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Foreign Affairs, Defence and Trade Legislation Committee
28/02/2018
Estimates
DEFENCE PORTFOLIO
Department of Veterans' Affairs

Department of Veterans' Affairs

[20:57]

CHAIR: I welcome now Mr Simon Lewis, Secretary, and officers of the Department of Veterans' Affairs. Minister, would you like to make an opening statement?

Senator Payne: No, thank you, Madam Chair.

CHAIR: Mr Lewis, would you like to make an opening statement?

Mr Lewis : No, thank you.

CHAIR: I will go straight to Senator Gallacher.

Senator GALLACHER: Do we have an officer or officers who have dealt with the Senate inquiry into suicide by veterans and ex-service personnel?

Mr Lewis : Certainly.

Senator GALLACHER: So we don't get at cross-purposes here, I have a comprehensive and detailed list of questions in respect to all of the recommendations, so if you just answer the question I'm asking at the time, we might move through it a little bit quicker. But it is quite comprehensive. By way of background for anybody listening, the government responded by accepting 22 in full and two in principle of the 24 recommendations. So we're not at cross-purposes here; we're just examining progress that may or may not have been made. As per recommendation 1, can the department provide detailed information—and the option is obviously to take on notice the detail, if it can't be dealt with in some sort of brevity—on both of the suicide trial sites. For example, how many veterans will participate in the trials? How are they selected and when will they begin? That's in respect of recommendation 1.

Senator Payne: We're just finding the right officer.

Senator GALLACHER: No problem.

Ms Cosson : You are referring to the Senate inquiry—'the constant battle' recommendation?

Senator GALLACHER: Yes.

Ms Cosson : This is in relation to the suicide prevention, with the trial sites. Ms Anderson will just give you a brief update on that one.

Senator GALLACHER: In respect of the suicide trial sites, how many veterans will participate in the trials? How are they selected and when will they begin?

Ms Anderson : I'll talk in some detail about the two mental health pilots that are being run out of my division. The first is the Coordinated Veterans' Care Mental Health Pilot. This pilot will recruit 250 veterans—that's 125 veterans per year—over the two years of the pilot. The pilot actually has commenced with some testing in Bundaberg at the Ashgrove country practice where we've got our first veteran who has been enrolled.

The purpose of the overall program, or the pilot, is to enhance community based support for those with mild to moderate anxiety or depression who also have physical health problems, such as musculoskeletal conditions, with associated pain. This pilot in particular has funding of $3.6 million over the life of the pilot.

The second pilot is the Mental Health Clinical Management Pilot. This pilot has $6.2 million allocated. It's going to look at involving up to 100 veterans over the two years of the pilot. The purpose of that pilot is to provide intensive non-clinical support for those people who have attempted suicide or are experiencing suicidal crisis or at risk of suicide following their discharge from hospital. So the numbers are smaller mainly because the actual pool of people will hopefully be much smaller, given those criteria.

Following discharge from hospital, the service will provide an outreach to ex-serving members, and that could involve everything from developing a safety plan, to connecting people with informal and formal supports outside of the hospital structure, providing continuity of care by acting as a conduit between the hospital and the community. So it's going to be providing intensive support services with a time limited approach to support a step down from that acute care environment in the hospital.

Senator GALLACHER: In terms of selection, is there an outreach program that selects them, do they self-nominate? How does it work?

Ms Anderson : In terms of the first one—the CVC Mental Health Pilot—that will be a discussion between the GP and the patient, or the client.

Senator GALLACHER: So it'll be a referral process?

Ms Anderson : Yes. In terms of the suicide, sorry, the Mental Health Clinical Management Pilot, it will require people who are in the hospital environment. They'll be approached to see if they are willing to join the pilot.

Senator GALLACHER: Have both the projects begun?

Ms Anderson : The first pilot that I described, the CVC pilot, as I said, is testing in an environment at the moment and we've got one veteran enrolled. The other one, the clinical management pilot will be due to roll out by about mid-year.

Senator GALLACHER: You mentioned Bundaberg. Where would the other one be?

Ms Anderson : There are a range of current scheduled locations. There are 10 in total. I can go through those if you like.

Senator GALLACHER: Perhaps we could get that detail on notice.

Ms Anderson : Certainly.

Senator GALLACHER: I'm going to try to go through all 22 recommendations, so we'll be a bit constrained for time. I'm happy to get that on notice. In addition, in response to recommendation 1, the government committed to piloting personalised and veteran-centric case management. That's what you've given us an update on now?

Ms Anderson : That's right.

Senator GALLACHER: That doesn't actually get off the ground until the middle of the year?

Ms Anderson : The CBC pilot will be launched within the next number of weeks. The clinical management pilot will certainly roll out by mid year.

Senator GALLACHER: And you've given us the target number of veterans that you're going to put through the program, but they're not actually sourced at the moment. They've got to come through referral or self-nomination?

Ms Anderson : That's right.

Senator GALLACHER: And you're going to supply on notice where they're going to be located?

Ms Anderson : That's right.

Senator GALLACHER: Have you given any thought as to how you're going to measure success in this area?

Ms Anderson : Yes. For both pilots we have engaged an evaluator to ensure that, over the duration of the two years, we've got a way of measuring success or otherwise.

Senator GALLACHER: Would that be an independent evaluator?

Ms Anderson : That's right.

Senator GALLACHER: Is there an abundance of people who evaluate these sorts of programs?

Ms Anderson : I wouldn't say there is an abundance but there are a number of evaluators that do specialise in these sorts of evaluations.

Senator GALLACHER: Can you provide a breakdown of the additional $4 million that has been utilised in this program? Has it been used to employ additional staff?

Ms Anderson : I can take that on notice.

Senator GALLACHER: And whether those staff are on contracts or what their—

Ms Anderson : There are no additional staff within the department to roll out either of the pilots. There are staff involved both in the general practices and in the hospital environment.

Senator GALLACHER: So no additional staff have been added for the establishment to the department?

Ms Anderson : No.

