating it, talking to the chaplains, psychologists, the physio or the pharmacist. Any approach can get you into treatment. So that is about a problem arising, but there is also the screening we do post operation and in medical checks, that are standardised screening tools that help to identify people who might be at risk or who might have a clinical condition.

We would say that any approach can get you into treatment. So at the grassroots level, there is the Keep Your Mates Safe program, which is the literacy about how you look after someone if you think they have a problem. If you think they are going to commit suicide you do not leave them alone. It is about how you get them. You tell any responsible person who has need but you stay with your mate while they go and get some assistance. So it is any approach.

Ms BRODTMANN: I know it is still early days but do you have any statistics on those approaches? Is it largely mate driven, colleague driven, commander driven?

Rear Adm. Walker : No, because it is probably not something that we have thought to track at this point. For us it is identifying the person. As long as a person gets there, is what we have been focusing on.

Senator IAN MACDONALD: Thanks for your submission and for the good work you all do. Mine is a very broad question. I notice you have a number of programs to do with your particular recovery roles on top of everything else you do. How are these paid for? Are they part of the general running operations of particular units? How does the budget come down? I am conscious that Defence has been tasked with substantial savings from the bottom line of the total budget. These things you do must cost money, and it is an expensive area—are they quarantined, in which case other elements of Defence have to make even greater savings, or are there cutbacks in this general area again? I suspect they all come from different areas, but as a general question I am wondering what impact the substantial savings you have to make will have on what you do here. I assume you will say there is no impact because you will continue to look after your people, but somewhere along the line there has to be a clash.

Air Marshal Binskin : In general, with the budget, as we look for the savings we prioritise, and clearly these are high on the priority list. That does not mean we do not look to make efficiencies: Can we do it better? Can we target more people? We look at that in general, but I do not believe that we specifically target any of these to reduce the costs. If anything we are continuing to put more money into it.

Senator IAN MACDONALD: I gathered that from what you said, but it means that the rest of your savings have to be even more substantial if these are going to stay the same or increase.

Air Marshal Binskin : That is exactly right. That is the way we prioritise the Defence budget.

Rear Adm. Walker : A number of the initiatives have dedicated project funding—money under mental health has gone to the Dunt review funding and the Simpson Assistance project has dedicated project funding—so those initiatives have not been cut. In terms of our general health expenditure we have maintained our budget, but it does not mean I am not under pressure to try to make sure I use that budget efficiently and effectively, using evidence based treatment, at all times. Our budget in those areas has been relatively unscathed.

Mrs MIRABELLA: What, if anything, has been done to quantify the value of helping existing or exiting service personnel with these mental health issues? I suspect that, although it is complicated modelling, you would have enough expertise across the forces, with quite a few clever people who could provide the modelling, to explain the value of it. We are heading into very challenging budgetary times, and it is often not well appreciated outside the forces that the rapid exit, sooner than they should, of serving personnel is an enormous burden on the budget in forward years, as is the cost of looking after ex-serving personnel out there in the community. I think that would be of great value. Have you started doing anything in that regard?

Air Marshal Binskin : We have started collecting data and statistics on our people in a mental health wellbeing study. We are going to continue to do those, but it is very difficult in one study to say, 'This is the improvement.' We will chart our progress over time, and once we start to do that we will be in a better position to start putting dollar values against how well we are doing. At the end of the day we are not doing it for dollar value of our people.

Mrs MIRABELLA: I understand that, and I fully endorse that, but it assists in so many ways that you are more familiar with than I am to be able to provide that modelling to quantify the value of looking after people.

Air Marshal Binskin : I agree and we will start to do that over time as we are starting to collect our data now. I mention one area that did concern me before but that we are just starting to get a handle on. Because in the rehabilitation we transfer to DVA later, what is that additional cost to our health system to do that? We are just starting to get an understanding of that. We have only been on the current program for two or three years, so it is going to take us time to do it. But I agree, we do need to see the value for money that we are getting. It is almost the same as evidence based medical care that we provide. We cannot keep throwing money at it without understanding what benefits it is giving. At the moment our focus has been on the people and now we will start tracking it and see where we can get the best efficiency for it.

CHAIR: Thank you for your attendance and your evidence. If you have been asked by the secretariat to provide any further information, please see them. A copy of the transcript of your evidence will be provided to you. You may wish to check that for any grammatical errors. Please notify the secretariat of any issues associated with that.