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Parliamentary Joint Committee on Foreign Affairs, Defence and Trade - 19/03/2013 - Care of Australian Defence Force personnel wounded and injured on operations

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

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

FOGARTY, Major General Gerard, AO, Head, People Capability Division, Defence People Group, Department of Defence

LAVER, Commodore Peter, Director-General Navy People, Department of Defence

RODGERS, Air Commodore Robert, CSM, Director-General Personnel—Air Force, Department of Defence

WALKER, Rear Admiral Robyn, AM, Commander Joint Health, Department of Defence

[18:13]

CHAIR: Although the subcommittee does not require you to give evidence on oath at today's hearing, it is a legal proceeding of the parliament and therefore has the same standing as proceedings of the respective houses. Giving false or misleading evidence is a serious matter and maybe regarded as a contempt of parliament. Evidence given today will be recorded in Hansard and will attract parliamentary privilege. Does anyone wish to make an opening statement? If not, we will go to questions.

Dr JENSEN: In the really bad old days I guess people with PTSD were seen as having a lack of moral fibre or shell shock or whatever. We have a far more sympathetic and better approach today. How do you go about balancing the needs of the sufferer, who wishes obviously to remain with the service, with the best interests of Defence and the duty to care for people serving under or alongside these sufferers, where there maybe consequences due to the effects of PTSD?

Rear Adm. Walker : As with many conditions, there is a spectrum of the severity of the condition. In previous evidence I have talked about how for some high-functioning individuals you would have no knowledge of it. Under the medical employment classification system, if we are aware of people who have symptoms of PTSD, we have a diagnosis and it then is into a treatment program. That will often be run, if required, through inpatient treatment at one of the DVA accredited facilities. There are restrictions put on that individual in terms of their deployability, their access to weapons, their other occupational restrictions, which is the same process we use for physical conditions but it is about ensuring that we have our duty of care to both the individual and the organisation, and to their colleagues, and allowing people the time, where possible, to recover from their treatment and, if possible, remain in service. Previously it was about 12 months. If you are not fit to deploy you are discharged. It is a flexible arrangement but it comes down to the individual, the individual's desires, the organisation's needs and whether in fact putting someone back into an environment that will continue to trigger their symptoms is in the best interests of the individual. Again, it is individually based but I would maintain that the system is there to protect the rights of the individual and the organisation.

Dr JENSEN: You talked about high-functioning individuals where potentially they can hide the symptoms effectively. Are there processes in place for identifying where this occurs because presumably high-functioning people would be at more senior rank and therefore potential consequences of falling off the perch in conditions of significant stress could be greater than just having, say, a private falling off the perch?

Rear Adm. Walker : It may or may not but again it is across the whole spectrum of the community. We ask people about their symptomatology at their medical examinations. They are asked at their psychological screens post deployment or, in special cases, mid deployment. If they deny them but are experiencing them, as I have said before, we are in a quandary, except in the circumstances where people clearly are unwell and you do not need to be a doctor to identify that. Your colleagues, your family and people will bring that to attention. It is not just PTSD; it is alcohol, it is drug use. In the community generally with depression there are people who will not reveal their issues despite the best of intentions.

Mr ROBERT: Two questions, one on serving soldiers in terms of physical illness and one on mental illness. How are we going keeping soldiers who have been physically hurt—wounded, injured—soldiering in the ARA? How are we maintaining them, keeping them, utilising them, retraining them et cetera?

Major Gen. Campbell : I am advised that, in regard to our physically wounded from Afghanistan we have to date of those 249, two being from Navy and the rest from Army, seen a return to full duties of 69 per cent. Just to give you a comparative, Comcare indicate that in the civilian workforce the 2011 rates of return to work were 79 per cent.

Mr ROBERT: I suggest the injuries under Comcare were a little less harsh than they ones you are dealing with generally.

Major Gen. Campbell : I do not wish to make any assumption. The first one I might ask Rear Admiral Walker if she would like to raise any general comments about mental health.

