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Joint Standing Committee on Foreign Affairs, Defence and Trade
04/05/2018
Department of Defence annual report 2016-17

GRIGGS, Vice Admiral Ray, AM, CSC, Vice Chief of Defence Force, Department of Defence

McDONALD, Air Vice Marshal Warren, AM, Chief, Joint Capabilities, Department of Defence

PEARSON, Mr Stephen, Chief Information Officer, Department of Defence

SKINNER, Mrs Rebecca, Associate Secretary, Department of Defence

SMART, Air Vice Marshal Tracy, AM, Commander Joint Health and Surgeon General, Australian Defence Force, Department of Defence

[13:04]

CHAIR: Air Vice Marshal McDonald, would you like to make an opening statement?

Air Vice Marshal McDonald : In the interests of time I'll table that for you now.

CHAIR: Thank you very much. Are there any particular aspects of that that you'd like to highlight, that are most important or of most interest to you?

Air Vice Marshal McDonald : We don't appear in the annual report because we were stood up on 1 July 2017. However, three main branches which were originally under VCDF are in that report: joint health, joint logistics and ADC. I am also responsible for Women, Peace and Security through the office of the CDF. I can report that that's well and truly on track to close out the 17 of the 24 actions.

CHAIR: Thanks. Air Vice Marshal Smart, would you like to make any opening statements?

Air Vice Marshal McDonald : The Surgeon General came along because there will be some questions on health.

Senator FAWCETT: Let's start with health then. We referred before to one of the recommendations of the recent Senate inquiry that looked at aligning Defence and DVA work in the mental health space, and there has been some work kicked off around that. But I'm wanting to make sure that we don't get alignment at a standard lower than what is actually needed. So I am interested to understand what thinking is happening within Defence—I will chase DVA separately—around what is changing in the current demographic with the current intensity and length and number of deployments that current service men and women have had. What is changing in that demographic and therefore what should change in terms of the nature of service provision? I'm interested to know whether you're doing work at that kind of conceptual level.

Air Vice Marshal Smart : We're not really seeing a major change at the moment and we're not doing a lot of work in that space in particular. There's certainly no intent at this stage to change Defence's approach to providing holistic health care, comprehensive health care, to the men and women in the ADF that's based on Medicare equivalence but is also what we need to keep them fit and healthy to do their job—so what is clinically and operationally required as well. So there's no intent to change the standards we provide, and in fact we're doing a lot of work to improve the quality as well as the affordability of our health services going forward.

We are working very closely with DVA. We have got them as key partners and stakeholders in our Next Generation Health Services contract, which is currently under tender, so I can't talk a lot about that at the moment under the procurement process. But we're certainly looking at whether there are more innovative ways through the tenderers to align Defence and DVA, particularly in that transition space, which we know is the crucial time for a lot of veterans. So we're doing a lot of work in that space and we've also been doing a lot of work over the last few years to ensure that out that our people, particularly those medically discharging—which is about 20 per cent plus or minus—have a soft landing into DVA. That's looking at earlier and earlier engagement of DVA in their care, even before they leave the service. There are a whole number of programs that we're doing in that space to make sure that landing is a lot softer.

We haven't seen any particular changes due to the demographics. We certainly did see an increased number of mental health reasons for MECRBs, Medical Employment Classification Review Boards, post Afghanistan. It seems that we have passed that peak. But we haven't seen any specific trends that mean we need to make major changes.

Senator FAWCETT: The evidence that came before the Senate committee pointed out a number of what I would call disruptors to the continuity of Defence care for people who had mental health issues. One is some people not wanting to make the chain of command available and so looking outside for private providers or going through VVCS, even to the extent of feedback saying that perhaps Defence didn't have access to people in uniform who had clinical psychology type qualifications. So people were being essentially fed into the state system around bases. Do you care to make a comment on some of those observations, but then particularly do you have—I'm happy for you to take this on notice—indicators of what the wait time is for a young man or woman in a regiment somewhere who says, 'I think I need some help to see a psychologist or psychiatrist' if they need help?

