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Standing Committee on Health, Aged Care and Sport
03/03/2017
Hearing health and wellbeing in Australia

CAMPION, Ms Sue, First Assistant Secretary, Health and Community Services Division, Department of Veterans' Affairs

KRAUSHAAR, Mr Paolo, Acting Assistant Secretary, Program Management Branch, Department of Veterans' Affairs

[11:35]

CHAIR: Welcome. Do you have any objection to being recorded by the media during your evidence today? No, we will proceed. These hearings are formal proceedings of the parliament. The giving of false or misleading evidence is a serious matter and may be regarded as a contempt of the parliament. The evidence given today will be recorded by Hansard and attracts parliamentary privilege. You have made a very comprehensive submission. Would you like to make an opening statement?

Ms Campion : No, thank you.

CHAIR: We will go straight to questions. DVA obviously looks after veterans. What is the interrelationship between DVA and the armed forces? Working backwards, you are obviously identifying problems that manifest themselves after someone has completed their service. Is there close cooperation between DVA and the defence forces to make sure that their health standards reflect what you see in veterans further down the track?

Ms Campion : Do you mean using what we see—

CHAIR: You effectively experience the aftermath, which presumably could feed into making sure—

Ms Campion : Prevention type things—is that it?

CHAIR: Yes.

Ms Campion : That is a good question. On that specific question, I would have to take it on notice and come back to the committee if that is okay. Generally, we have a closer relationship with Defence. We have a number of forums to look at issues that we have in common obviously because there is a continuum between Defence and DVA, and that includes looking at health issues. What we are trying to do at the moment, and it will take a period of time, is to more closely align our health service provision between the two agencies because we have quite separate systems at the moment, and particularly focusing on continuity of care and service provision as people leave Defence and join DVA. Defence has a very specific system for its members, whereas once people leave Defence they are part of the community and they are accessing services just like you and I do in terms of GPs and specialists. Trying to ensure that the conditions for which they are covered while they are serving also translate into service provision when they leave is a really important issue.

CHAIR: I read in your submission that hearing loss and conditions like tinnitus are in the top three medical conditions for Vietnam veterans and other veterans. Are you finding that with more recent veterans who have served that those problems are diminishing or is hearing loss a consistent issue for those who have served in the military?

Ms Campion : It seems that at the moment it is up there amongst those top three conditions, as we set out in our submission. Following the Vietnam conflict and conflicts since then, those are two very prevalent conditions and that is why we have a streamlined process for those conditions. We do not make people go through and prove they were doing certain activities for a certain period of time—for example, to prove a claim that they have those conditions.

CHAIR: In the interrelationship between DVA health services and the NDIS, will any of your DVA clients be transitioning to the NDIS and be outside the DVA orbit as a result?

Ms Campion : Not for health. I think I heard the NDIA people mention that health is separate to the NDIA. For non-health services, certainly, if our clients meet the other requirements of the NDIA—the nature of the disability and severity and the age requirements—they may well be able to access services.

CHAIR: I was thinking of people suffering from hearing loss.

Ms Campion : For hearing, that is an issue we are working with the NDIA on, to look at what the impacts might be or what options our clients might have. But, as I said, for health services more generally, they will not be part of the NDIA; they will be part of the DVA arrangements.

Mr GEORGANAS: Is the department aware of any measures to reduce hearing loss in the defence department? We spoke about a few of them earlier. If there are programs, are there studies being done showing that those numbers are declining? And what is the major cause of people coming out of the Defence Force with hearing loss?

Ms Campion : They are very good questions. I am afraid I do not have the answers to all of them.

CHAIR: Feel free to take them on notice.

Ms Campion : We will take them on notice. In our submission, we did touch on some examples of the types of activities that contribute to hearing loss amongst people in the Defence Force, but, to give you a more comprehensive list of those things and also the measures that Defence is using to minimise those risks, we will take them on notice.

Mr GEORGANAS: That would be good.

Mr TIM WILSON: That leads into the question I was going to ask: what is DVA doing to feed back to the defence forces what can be done to minimise this risk, if anything? If you cannot answer that, I am happy for you to take that on notice as well.

Ms Campion : Yes, we will take that on notice. As I said, we have a number of mechanisms where we do work with Defence. We have a number of committees and those sorts of things where we look at issues in common or, as I said, because it is a bit of a continuum, ways that we can better understand how things develop and progress and how clients can transition from Defence to us with us knowing what those conditions are and what their requirements are without them having to start from scratch and tell us over again.