Rear Adm. Walker : I do not have any specific breakdown available tonight on SF versus Army. I can go back to look at the prevalence study to see if we can pull that data out.

Mr ROBERT: That would be helpful, just noting the public commentary in terms of the high rate of multiple deployments in our SF community.

Rear Adm. Walker : We have some because that will be coming out shortly as a result of the prospective study into the Middle East area of operations deployment in the census study. That data will be available publicly within the next couple of months and that may well give us some information rather than anecdote.

Mr ROBERT: We will take that on notice, Admiral—anyone—Deputy Chief of Army, in terms of how we are going supporting those suffering from mental health issues.

Major Gen. Campbell : First I would like to comment that if we work backwards from the long term, it was asked earlier with regard to the development of DVA support to our wounded. I have been a participant with some of Army's wounded in development programs with DVA for new staff and mid-career staff to ensure that they are up to date with the realities both of circumstance and case experience. Those events have been very powerful, so that is dealing with the question of ensuring that there is a continuity of appreciation.

In an army sense, there is a great deal of attention across our levels of command and in our training institutions to be aware of the reality and to acknowledge it as like a physical injury, something that requires attention, maybe more complex and takes longer but is equally repairable and has both an individual's responsibility and an organisation's to attend to the needs of the individual and the safety of the team.

We have in each of our principal troop locations the soldier recovery centres which provide a more concentrated multidisciplinary support experience in Darwin, Townsville, Brisbane and also in our special forces location in Holsworthy. We add to that similar multidisciplinary support for our recruits at Kapooka and also for those who may be injured in initial employment training that is done in Holsworthy.

That is at the regional or brigade level, and into units there is very close attention to the individual case management of the complex cases and the unit management of persons whose care is less complex and following more normalized paths. I do not in any way suggest that there isn't further work to be done and there isn’t a need to be attentive to it both in practical measures and also in the awareness at all levels. The comment was made earlier about those who would seek not to refer or not to declare and whether that arises from personal professional desires or concern for stigma. Those issues are as important to us to attend to as the maintenance and support of our soldiers.

Senator FAWCETT: My impression over the course of this inquiry is that Defence has been very proactive in responding to the conflicts, from Iraq through Afghanistan, and that the system has improved considerably. It is probably still not perfect, but I want to put it on record that it is apparent that Defence has been working hard to make the system work well. Thank you for that. Clearly for people coming back to Australia part of the health care they receive depends on how you approach it. There has been a lot of controversy over the past few months about the outsourcing to Medibank of both the garrison, through Aspen, and the referrals to specialists. Can you give us a quick update on the status of that? Are all garrisons now covered? Have all the outsourcing models been put in place. And then on notice I would be interested if you come back to us with any stats you are collecting in terms of differences in waiting times for people to see medical support, whether it be doctors or allied health professionals on garrison, or satisfaction rates, wait times et cetera for specialists. That would be a useful trend to look at before and after that implementation.

Rear Adm. Walker : The on base services transitioned from November. All five service packages have transitioned successfully. I am unaware of any ADF member who has not received health care for an urgent medical condition. I am aware that we still have some transition issues in that the on base workforce, particularly in Townsville and Darwin, are still not meeting the KPIs that we required under the contract and we are working with the contractors to address those issues. But I would say that health care is being delivered in a timely fashion for people who need health care urgently.

Senator FAWCETT: That qualification causes me a little concern because it can mask a range of things. But I am happy to take your answer on notice. The other thing I am interested to know as part of that is: has the position of the professional colleges changed at all? I am aware that the various associations were not particularly supportive. The argument that was given to us by you and by Defence was that, if people have met their appropriate qualifications and they are qualified, the rebuttal to that from providers is that yes, you have different levels of airline—and there are probably not too many one-or two-stars who fly on a certain airline that was grounded a while ago. We are interested to understand whether or not, as it settles down, people have said it is not as bad as we thought or whether there are still concerns, particularly among service people or among the peers of those people who have engaged with the system.

Rear Adm. Walker : I will not speak for the professional colleges. However, I doubt that they have stopped.