Air Vice Marshal Smart : That's a very big and complex question, but basically we have a large number of mental health providers in our system and we actually pride ourselves on a multidisciplinary approach. That includes psychologists—uniform, contractors and public servants, social workers, mental health nurses, and of course we've also been upskilling our general practitioners on bases in mental health. But we also have access to a very broad range of external providers through our Medibank Health Solutions contract. We've got about 300 psychiatrists that we can access through that contract. There are probably about 40 we use regularly.

One of the things we're trying to do, both Defence and DVA, is to work with the College of Psychiatrists to look at how we might be able to upskill psychiatrists more generally in the population on 'cultural competence' in military and veterans' mental health. There's a lot of work. The college are very keen to work with us on that, and they are actually going to create a community of interest within the college to upskill people in this area.

Certainly, in terms of waiting times, we can provide that information. It does fluctuate, depending on who is available and people being on sick leave. But, generally speaking, people do have good access to mental health providers.

We are aware of the anecdotal reports of people seeking support outside. We actually do have a contract, or an agreement for service, with VVCS, so we do use their services as well. We are actually about to do a bit of work that will show us how much our people are using Medicare services outside, which will give us a bit more granularity on what that looks like. But I think that, in most cases, that's not because they can't access health care on bases; it's because, as you said, they're not willing to let Defence see that they have a problem.

Having said that, I think the work we've done on mental health awareness is really starting to pay off and be visible. Recently, the Transition and Wellbeing Research Program first two reports came out. One of them was Pathways to care, which shows that Defence people who have a mental problem are far more likely than the general population to put up their hand in the first three months of having a problem and, once they do, they're actually very satisfied with those services. So I think there's some evidence that that problem, that perception—'Don't go and see someone'—is actually changing. But we still acknowledge that we need to keep promoting that. Does that answer your question more or less?

Air Vice Marshal McDonald : As an example, if a private says, 'I have a problem'—before I came in and had Joint Health Command as a command, out in the other commands, the soldiers, sailors and airmen—it's almost immediate. They are very quick. They'll push things aside and get the help for the person. I've not seen delays in it.

Air Vice Marshal Smart : We still have sick parade. People can come in on the day and be seen that way. We also have a mental health intake service. That is new over the last few years. It allows those people to be triaged: how urgent is it, who do they need to see and those sorts of things.

Senator FAWCETT: One of the submissions to this particular review of the annual report highlighted that some of the access for soldiers to do the post-deployment screening wasn't available from their home computers and had to be done on base, and it highlighted that some people, for a range of reasons, want to do it off base. Are you aware of that issue? Is there a resolution to it?

Air Vice Marshal Smart : There are a couple of parts to that. First of all, our screening process—almost uniquely around the world—is not just filling out a form; it's actually seeing a psychologist face to face. Therefore we do the screening and get the individuals to fill out the screen when they come to the health centre, deployed or in our own environment. We have done some work on doing not just post-deployment screening but also periodic mental screening. In other words, if you come in to see a GP or whatever and you haven't had a screening within 12 months, we are now looking at doing a screening while you are waiting in the waiting room, with an iPad et cetera. That's our formal screening process. It is face to face—you do see a health practitioner. Also, as part of some of the work we are doing around that, we are looking at doing a kind of anonymous self-help, self-check mental health screening, which will allow individuals to do their own screening and then give them advice on maybe what they should do—some apps they might be able to use—or say that they perhaps should go and see someone about it. The intent is to have that available on the internet, not just on the DRN.

Senator FAWCETT: There was a key bit of evidence that came out a few years ago now. I'm trying to think of the name of the inquiry, but it was one that this committee did into wounded and ill soldiers, basically from point of injury through to discharge. The evidence was about the role of spouses and partners in encouraging people to seek care. One of the things that resonated as I read that submission to this inquiry was that we got the strong sense that there are times when the service man or woman in the service environment essentially toughs it out and, when they go home, the pressure is there to actually do something about it. It resonated with me that the ability for a couple to sit down and go, 'Let's fill out this prescreening form and then you'll turn up to sick parade and see the psychologist,' actually makes sense in terms of getting people to take that first step. Is there a technical barrier to making that available to people doing it off the DRN?