Senator GALLACHER: What is the role of the case manager who's assigned to these individuals? What does their role look like?

Ms Cosson : What we're doing at the moment is a number of complimentary activities while these pilots are getting underway. One of the activities is looking at our case management arrangements in the department. We were provided $4 million to undertake a pilot for two years, commencing from 1 July this year. We've established a multidisciplinary team including not only people that understand our business but also psychologists. We're looking at engaging a social worker to do the initial triage: to understand, when someone is referred to the department, what level of support they actually need. We've got a number of different capabilities within the department that can then be activated when we've got an understanding of the needs of a particular veteran.

Every Monday we talk about our high-risk cases: those veterans or family members that have been raised for our attention. We go through and discuss each individual case to understand what level of support and what level of need is required. We're doing that at the moment while we try to understand what is a good case management model for us. We've looked at Canada and we've looked at the UK. We're talking to Human Services as well, because they have a case management model. We want to ensure that we implement a best of breed case management arrangement. We're very sensitive about not wanting to start a case management arrangement until we've tested some of the different lessons that have been learned from other countries and from other agencies across the Commonwealth. That is the $4 million I think you're referring to, that case management model, which will kick off on 1 July this year.

Senator GALLACHER: In respect to case managers—just a couple of questions there—how do they facilitate access to medical, social and employment support? How do they actually do that?

Ms Cosson : We have just been talking about this today, where we do have a case where we want to appoint a case manager that is external to the department. In some instances, our veterans don’t feel comfortable dealing with a member of the department. So we were talking about a case manager that we can talk to about the special needs of the veteran; how they can access the services of the department; what are our legislative guidelines in providing a support to a veteran. But it is also important that they are a clinician and that they appreciate what are the clinical needs of that veteran to help them then connect with psychosocial support; make sure they're connected to a psychiatrist; make sure they can talk to their GP. So we want a clinical case manager in some of those high-risk complex cases. Some of our other cases won't need a clinician, but they will need someone that can help them, perhaps mentor them, into employment—this is a role we have been talking with the ex-service community about—where they've had lived experience, and some of these veterans are trying to connect with someone. It may then be something from an ex-service organisation that can help mentor them into employment or, with the Prime Minister's Veterans' Employment Program where we can, as a department, get them into employment that might suit their skills and their background.

Senator GALLACHER: There's a really difficult question about how often do the case managers contact the individual on a—well, admittedly, it depends on the individual, but is there some sort of benchmark that allows you to measure an interaction over a period of time that you would expect—you know, fortnightly, weekly or monthly? It is a difficult question, I understand.

Ms Cosson : It is.

Mr Bayles : There is really no specific benchmark. I think you are right; it would depend on the case. Someone might need contact only every four weeks. Someone else might need pretty regular contact. It depends on their particular needs and how they're—

Senator GALLACHER: But, if someone felt they weren't getting enough contact, that could be addressed?

Mr Bayles : Yes. It would be tailored and personal to the individual. That is the intention.

Dr Hodson : In support of the department in this area, since last October we have also strengthened the ability to do the high-end risk cases—the actual clinical management of those people who are potentially suicidal. Since last October, in a five-month period, we have done 119 reach-outs on behalf of the department where people have been identified as potentially at risk. That has resulted in a series of hospital admissions or just sometimes people coming back into the service or referral to another service. When you are doing high-risk case management, we might actually call a number of times a day. We have an after-hours call service and over the weekends we will often have a check-in service across a weekend. Really importantly, last week, we put on, nationally, five new positions. We want six; we just need to get the right people. These are clinical case coordinators; they have come out of acute mental health services and they've gone into all of our regions. So, when the department needs someone managed who is actually at high-risk, we've actually strengthened, nationally, now, our ability to do that.

Senator GALLACHER: It is a really difficult area, though. Having worked with some veterans and worked alongside them for a number of years, you almost have to be psychic to determine which way we should be going on a weekly basis.

Dr Hodson : This can change daily. That is one of the issues in this space; you have got to be reaching out constantly. It is why we have actually had to put in an additional level of case management. Most of these senior clinicians have come out of community mental health or acute mental health settings. They are well connected back into the community, because often what we need to do is pull people into care, but then we have also got to work through the discharge process and back in. We do the crisis support and, importantly, what were doing probably more than we've done before is reaching back to the department to help deal with the trigger that resulted in the crisis in the first place.

Senator MOORE: Ms Cosson, do you have any further detail you could provide us on notice about the trial? I would imagine that you're looking at a range of different models of case management, and we won't have any capacity to go through that. You mentioned one variation tonight. I think it's really important that we get some idea about the range of case management models you're looking at. That would evolve over the two years. I'm sure the ones you start won't necessarily be the ones you end up with. It would be very useful to get an idea about the scope and where the trial is taking place as well. I would expect that, in some service areas across different states, you'd be trialling different models.

Ms Cosson : Absolutely. We're working very closely with Defence on those sites. I'm happy to take that on notice.

Senator MOORE: That'd be great.

CHAIR: We've completed recommendation 1. Could we go to recommendation 2? Could the department provide an update on the progress of the independent study into the mental health impacts of compensation claim assessment processes on veterans engaging with DVA and CSC? You've commissioned someone to undertake a study. Who is that?

Ms Cosson : Not at this stage. We are scoping what this recommendation requires. What we have been doing as part of our Veteran Centric Reform is convene a claims workshop under the deputy president's leadership, but we've also, as part of Veteran Centric Reform, met with over a thousand veterans who, in most instances, have had a very difficult time with the claiming process, to learn the lessons from them. A lot of those lessons have helped us design the future status part of our transformation. What we need to do is now scope: what would this independent review actually do for us based on some of the lessons that we've already identified? We will be commissioning an independent—

Senator GALLACHER: Does that go out as a tender?

Ms Cosson : We could look at a list of eminent people or people we are aware of who could undertake this review and work with the department, but we haven't identified someone.

Senator MOORE: Personalised surveys, interviews, rather than just a tick-a-box process?