Mr GEORGANAS: I think I saw somewhere in your submission that hearing loss in veterans is far higher than in the general community. Do you have figures that would show us the ratio compared to the Australian community?

Ms Campion : We would probably have to work with the Department of Health to determine those, but our clients make up about 10 per cent, I think, of those who are registered under the Hearing Services Program. There are probably a couple of issues there. Obviously the nature of service and how it can impact on hearing loss is one issue, as probably is the age profile of our clients. Our clients do not just include veterans; we also have war widows. Our clients, particularly the war widows, do tend to live a bit longer, so it may be that we are potentially overrepresented under the Hearing Services Program due to those two issues—people are impacted by service, but we also have an older cohort of people in our client group. But, as I said, in trying to map out how our clients compare to the general population, we would probably have to do a piece of work with the Department of Health.

Dr FREELANDER: Are you aware of any way that the armed services follow up people once they have left the services to check on their hearing? Is there any program like that that you are aware of?

CHAIR: A screening program.

Ms Campion : I am not aware.

Dr FREELANDER: Is there any program while they are serving that screens their hearing?

Mr Kraushaar : I am not aware of either case.

Dr FREELANDER: I think we should know that.

Mr Kraushaar : In relation to the first question, when they leave the Department of Defence and they become a Department of Veterans' Affairs client, if they have manifested hearing loss it is a streamlined condition. They will receive treatment. We could always feed that back to the Department of Defence, but, in general, in terms of follow-up from the Department of Defence, I am not aware.

Dr FREELANDER: So they are sort of cut loose, in other words?

CHAIR: They have moved into DVA.

Ms Campion : They move into the veterans—

Dr FREELANDER: But there is no tracking of them. How do they know how to prevent hearing loss? Are you aware of any programs for hearing assessment during service?

Mr Kraushaar : We would have to take that on notice. My understanding is that in relation to hearing loss it is often around activities at the time, so hearing loss should actually start to manifest itself during Defence service, so that would be something that the Department of Defence would, I imagine, be responsible for during the person's service.

CHAIR: I suppose that raises a broader question. For example, when someone leaves the military and, effectively, becomes a DVA client, there are obviously certain medical conditions that are more prevalent for people who have served in the military or in conflict zones. Is there some type of ongoing monitoring regime for known conditions that are more likely to arise from military service?

Ms Campion : Not to our knowledge, no.

CHAIR: None that DVA operate, support or fund?

Ms Campion : Monitoring programs?

CHAIR: For example, take a Vietnam veteran. Either individually or on a broad scale, or maybe as a representative group, are there longitudinal studies that look at the health conditions arising from their military service in Vietnam?

Ms Campion : We do not necessarily have a formal program to monitor different cohorts, or people who have been in different conflicts. But at DVA we certainly do have a research program. We have about $3 million a year that we spend on research, and we fund a range of different projects. That is determined by the sorts of things that are emerging as areas that we think need exploration, or by other sorts of priorities. At the moment we have one that is not a longitudinal study, but it is looking at issues that affect people as they are transitioning from Defence to civilian life, and it picks up a range of issues. It covers things like housing and employment, but it is also looking at health issues as well.

Dr FREELANDER: Would it not be better to have a prospective study and look at the continuum from service through to after service?

Ms Campion : We have a very rich dataset at DVA, as you are probably aware. We are the envy of many, because, once people are our clients and they get a gold or a white card, we have a very comprehensive understanding of all of the types of services that they are receiving from GPs and specialists, and pharmaceuticals—the whole range.

Dr FREELANDER: Have you had any problems in your interactions with Australian Hearing services?

Ms Campion : Not to my knowledge.

Dr FREELANDER: You are happy with the service provided to veterans?

Mr Kraushaar : We are happy with the overall program of services provided to veterans through the Office of Hearing Services, which includes Australian Hearing, and also includes private providers. I should add that we also offer additional services to a subset of our clients, with the Office of Hearing Services, because our general population, including service pensioners, may go to OHS. The subset is the treatment population. For the treatment population, we provide additional services which are not available through the Office of Hearing Service's Hearing Services Program. These will include things such as assisted listening devices, tinnitus treatment and so forth.

CHAIR: Thank you for joining us today. Unfortunately, you have a lot of questions on notice. They were probably better directed to Defence than DVA, but we would be very grateful for anything you can answer or assist in answering.

Ms Campion : We are very happy to take those and work with Defence to give you some answers.

CHAIR: Fantastic. There will be a Hansard transcript available for you to review. Thank you for your time. I formally close this public hearing.

Committee adjourned at 11:50