Air Vice Marshal Smart : It's not something we've considered. I think, again, having this new type of screening is something that could be used in that context. It may work for some people. I'm not sure that it necessarily would change what the individual is saying. It's not something we've looked at.

Senator FAWCETT: Can you take it on notice?

Air Vice Marshal Smart : Yes.

Senator FAWCETT: Is it technically viable? What would the cost be? If it makes it a difference for one per cent, it's worthwhile.

Air Vice Marshal Smart : I think what we are focusing on is how we can engage families more generally rather than just the screening process. I think that's where our efforts are going at the moment. How can we even get families involved in identifying even to us—rather than allowing the member—that there is a problem? That's something that we are working on with Defence Community Organisation at the moment—increasing awareness of our services and the ability to access them.

Air Vice Marshal McDonald : We'll take it on notice.

Senator FAWCETT: You mentioned there was a subgroup of about 40 psychiatrists that you use frequently. I'm interested to know whether that is driven by cost—that they are the people who are happy to bid in, if you like, at that cost point—or whether you actually track the medical efficacy of the treatment of the veteran and preference psychiatrists who have better outcomes with veterans, or service members.

Air Vice Marshal Smart : We have 300 we can access, so that gives us as good an access as anybody in Australia. In fact, it's sometimes more, because we have a number of places now where we actually bring psychiatrists on base to provide, particularly in areas where it is difficult to get civilian psychiatrists. That's certainly available, but the 40-odd we use are ones who have been working for us for a long time so they do have that cultural competence: they understand the military environment—they understand that space—more than the average psychiatrist. But, with all of our cases, we send people to psychiatrists, and it's very important, obviously, that they develop a good clinical relationship and they are progressing. If they're not progressing, then we look at what is going on and whether there is another psychiatrist that might better fulfil their needs. We are also doing, as I said, a lot of efforts to upskill more psychiatrists so that they will have that understanding, because we don't want people to go to someone and say: 'They don't understand at all what I'm going through. They don't understand the environment.' That creates an instant barrier to actually getting a good treatment experience.

Senator FAWCETT: I suppose every case is different, and it's hard to take any given case and put some parameters around how quickly they should progress towards remediation, but, as a global population of defence members, do you compare against peers in the UK, Canada, the US, to kind of go, 'Is our approach to treatment having comparable outcomes in terms of people returning to unrestricted duty?'

Air Vice Marshal Smart : It's very difficult to compare like with like with other services, but we use the best-practice clinical guidelines in how we manage things like post-traumatic stress disorder. I think our results are very similar to what we are seeing in other nations, but I can take that on notice to get more direct comparisons. But it is difficult to compare like for like with different systems.

Senator FAWCETT: This is again anecdotal, but I think increasingly there is some documented evidence around the efficacy of hubs of expertise where there is both service provision and research and a community of knowledge that develops. We have largely lost that over the last couple of decades in Australia. Is Defence, as part of your work with DVA in looking at this whole piece, looking at examples overseas, or even here in Australia—Phoenix and some of the others—where hubbing occurs, to go, 'Is this something where we should be looking at our funding models to encourage the creation of these hubs, as opposed to the distributed model, where we send them out, like Medicare, to find service providers?'

Air Vice Marshal Smart : I don't think we send them out randomly. As I said, we use people we're familiar with, some of whom come into our bases. We also have the ADF Centre for Mental Health, located in Sydney. They're doing a lot of work in tele-psychiatry, second-opinion clinics and a lot of training-type opportunities. We've looked at having hubs in rehabilitation before. It's a matter of numbers. We don't have large numbers of people who require intensive high-end treatment in a particular year. Because the Defence Force is so dispersed, it's difficult to say where to put that hub. We're developing the psychiatrists, and in the white paper we have seven positions for uniform psychiatrists that we will grow over the next decade or so. We're looking at more of a hub-and-spoke arrangement, where we have the centre and then specialist services extending out into the regions from that, but in a more joined-up approach, and developing a support network around that in the community. That's probably the most effective and efficient manner in which we can provide that specialist support. There's no evidence at the moment that our people aren't getting the specialist support they need.