Ms Cosson : Absolutely.

Senator MOORE: That's a step into recommendation 2.

Ms Cosson : Yes.

Senator MOORE: The only reason that was done was as part of the planning around recommendation 2?

Ms Cosson : Certainly.

Senator GALLACHER: Do we know what the cost of the study will be?

Ms Cosson : No, sorry, Senator, not until we know the scope of the study and who we might be engaging to undertake that study.

Mr Lewis : One thing that is clear is that we'll be absorbing the cost.

Senator GALLACHER: So questions about how long it will take and whether there is a deadline are all premature?

Mr Lewis : I would expect that we'd be able to give you much more detail on this when we next meet in May.

Senator MOORE: Could I just go back to recommendation 1? We're rushing through this. We went to recommendation 2 and I'm going back to recommendation 1. We didn't ask funding questions on recommendation 1. Would that be absorbed within the current budget as well?

Ms Cosson : We received funding in the budget to respond to recommendation—

Senator MOORE: To cover the whole thing? You said there was an extra $4 million or so. What is the total funding for it? Does the $4 million cover everything?

Ms Cosson : It's $9.8 million for the pilot and then $4 million is additional funding to do the pilot for case management.

Senator MOORE: So the case management had the extra funding of $4 million and the whole pilot cost $9.8 million. They're separate. I thought it was probably reasonable to get the funding down the other side.

CHAIR: We can move along to recommendation 4. Could we get an update on the review of the veterans-specific online training programs? Has this review being completed?

Ms Cosson : No, Senator, this review has not been completed. What we have been doing is preparing some online tools. Dr Hodson can talk about the online tools that have been developed through the Veterans and Veterans Families Counselling Service.

Dr Hodson : We review the options that are out there to strengthen the continuum. There is one of the first tools, which we're putting in place at the moment. The Australian Psychological Society had worked with Griffith University to do upskilling for clinicians. It's a six-hour online upskilling program. We have worked with the Australian Psychological Society to roll that out to all our clinicians currently within our service and we're about to roll that out to our entire network. That will be the upskilling in the next six months.

Senator MOORE: That's general professional training?

Dr Hodson : Yes.

Senator MOORE: So what you're doing is taking the current workforce and giving them that Griffith training—which is a very good course—which is general and then looking at how that can work within DVA. Is that right?

Dr Hodson : Yes. Basically, this is making sure that the people who are asked to actually deal with people at risk have the skills to do it.

Senator MOORE: How much does that cost?

Dr Hodson : I'll take the exact figure on notice, but to do the entire work force is about $400,000. That is our entire network of about 1,400 clinicians. They don't just see veterans, so we see this as a great opportunity to upskill people in rural Australia on a key area of suicide management.

Senator GALLACHER: This is one component of the veteran-specific online training programs?

Dr Hodson : We did that as the first step that we identified as a really good thing to do quickly while we do the more comprehensive assessment over a couple of years: how could we step up the workforce?

Senator GALLACHER: Is there a time frame for the overall review or the overarching review to be completed?

Mr Garrity : We're currently drafting terms of reference to engage an external provider to undertake that review. The anticipation is that we would, through that review, conduct an environmental scan, in terms of current programs and online provider training being delivered and use that as a basis for a gap analysis and then look at an accreditation framework for training programs that could be used in relation to certified accreditation. We would anticipate being able to go to market for their review within the next six weeks.

Senator GALLACHER: Obviously that review would go to the minister. Would there be any process for recommendations that came out of that review? Would they be made public?

Mr Lewis : That would be up to the minister, but we would recommend that they were public.

Senator GALLACHER: So it looks as though progress is happening, but it is six weeks before you go to tender.

Mr Garrity : That's correct.

Senator GALLACHER: And what is the cost of that?

Mr Garrity : It would be dependent on the submissions and the assessment of the submissions we receive.

Senator MOORE: There's no budget in the contract? You're going out to contract. You're putting budget around that?

Mr Garrity : We would make an assessment based on submissions. There's no budget with this model.

Senator GALLACHER: I think, Secretary, you said that you're going to absorb all of these costs?

Mr Lewis : We'll need to absorb the costs.

Senator GALLACHER: Is it quite an impost on you?

Mr Lewis : It could be significant. But we've already agreed to these recommendations. When the minister asked for our advice we went back and supported the recommendations. That means we need to find the money. I could come in with one extra comment. I know you'll probably come to the Productivity Commission in a moment, but I'd like to jump ahead to explain. There are quite a number of reviews, as you know from this set of recommendations. We thought it was important to get the bedded down review, which is a critical one in my view. We're very supportive of it. The Productivity Commission does tremendous work. We've put a lot of effort into resolving the terms of reference for that review, which I think sets the bounds for a lot of the work that will happen over the coming months. From that, I think it will make it much easier to sort out some of the smaller—if I can call them that—and more focused reviews. I'm very hopeful there will be announcements about that very soon. That sets the scene for some of the other ones to follow. I wouldn't want you to think we've been taking extra time on any of these reviews. We're very keen to get the big ones underway early.

Senator GALLACHER: I'm sure I speak for the entire committee when I say that the committee was very, very happy with the response by the government. We're more or less trying to appreciate how it's going. It's a very positive story, I think, for all concerned.

I go to recommendation 5: the Department of Defence and DVA to align mental health arrangements. Can the department advise what progress has been made with that recommendation?

Ms Cosson : I could take that one. The work we've been doing with Defence, with the Transition Taskforce, is connecting us earlier with our veterans before they separate from their military service. For those that are medically discharging or those that do have mental health conditions, what we are doing is ensuring that continuity of care. We have a pilot which is—one of them is called the 'transition health assessment', where we're working with Defence and with Commonwealth Super Corporation to make sure those members that are suffering from mental health issues have certainty in relation to the care that they will receive once they've separated from the military, but also that they have certainty in relation to the benefits that they will receive after they've separated. That pilot is going extremely well, and we want to be able to roll that out more broadly.