Air Marshal Binskin : If the colleges are worried about the certification standards of their people, then they should review that. That is not just an issue for defence; it is an issue for the Australian public. If they are concerned, I would put it to you that they should actually be reviewing that.

CHAIR: I have a supplementary question to Senator Fawcett's first question in respect of the Medicare transition. My understanding is that there are 36 on base psychologists, 163 off base psychiatrists and 859 off base psychologists. What I would like to know on notice is how that relates to the number of health providers prior to the Medicare transition.

Rear Adm. Walker : Essentially there has been no change to the on base staff.

CHAIR: For how long?

Rear Adm. Walker : Prior to the contract or now. In fact, in terms of APS or ADF members, there has been no reduction in those numbers, in a sense. Positions have not been changed or abolished. We have always relied on external mental health providers, in terms of psychiatrists and psychologists, around the country.

CHAIR: My question is: how does that relate to the relativities of now as opposed to pre the new contract?

Rear Adm. Walker : As I say, there has been no change in the numbers of people that we would have employed in ADF or APS on-base prior to the contract or post the contract. As for contracted staff, again, I do not know whether those numbers are correct, but we have always used external providers for additional support. So there has been no decrease in providers.

CHAIR: All right. Thanks.

Air Marshal Binskin : Can I just address one part of the question from Senator Fawcett earlier—you were talking about numbers on bases, and we will give you the statistics for before and after. One thing the new contract has allowed us to do is adjust the numbers of providers at the different bases. As you know, we have moved Defence units around—7RAR going to Adelaide was one of those—and this contract being put in place allowed us to adjust the numbers of medical personnel to match the numbers of people that we have on bases as well. I think you will see that when you see the stats.

Senator FAWCETT: This is my last question, and I am happy for you to provide the answer on notice. Clearly, since 2009 there have been ongoing cost growth pressures across the ADF that correspond with decreases in budget allocations. The government has worked with Defence to get appropriate decisions about your priorities, and we have heard through a number of estimates sessions that that has caused Defence to have to make decisions about where you spend the money, where the priorities are—and we accept that. What I would like to know is: in the area of health, from Joint Health Command and any other areas that feed into that, where are those trade-offs being made? Can you give an indication of the areas where you have taken a hit or reduced some capability as a result of the budgetary pressures that have been placed on you.

Rear Adm. Walker : Senator, we have not reduced the type or quantity of, or eligibility for, any health services, other than where it has been shown, based on evidence, that that would not be an appropriate treatment. If someone needs a treatment, it is provided. The cost is not the factor that decides whether or not you have treatment; it is all about your clinical need and the evidence base for having that treatment. There are no treatment services that are not provided on the basis of any budgetary restrictions. The whole point of us moving to the new contract arrangements was to better understand and manage our health budget in an environment where we knew we were being overcharged for services, which then increases the pressure on the budget. Whilst I have not been able to articulately say it before, it is not cost-cutting, because we have never refused anyone treatment; but it is about trying to manage our health budget in a more responsible way.

Senator FAWCETT: Admiral Walker, you misunderstood my question. I am not accusing you of cost-cutting by making this change. I am asking you: if you look at your health capability as having fundamental inputs into capability, then where are the pressure points where you have had to make trade-offs over that?

CHAIR: You might want to put that on notice at this time of day.

Major Gen. Campbell : Senator, could I just add a couple of points. Army's programs related to support for our wounded, injured and ill have been maintained. In the course of the current financial year, they have been augmented financially, and they will be augmented in our next budget, regardless of what the allocation to Army is. The Chief of Army's very clear intent is that we will support operations and we will support our wounded.

CHAIR: Okay. Thank you for your attendance here today. There is a bit of homework that needs to be provided to the secretariat. You will receive a copy of the Hansard transcript to check, to which you can make any changes of grammar or fact. Thank you again.

Resolved (on motion by Senator Fawcett):

That this committee authorises publication of the transcript of the evidence given before it at public hearing this day.

Committee adjourned at 18:35