Mr PERRETT: I'm interested in whether we have any data on how many ADF personnel end up working for DVA, or on DVA people who spend any time with the ADF. It might be a personnel question rather than a health one. I see some of the great work my RSLs and Soldier On are doing. There's military expertise and some supported lay expertise—not psychologists—and they seem to have a good connection with DVA. I wonder if some of these issues could be short-circuited by having some of the cultures interconnected.

Mrs Skinner : The new secretary of DVA is Liz Cosson, a retired major general.

Mr PERRETT: Things might start.

Mrs Skinner : There are, and have always been, a range of ex-military senior and other appointments.

Vice Adm. Griggs : Emeritus senior appointments.

Mrs Skinner : It's a workforce that knows each other well.

Air Vice Marshal Smart : We look for other opportunities to educate both sides as well. We have a very close relationship with DVA, to the extent that we are now identifying people early, even before they have their medical board, saying, 'This person is likely to be discharged; let's get DVA involved months before they might leave,' and stopping them from falling through the cracks, which may have happened in the past.

Mr PERRETT: Many people in health are drawn to the critical care, the M*A*S*H scenario, which doesn't happen very often, thank goodness. The daily sick call, the colds-and-holes sort of medicine, is so much a part of the workforce issue, but—I didn't pick up that point about the seven psychologists who will be in uniform—

Air Vice Marshal Smart : Psychiatrists.

Mr PERRETT: Psychiatrists, I beg your pardon. They'll be in uniform, not specialist reserves?

Air Vice Marshal Smart : Correct. That's what we will be building towards. At the moment I can tell you that we have four psychiatrists in the Reserves, one of whom is also a contractor for us at the ADF Centre for Mental Health. We have 63 full-time uniformed psychologists and probably 130 or so in the Reserves. We have a large number of psychologists in uniform, but it's the psychiatrists, the doctors who do the specialty training, where we have relied on either Reserves or external providers. That's where we're looking to grow. Obviously, that is not easy; you can't just put a uniform on someone. So it will take some time to grow that capability. But, in the meantime, we think we need to also address the problem by upskilling civilian psychiatrists to understand more about the environment—again, both in the military and among veterans, because it is a continuum.

Air Vice Marshal McDonald : And it's the application of resources where it counts. The uniformed people sitting across from you are 53 per cent less likely to commit suicide than the general populace. If I'm in the Reserve, I'm 49 per cent less likely. If I transfer out for a medical reason—if I've got some issues—as a veteran on the street I'm 14 per cent more likely. So we've got to be careful where we focus our resources when the facts and figures are on the table. Bringing in too many high-end clinical psychiatrists might not actually be to our benefit, because of the low rates. That's why we're working very closely, hand in hand again, with DVA. Tracy is across there on regular occasions, and, obviously, the minister has a laser-like focus on it, trying to get the right mix. It's a complicated space. But I think the statistics are starting to come through where we're getting hold of this. Amongst 60,000 people, there are always cases where it doesn't go the way everyone would like it to go, but I think we are getting it right—more so than the other.

Mr PERRETT: I've been an MP for 10 or 11 years. Certainly, I'm hearing much better things from my RSLs and from Soldier On and the like, whereas I got the impression in the past that Defence weren't tapped into that need as explicitly as they are now.

Air Vice Marshal McDonald : And VCDF, sitting right next to me, has been very focused on this throughout his tenure. It's been driving all these things inside Defence to make sure we get it right. If you sit back and look at the entire program for mental health inside Defence, I challenge anyone to find one as substantial, including the funding level associated with it.