One other pilot that we have is the 'Special operations forces pilot', where we have been invited into Holsworthy to sit with the commandos and work with their members who are separating—to once again go through all of their records of service, their medical records to once again develop a plan for their separation—and to put forward all their claims with the department. So that is, once again, giving them certainty prior to them leaving.

The third one I'll talk about—the final one for this recommendation at this stage—is where we want to issue white cards on separation. As the committee would be aware, we know everybody now when they enlist but we also know everyone that is separating, transitioning, out of service. What we want to be able to do is connect them with their white card so that they can seek the treatment when they need it.

They're three initiatives that are underway and we continue to work with Defence because that early engagement is the key. That's what we're finding with the special operations forces pilot; because we have access to their records, straight away there's no question and we don't have to go finding the evidence. Importantly we can also respect the security issues and we don't have to reach back into Defence. We have it available to us at the time of separation.

Senator GALLACHER: Those two pilots in particular will better inform you of how to deal with them on the whole-of-Defence basis?

Ms Cosson : Absolutely. Yes. Ultimately we would like to have the information pushed to us at time of injury, but at the moment we don't have that information-sharing—that would be the goal longer term. These pilots are certainly showing us that, if we're working with individuals prior to that separation or working with their families, they are experiencing a smoother transition out of military.

Senator GALLACHER: Mr Lewis, you mentioned the Productivity Commission recommendation. Are those terms of reference completed?

Mr Lewis : Essentially they are complete, but obviously it's a matter for the terms of reference now to be issued by the government. That should be happening imminently. We're obviously very keen for that review to get underway very quickly. In fact, some of the advance work is already underway with the Productivity Commission—two commissioners are involved—we've been through the department several times because we're keen to help them get up to speed as quickly as possible.

Senator GALLACHER: When were the terms finalised by the department?

Mr Lewis : We put advice to the government basically and it's now between ministers. It's not a matter for my minister to issue those terms of references; it's a matter for the Treasurer.

Senator GALLACHER: So the department has completed its—

Mr Lewis : We've done our bit; it's out of our hands.

Senator GALLACHER: It's moved on from your minister—it's with whole-of-government is it?

Senator Payne: Treasurer.

Mr Lewis : It's with the Treasury/Treasurer—but I don't believe there are any issues, I think it's a case of finalising the paperwork and getting the announcement made.

Senator GALLACHER: You're confident the terms of reference will reflect the concerns raised by the veterans?

Mr Lewis : I think it'll be very consistent with what the committee is expecting.

Senator Payne: And, Senator, I'll check on that for you.

Senator GALLACHER: So we have to wait for a decision now about the announcement of a productivity commission review?

Mr Lewis : The government has already agreed to the recommendation. It's just a case of getting the—

Senator GALLACHER: They've agreed to it, but there's no formal date.

Mr Lewis : But as I said, the two commissioners have already been appointed; they've spent multiple days already in the department, and we're busy briefing them up.

Senator GALLACHER: I'm trying not to ask hypotheticals, so: a Productivity Commission report would normally take—is it how long is a piece of string, or is it a three-month thing?

Ms Cosson : Twelve months, it'd be.

Mr Lewis : Twelve months or so. It's a reasonably standard process that the Productivity Commission works through, where they will invite submissions; they will conduct hearings; they will have a draft report.

Senator GALLACHER: And how many pieces of legislation does your department have to comply with?

Mr Lewis : There are the three main acts, which are going to be an obvious focus of attention. If I had my general counsel here at the table, she'd say there's more than just the three, but, if you think of it in very broad terms, there's the Veterans' Entitlements Act, there's the Military Rehabilitation and Compensation Act, and there's the piece of legislation which was part 10 of the old SRCA, but we've now extracted as a separate piece of legislation, which we call the DRCA, which is a Defence-related SRCA. And those three acts are all now the responsibility of the veterans' affairs minister, so it's brilliant timing for the Productivity Commission to look at the opportunities around alignment and simplification.

CHAIR: Thank you very much. The committee will now suspend for a tea break.

Proceedings suspended from 21 : 31 to 21 : 41

CHAIR: This hearing has now resumed.

Senator FAWCETT: Mr Lewis, welcome. In the questions you've been asked today, you've already covered off a number of elements of the Veteran Centric Reform. But I'm looking to get a little more granularity on where you're up to. You were given $166-odd million for that first phase. We're approaching a new budget cycle. I'm interested to understand what the key achievements have been in the spend of that first phase to date. I'm happy for you to give an overview. I've got a few specific questions. Looking at the last portfolio budget statement—for example, page 62—you had a table there. Just one example is where you had performance targets that you were saying you weren't meeting, and a little asterisk said that, in part, it was because of the archaic ICT systems that you had—the implication being that, as we spend more money on that, you might start meeting the targets there. I'm keen to understand how you're going against some of those metrics that you've set yourselves in your reporting.

Mr Lewis : I'm not sure our money was going to resolve that particular metric, but we are seeking to resolve that metric via other devices. I might turn to Ms Cosson to provide you with an overview in relation to the Veteran Centric Reform.

Senator FAWCETT: Your footnote says:

Data quality is expected to improve with the introduction of ICT enhancements from 28 May 2017.

Ms Cosson : I will start off and my colleague might jump in with some further detail. Certainly some of the achievements since the commencement of Veteran Centric Reform, I'm happy to report, are going well. The first one I'd like to highlight is the fact that we are still working with our veteran community. One of the foundation pieces for Veteran Centric Reform was co-design with our veteran community and interviewing them, convening workshops and just listening to what their issues were and what their concerns were so that we could design that future state. That has been continuing. We continually adjust our thinking and, importantly, adjust our digital doorway that we have developed as part of VCR, which is MyService. We have now over 2,000 clients registered through MyService. It was initially intended for the veterans seeking to have initial liability established under the Military Rehabilitation and Compensation Act. We've now extended that to our other acts. What we're finding is that veterans are able to submit a claim quickly and also get a result quicker. There is an average of 120 days for those who use MyService. On average, it takes about 33 days. So we have seen an improvement in the time taken to process.