CHAIR: Thank you very much. Could I come to 2047 and get an update on that program.

Air Vice Marshal McDonald : That's not in my space.

CHAIR: No, it's not. Actually, we'll come back to 2047. I do have one specifically on ICT again.

Air Vice Marshal McDonald : Stephen?

CHAIR: Yes. It's in relation to the alignment of ICT capability processes with the capability life cycle and the IIP, basically. How is all of that coming together? It crosses over a few areas.

Vice Adm. Griggs : It doesn't cross over; it's integrated.

Mrs Skinner : The major ICT programs are integrated.

CHAIR: Yes.

Mrs Skinner : It's in the Integrated Investment Program.

Vice Adm. Griggs : There is no difference now between the conduct of an ICT project, the conduct of a capability project and the conduct of an infrastructure project. They all have a common process. They all do Smart Buyer. They all go through the same gates—through the IC.

CHAIR: Coming back to some of the questions I was asking earlier on, how do you measure success with Smart Buyer? You've said already that it's being implemented well and people are being trained in it. But how do you measure tangible success, not just in terms of the process? Is it actually realising some tangible outcomes either in terms of more efficiency in effective delivery of capability or in terms of financial efficiencies? What's the measure of success?

Vice Adm. Griggs : The ultimate measure will be the delivery of these projects without some of the problems that we've had—and, obviously, the lead time on these is longer than we've had. I think, though, that from a committee perspective we're seeing a broader range of issues coming to the table much earlier, and clear evidence that issues like inoperability and integration have been taken into account—that dependent projects and programs are identified, and issues that come out of those dependencies are bought up in the consideration of these projects at the early stage. The ultimate measure of effectiveness is on-time and on-budget delivery of the capability that the capability manager needs.

CHAIR: Which makes sense—it does make sense—but it does come into what we were discussing before: given that that reporting process is very much in year, how do we as a parliamentary committee get oversight and look at this progressively so that we can see the integration and some of those IIP milestones, which are not in the annual report and not readily visible to the parliament at this point? It's not a criticism; it's just an observation. How do we make that more transparent and visible so we can see some tangible results?

Vice Adm. Griggs : We've got your very clear theme today. We'll go away and have a look at it—

CHAIR: And if you could get this Smart Buyer—

Vice Adm. Griggs : including looking at the way, as you showed us, it was articulated in 2014-15, for example. If that's more helpful, we'll have a look at going back to that presentation.

CHAIR: It's not necessarily more helpful, but there were a couple of things in there that made it much easier.

Mrs Skinner : Yes. I'm going to go back to my office—it's on my shelf—and I'll have a look at it.

CHAIR: Thank you. My last line of questioning is about JP2047.

Mr Pearson : JP2047 is on time and under budget so far.

Mrs Skinner : Is there a particular question on 2047?

CHAIR: Just give us a project update about what it is and where it's up to and how it's tracking in terms of it having been identified as a critical Navy project for the three services. This is a project that we'll come back to and have more focus on more regularly, I suspect. So can you just give us an overview of the project.

Mrs Skinner : One point before I hand over to the CIO—

CHAIR: Please.

Mrs Skinner : You've asked a bit about ICT programs today. There are three pillar programs that have been slowly enhancing and modernising the ability of Defence to get its business done—Centralised Processing, which has concluded and was a good project in the end; End User Computing, which is bringing our normal desktops into the 21st century; and 2047, which gives you communications infrastructure. Those three big pieces of work are really starting to land now. The user experience of being able to access networks and having more modern-looking ICT, and our data management security of all of that have been enhanced over the last four to five years. I thought I'd make that point before handing to 2047 specifically.

CHAIR: That was very helpful, thank you. On notice, could you provide a bit more of a brief to the committee on that body of work between those three projects.

Mrs Skinner : Sure.

CHAIR: Now we'll go to 2047 specifically.