Senator FAWCETT: Can I just come back to you on that figure? Did you say 2,000 registered?

Ms Cosson : Over 2,000 have registered.

Senator FAWCETT: Out of a potential population of how many?

Ms Cosson : With our younger veterans, we've got about 5,500 who separate each year from the Defence Force. You could probably use that figure, because it was just for the MRCA clients. What we were doing is connecting with those that were in the process of transitioning—someone like me. I registered through MyService, just to see how it worked. You could say that it's out of a population of quite a few: 5,500 separate a year. But, as you know, we probably only know one in five of our veterans who have served from 1999 onwards.

Senator FAWCETT: With that cohort who are separating, though, given the increased collaboration you're trying to do with Defence, why can't we make it part of their discharge procedure that they actually register?

Ms Cosson : With the pilot that I mentioned, with the transition health assessment pilot and the special operations forces pilot, that's exactly what we're doing. We're sitting with those veterans who are in the process of transitioning and helping them register through MyService. That's very successful.

Senator FAWCETT: Do you have a plan to roll out beyond the pilots?

Ms Cosson : We do, but it is dependent on a lot of the back-end ICT. At the moment MyService is the digital door for claiming. The IT systems sitting behind it need to have greater connectivity. We're working around it. That's why we haven't gone out with a huge campaign to advertise it—because we just need to keep up. It was a test as part of our budget submission that we could become digitally enabled. We used a lighthouse project, which we talked to the committee about before, to demonstrate that we could have a digital capability.

Senator FAWCETT: You are saying that that group has reduced from 120 days to around 30 days?

Ms Cosson : To 33 on average—that's right.

Senator FAWCETT: Obviously, despite the interface, the connectivity was still there behind the scenes.

Ms Cosson : There were a lot of people behind the scenes trying to make that work, very successfully. We had great support from the team that works for the deputy president in Melbourne, helping to facilitate that. Also, importantly, as part of that trial we looked at streamlining a lot of our decisions. We were able to use evidence to identify the top claims and which of the top claims would be accepted. We worked with Defence, through the training establishments, to understand what evidence was required for musculoskeletal claims, for example. That helped accelerate the decision-making, because they were decision ready once they accessed MyService. So we were looking not only at the IT component of veteran-centric reform but also at the policy and how we could do it better, how we could streamline it and make it decision ready.

Senator FAWCETT: Are you getting feedback from the ESO Round Table?

Ms Cosson : Yes, absolutely. We had a number of showcases with the ex-service community, not just the round table but more broadly. We were able to demonstrate MyService. They provided us input, particularly where, if they were advocates, how they could access the system if they wanted to support a veteran. We were able to modify it and design that into the system to support that ex-service community. They're positive, from what we've been able to demonstrate and the feedback that we've received.

Senator FAWCETT: As you roll through this reform program, one of the parallel things we've discussed with you and I know you've been looking at is training for advocates, as well as best funding formulas et cetera. How joined up are these activities? Is the rollout of the veteran-centric reform shaping your advocate training approach?

Mr Lewis : They are obviously very closely linked. I will get Ms Foreman to address your specific comment in a moment. We've been making some terrific progress in relation to our advocacy training and our accreditation process, which we've talked to you about in the past. Of course we do now have a review, which will be kicking off very shortly, as well. It is one of the list that we did not quite get to before tea. Ms Foreman might touch on that as well. We're making significant progress and I expect we'll have quite a few more accredited advocates by the end of this financial year.

Ms Foreman : What we're doing with the advocacy program at the moment is modernising it as it's transitioned from the old TIP, or the Training and Information Program, to the Advocacy Training and Development Program. It's an accredited program. It's been accredited by the Standards Australia quality assurance program as a proper adult education program. It comprises an online component. All advocates now have to do an online component; they have to have a mentor and learn through their mentor; and they do face-to-face training as appropriate. They have to meet a certain standard to be an accredited advocate at a cert level I, II, III or IV. We're modernising that program.

As the secretary just said, the Senate committee noted and we've known for some time that this model of advocacy is relying on volunteers. Volunteers are terrific—they contribute a lot, they're very passionate—but if we look at the longer term and the ageing of our older veterans, we're not going to have a sustainable supply of volunteer advocates. In the longer term, we need to come up with another program that's professional, because that's what our younger veterans are seeking. They want to know that the advocate that they're dealing with has had the proper training. The current program is addressing that need at the moment, but we know that it's not sustainable. We need to look at how do we move forward into the future, and that's a study that my secretary was just talking about.

We need to look at what the options might be. Some people have singled out the Canadian model, which is a professional bureau of advocates, and that's one way we could go. Whatever way we go, Senator, we won't have a new solution in six months' time. We're going to have to transition again from where we are now to where we want to be, and that has to be done really well. Often in policy you know what the problems are and you know where you want to be, but it's how you get from where you are to the new model that is going to be really important to its success. So that review will be happening shortly.

Senator FAWCETT: Thank you. Don't go away; I want to come back to you about assistance dogs in a minute, but I want to finish veteran-centric reform first. I want to ask about the legislation that was introduced into the House of Reps this month. From your perspective, in terms of progressing the reforms that you're looking at, what are the time critical paths you need that to be passed on?

Mr Lewis : I will ask Ms Spiers to come to the table.

Ms Foreman : I will begin while Carolyn sits down. There are several payments and packages in that bill that Ms Spiers is about to talk about. The first one is the veteran payment. That's a new income support payment. It came out of the suicide inquiry and the other work that we're doing to try to prevent suicide. The veteran payment is about recognising that young veterans with mental health conditions are often very vulnerable between when they lodge their claim and when we make a decision. We have a new payment that we'll be able to make available to younger veterans—veterans covered by the Military Rehabilitation and Compensation Act—and there will be income support payment. Once they lodge their claim for any mental health condition, we'll be able to make a payment to them. That payment will continue until six weeks after we've made a decision on whether we accept liability. If we don't accept liability, we'll transition the veteran to an income support payment through the Department of Social Services or Department of Human Services. If we do accept liability, the veteran will be eligible for our income replacement or incapacity payments. That's got a 1 May start date.

The other element of the package with a 1 May start date is the family assistance package, which is a new direction for this department. We're actually going to be providing assistance directly to families. For our younger veterans who are returning from conflicts or where there's been a death of a veteran, there are extended services now. The families will be able to access extra child care; they'll be able to access additional household assistance and home care; and there is also a third element. Just one second—

Senator FAWCETT: Counselling?

Ms Foreman : Counselling services. That includes financial counselling, but it also includes mental health training. When veterans come back from Afghanistan and they've got mental health conditions, it's a challenge for the family. It's difficult sometimes to know how to work with the veteran when they need assistance, when they need to call for professional help. This families package recognises the vital role that families play as veterans are returned to health. That also has a 1 May start date, so they're the critical times. Ms Spiers can fill you in on the other aspects.

Ms Spiers : I think Ms Foreman has covered two of the key measures. The other very strong Veteran Centric Reform element is our change to qualifying service claiming requirements. Currently qualifying service, as you would be aware, is those that have faced the enemy in war. They get the additional access to gold card when they turn 70, for instance, and access to service pension when they are no longer able to work. The existing legislation requires them to actually lodge a claim form. As Ms Cosson has mentioned earlier and, I think, in previous estimates, we're getting far better information directly from Defence about when people actually undertake deployments to places like Afghanistan. The difficulty we then have is that we get the information automatically from Defence but, for a person to then claim for qualifying service, they have to physically lodge a claim form. So one of the reforms in the bill is to say you can still do a claim in the traditional way, and we'll allow that to happen, but we can also allow this automatic transfer of information from Defence to trigger a determination for qualifying service, and therefore the individual doesn't have to actually go through any process to achieve that.

As you might be aware, the bill was introduced on 15 February, and it has gone through the Federation Chamber today, so I'm anticipating third reading in the House tomorrow. We sought and gained T status for the bill, so we're expecting it to enter the Senate in a timely manner so that we can achieve the 1 May deadline for the two key measures there.

Senator FAWCETT: We look forward to getting that. You mentioned the family measures and also the veterans payment. There's a differential there for a spouse?

Ms Foreman : The veteran payment is a payment primarily for the veteran. However, a partner of the veteran is also eligible for that payment, just as with other income support—it's an income support payment. It's paid just above the disability support pension rate. So we've got a single veteran rate and we've got a partnered veteran rate, where both the partner and the veteran get a payment. That's a direct payment, whereas the family package is not a direct payment; it's access to different types of assistance. It's increased services in the area of child care and counselling.

Senator FAWCETT: Traditionally, we have provided veterans and their families with support.

Ms Foreman : Yes.

Senator FAWCETT: When a veteran has passed away, we have provided support to widows at varying levels.

Ms Foreman : That's right.

Senator FAWCETT: I had a constituent raise an issue in a forum just last week in Adelaide. She's the wife of a veteran who's TPI, and she has given up her career to support him over many years. If he had died, my understanding is that she would have continued to be supported by DVA as the widow of a veteran.

Ms Foreman : That's right.

Senator FAWCETT: There was domestic violence involved. She took out an AVO. He has chosen to divorce her, and my understanding is that DVA say, 'Well, you're not a widow and you're no longer the partner of a veteran,' but it's the same woman who's provided the same support over many years. Where does DVA go with that? What can we change to address that kind of situation?

Ms Foreman : Essentially we need to change the law. At the moment, under the Veterans' Entitlements Act, you are entitled to a partner pension if you are married to a veteran. You're also entitled to a gold card if the veteran dies of a war-caused injury, and you're also entitled to widows pension. Your entitlement relates to your relationship to the veteran and your dependency on the veteran. When you get divorced, that dependency is severed. While you're separated—

Senator FAWCETT: It's severed if he dies as well.

Ms Foreman : It is. I agree with you, but what I'm saying is that we need to amend the legislation in that area to give effect to the issue. We've started down that path in the sense that you can continue to access partner pension if you have separated due to domestic violence. So while you're in separation you can access that pension, but once the divorce comes through, under the law, your ties with that veteran have been severed, and you're no longer, under the law, considered to be dependent on the veteran. I know what you're saying: that sounds unfair. That's an area of legislative reform that we may need to look at.

Ms Spiers : We are aware of the case that you refer to but there are many other cases like that. As you know, since 1972, with no-fault divorces, people can choose to divorce so divorce this is the sever.

Senator FAWCETT: I know many young soldiers that have come back from deployment and it is an empty house. Clearly in that situation, you don't necessarily want the benefits going. So there are complexities; I understand that. But in cases like the one I have described, where someone has given up a career to care for a veteran who is a TPI, that outcome doesn't appear to be fair. We may come back to the executive and the minister with some suggestions around that. Who's responsible for assistance dogs?

Mr Lewis : I am glad you are asking the question, Senator. Keep the acid on us.

Ms Anderson : I will answer your question about assistance dogs.

CHAIR: What was the question?

Senator FAWCETT: I am disturbed if you are now responsible for the assistance dogs and I have to tell you what my interest is because that says to me the corporate knowledge has not been passed on within the department.

Mr Lewis : It still needs to be a question—good try!

Senator FAWCETT: We discussed this several times in the past. There is a body of evidence going back 10 or 12 years in a whole range of disability and autism and other sectors around the efficacy of assistance dogs. The department told us probably two years ago in estimates that they could not move until they had done their own studies in that area.