Mr Pearson : Essentially, there has been a huge amount of work in the infrastructure layer, as the associate secretary mentioned. We've got fibre links replacing copper wire, which, from a security perspective as well as a performance perspective, is important. A range of new towers are coming up, so our performance capability is greatly enhanced. From the user perspective, what's really exciting about the program is that there's much more capability from a unified collaboration perspective. Across each of our capabilities, we're now using tools such as Skype for Business and at-desk video conferencing with a much more robust and modern capability to be mobile as well as at the desktop. This goes right to the tactical interface as well. Whether it's the corporate background or on the war-fighter side, we have a much broader and consistent user experience across Defence, which has been really important for us. It's rationalised our networks and increased the capability we're getting from our network layer as well. In 2019, we should see the conclusion of JP2047.

CHAIR: At that conclusion in 2019, what will the system look like? What will have been delivered and how will it operate?

Mr Pearson : We'll have new networks. We'll have a new collaboration capability at the desktop and in a mobile environment. What's really important here, though, is that it's actually a step in the broader IIP, because this is a key enabler for ERP and our enterprise information management capability. In the modern age, we need to be able to make decisions not only as a corporate player but also across the board. So these in themselves are incredibly important to get us off ageing infrastructure and up to a modern, supportable capability. But I would add that it's incredibly important for landing these broader capabilities like ERP and EIM onto an environment that's very sustainable as opposed to perhaps what we have at the moment.

CHAIR: Given the complexity and given the time frame we've got currently, would you be able to map it out for the committee? I'm sure you've got a map somewhere. This is going to be an enduring issue for this committee, given the importance of the ICT backbone for everything else. Could you show us what you currently have, how it is migrating and how some of these systems fit into the future state. It can be in the same diagram or separately. That would help us get a better understanding of what you're doing currently at CIO group in the ICT space and how that backbone will roll out for Defence. The other services have said that they need that to be delivered for them to go fifth generation, in some cases. Could you provide us with some information on that so that, as we go through into the next annual report, we can then say, 'This is what you said this year. This was the scheduled time line for this year. How is it going? What's been delivered? Where are the areas we should be focusing on?' rather than—

Mrs Skinner : We will have a look. I think we've got an ICT road map and ICT strategy that would probably assist to be able to see that.

CHAIR: Once we've had a look at that, we might invite you back separately for a separate briefing to walk us through that process. And when we've got more work done on the aspects today, we might invite you for a separate briefing in a separate forum so the committee can get a much better understanding of how those processes work.

Mr Pearson : The processes, milestones, direction, end game, what the outcome looks like, with the time frames associated with it.

CHAIR: Yes—not to go to a substantial body of work that hasn't been done, but I suspect you must have all that there.

Mrs Skinner : We've got a strategy and a bit of a road map. I think we'll have a look at that and see how that supports at least the first conversation, and then if there are particular things to follow up we can do that.

CHAIR: Thank you very much.

Vice Adm. Griggs : This is my final interaction with the joint standing committee, so can I just pass on my thanks to committee members for the last seven years. We've had a lot of interaction and I've enjoyed nearly all of it! I just wanted to make that point.

Mr PERRETT: What a diplomat!

CHAIR: Thank you very much. On behalf of the committee during my tenure, Senator Fawcett's tenure and that of others, we've greatly appreciated the spirit in which you and the officials have engaged with this committee. I think it's particularly important for the House of Representatives members of this committee because they don't get the opportunity senators get in the estimates processes and in other committees. So we do appreciate the spirit in which you engage with this committee in this process and very much look forward to engaging with the department further to help us on this journey. Thank you very much.

Senator FAWCETT: And all the best in your career beyond Defence.

Vice Adm. Griggs : Thank you very much.

CHAIR: On behalf of the committee, good luck with your future endeavours, and we do appreciate very much the spirit in which you have always engaged with the committee.

I thank all witnesses who have appeared here today. We have asked you to provide some significant additional information, so the secretariat will be in touch with you about that. I declare this public hearing closed.

Subc ommittee adjourned at 13:39