Mr Lewis : A correction, if I may jump straight in, I think two years ago we were saying that there were studies underway in the United States and Canada and we were waiting to see the results of those. But in more recent times, we said we were going to do our own study. That was late last year. I'm completely with the committee on this. I think this is a test we should be doing. I think there is a lot of potential benefit in it. As I've discussed before, we need to be cognisant of our duty of care to the animals as well as to the veterans that participate in the trial. So if your question is for an update as to how we are going with our tender process, we actually have that tender process well underway. I am not sure Ms Anderson will be able to give you a lot of details because we are still tendering in-confidence with tenders actually being analysed at the present time. I think we will be well-placed and I would be very confident that we will be able to talk to you in detail about the tenderer appointed and contracted by the time we convene in May, with a tender underway.

Senator FAWCETT: I look forward to that.

Senator Payne: That is very good news, Mr Lewis.

Senator MOORE: Are you only looking at dogs?

Mr Lewis : In this particular trial, there are horses.

Senator MOORE: In previous discussions, we talked about the fact that there is evidence around them. So your tender is to look specifically at dogs?

Mr Lewis : It is.

Senator MOORE: Is there any willingness within the department to widen that research, once you have it, to other forms of animal support?

Mr Lewis : Let's see how this one goes first.

Senator MOORE: Because there are lots of studies about them as well.

Senator Payne: On the Defence tender site, there seems to be a lot of live animals. Perhaps we could transfer some.

Senator MOORE: There have been trials on monkeys.

Senator GALLACHER: Given the time we have left, we would like to place on notice more questions about the recommendations 3 through to 23. I want to move to changes in transport options in New South Wales. Has anybody got an understanding? Can someone please detail the changes to transport that have impacted the veterans in St Mary's, New South Wales. Has anybody got a handle on that?

Senator Payne: I probably need to declare an interest in this one.

Senator GALLACHER: We're talking about the way that veterans access transport—taxies et cetera.

Ms Anderson : In terms of the booked car with driver, which is a subsection of the Repatriation Transport Scheme—I'm not sure if you're referring to a competitive request for tender that was released in 2016. Is that the one that you're referring to?

Senator GALLACHER: Basically what we've got here is that in September 2017 a procedural change was made to transport which has impacted a number of veterans in the St Mary's area. Prior to the change, veterans used the local company. That's no longer the case and apparently they're no longer getting the service they used to get, and it's presenting a number of problems for veterans and causing considerable angst.

Ms Anderson : Senator, I may need to take that one on notice. I don't have that level of detail with me at the moment.

Mr Lewis : We may have to take that on notice. How many transport bookings do we make a year? It's well over a million. We might need to take on notice the details of this one and come back to you on notice.

Senator GALLACHER: Can you detail the changes you've made in respect to veterans in St Marys? When were the changes introduced? Is this change across the board or only in New South Wales? Has the department received complaints in respect to this change? If so, how many? What was the nature? What is the process for the complaints?

Mr Lewis : We track complaints and compliments, and our complaint rate is very low. But, when you have well over a million transport bookings a year, it's still a significant number. If you're talking about just complaints in the St Mary's one—

Senator GALLACHER: Yes, it is very specific.

Mr Lewis : We'll see what we can do to answer your question.

Senator Payne: I actually do spend a bit of time there and it hasn't been raised with me.

Mr Lewis : We'll take that on notice. I am not aware of the issue.

Senator GALLACHER: Okay; well you've got the detail on that.

Senator MOORE: I have questions around the ongoing freeze to the RMSF, which is linked to the Medicare freeze, and the impact on veterans.

Ms Anderson : As of 1 July, 2017, for GPs who are bulkbilling, there was an increase to their Medicare indexation. From 1 July, 2018, this year, there will be an increase for the standard GP consultations. The indexation of fees for specialist consultations will also recommence as of 1 July this year. For specialist procedures, that will recommence on 1 July 2019. For DVAs' dental and allied health items, the indexation of fees will recommence on 1 July this year.

Senator MOORE: Where do mental health services—which would range between some specialist GPs and, I would think, specialist psychologists and psychiatrists—fit in?

Ms Anderson : If it's a GP who's providing the mental health support, they will see an increase in their indexation from 1 July. If it's a specialist, they will also see an increase in indexation from 1 July this year. If it's mental health care worker, if they're an allied health professional, they'll also see an increase in their indexation from 1 July this year.

Senator MOORE: Has the issue of access to services been raised by veterans through the department?

Ms Anderson : We're aware of more recent media coverage and certainly anecdotally we're aware of some issues that some of our clients have had in accessing, in particular, specialists in some areas. More recently, there has been coverage of psychiatrists not accepting DVA clients.

We're in the process of doing quite a deep analysis of the various Medicare items, the DVA fee and the average that the AMA has provided to us on specialist fees, in particular psychiatrist fees to look at what the difference is for each of those items. We're actually seeing an increase in the number of services provided by psychiatrists, if we look back at our data. So that's something that we need to be looking into in more detail—and that needs to be not just the fees but also the geographic spread of those psychiatrists.

Senator GALLACHER: Some anecdotal information is the Northern Territory, Darwin in particular, is one area of particular concern. I know from personal experience that, if you go there with your Medicare card, they tell you to get your wallet out, pay the fee and look after the Medicare rebate and so on. Is that quite common in the Northern Territory across all of the range of services that service people are trying to access?

Ms Anderson : Not necessarily. That's one that we're aware of more recently. There are five psychiatrists providing services to DVA clients in the Northern Territory.

Senator GALLACHER: Predominantly, that would be in Katherine and Darwin, would it?

Ms Anderson : Yes, and it could be Alice Springs as well. I would imagine that there would be some fly-in services that are provided as well. As I said, we do need to look at the geographic spread of where clients are needing, in particular, psychiatric support versus where the specialists are located.

Senator GALLACHER: I imagine that Enoggera would be okay, but are Townsville and Darwin areas at issue?

Ms Anderson : Not that we're necessarily aware of, but this is more information that can be provided at the next estimates once we have had the opportunity to do that deeper analysis.

Senator MOORE: Are you only looking at psychiatrists, or are you looking at psychologists and other allied health as well?

Ms Anderson : We are looking at allied health as well.

Senator MOORE: So, in the mental health space, you've got psychiatrists and psychologists and some of the others that are acceptable. I forget which ones. I think OTs and social workers are also in that level.

Ms Anderson : That's right.

Senator MOORE: Is it just within the mental health are that you're doing this analysis, or are you doing it across all specialties?

Ms Anderson : It is in terms of the specialties. We're looking first at psychiatry. But we do have an allied health review underway.

Senator MOORE: At the moment?

Ms Anderson : Yes.

Senator MOORE: And that's all areas of allied health?

Ms Anderson : That's right—dental and allied health.

Senator MOORE: And the other forms of specialties will come sequentially after you finish the mental health area?

Ms Anderson : Yes.

Senator MOORE: Are you doing that in consultation with the various colleges?

Ms Anderson : Yes. So far, we've had quite a lot of interaction with the various colleges—and obviously that needs to continue.

Senator MOORE: Have you had a number of applications for veterans to the department to request additional funding to cover costs?

Ms Hancock : We get queries from veterans or people on their behalf from time to time. It's not particularly frequent but, when we are contacted by somebody who's having trouble finding a provider, there's a number of things that we can do to help. Firstly, we would have a look at the area in which they live and see from our records if there are providers in that specialty that they're seeking who are actively treating veterans and see if we can arrange a referral to those practitioners who are taking DVA clients. If we have no success there, we can, for example, pay for somebody to travel to another provider who is prepared to treat them, or we can consider what's called an above-fee request where the provider will approach us and say, 'I'm prepared to treat this client but, for various reasons, I will charge above the regular rate.'

Senator MOORE: And that's case by case?

Ms Hancock : Yes; that's case by case.

Senator GALLACHER: Can I ask a really dumb question? On another committee, Defence have a project that they call Transforming Health. It's got a $200 million investment in facilities all around the country. They gave quite comprehensive stats about the number of visits and the number of psychiatric evaluations that are undertaken on base. I thought there were a staggering number of psychiatric visits in places like Wodonga and Townsville, particularly pre and post deployment. This effort is going on in Defence. Is there no capacity to link that improved transformational medical provision service with veterans? They're going to be geographically the same.

Ms Hancock : Indeed there is. We discuss our mutual interests in providing good medical services to both current and former serving members. One thing that is, I think, worth noting in this context is that we have providers who are basically doctors in the community. They treat DVA patients. They also, in many cases, are the doctors who are treating current serving members on bases as well. They're the same practitioners, so it's sensible for us to understand what Defence is doing and vice versa.

Senator GALLACHER: At the moment, is there an element of separateness which you're trying to close?

Ms Cosson : Yes, that's correct. We are trying to close that gap. There was a point in time when Defence did have its own health contracts and providers, but, over the last couple of years, we've been working with Defence. We sit on the steering committee with them in their transformation program. With our transformation program, Defence is also integrated with us. We are seeing that gap closing, particularly having a look at their providers to see where we can leverage those providers, and they're looking at us as well because we are a major purchaser of health services.

Senator GALLACHER: It would be refreshing if we can make that a success.

Ms Cosson : It's really good at the moment. We're working very closely.

Mr Lewis : It's a critical point, and underlining it all is data. We need to get this data integrated. You mentioned all of those visits coming through. We need a much bigger pipe coming from Defence through to DVA, because a lot of that case history will be relevant to our future claims.

Senator GALLACHER: As it was explained to me, a lot of the evaluations are necessary to give commanders the ability to defend the country, and they need to be assured of people being in the right shape. It's a small step to make sure that they're leaving in the right shape.

Mr Lewis : Precisely.

Senator MOORE: And staying in the right shape. Ms Hancock, you said that, from time to time, you get direct contact from people who are seeking support and you talked about the help with the gaps. Do you keep data on that and where they're from?

Ms Hancock : I'd have to take that on notice.

Senator MOORE: Could you take that on notice and see whether that's something we can get—of course depersonalised—to see what the data shows in terms of the people contacting you and whether it's worse in some states than others. I presume it will be, depending on remoteness.

Ms Hancock : Sure.

Senator MOORE: I know that veterans raise it at various fora too. It's an issue. A Northern Territory veteran raised it recently and spoke to the department directly about the concerns in this space. I think you'd find that just about everywhere at different times. What about practitioners? Do specialists and practitioners contact the department and talk about their concerns about the fact that they're not able to do the service as they want to?

Ms Hancock : Specialists and other health practitioners have a range of ways in which they interact with the department. We have the Health Consultative Forum, which meets regularly, where the peak bodies for the various health professions come together and discuss issues of interest between DVA and the professions, and certainly fees come up in that context. Also, as Ms Anderson mentioned before, the dental and allied health review that's been underway for a couple of years has involved a number of discussions with the professions, including in relation to fees.

Ms Anderson : It's also fair to say that we're putting an emphasis on improving our partnership relationship with providers, whether they be general practitioners, specialists or allied health and dental.

Senator MOORE: Is dental the one that's not changing until 1 July 2019?

I've just been incapable of reading. I can only just read my own writing, so I've written down the dates.

Ms Hancock : No, our dental and Allied indexation is 1 July 2018.

Senator MOORE: Because it was 'specialists 2018—something—2019, and Allied Health 2018'.

Ms Hancock : No, they're all going to be 2018.

Senator MOORE: So what was 1 July 2019?

Ms Hancock : The 2019 is specialist procedures.

Senator MOORE: That was what I couldn't read, thank you. You said earlier that when people contact you, you can provide them with information. It does seem to be that they have to seek out the information. So is there any point where this information is made public? So if I lived in a place like Biloela in Central Queensland, and I was seeking this kind of support, where would I go to find out which practitioners are recommended or provide services for veterans?

Ms Anderson : This is actually a piece of work that we're hoping to make some real inroads into through our veteran-centric reform, the transformation process, whereby it's much easier for veterans to go online and locate in their geographic area a list of whichever form of health expert they need who has their books open and who is willing to see DVA clients. So that is a work in very early stages but that's something that we see would be of great assistance to veterans.

Senator MOORE: Absolutely. I would imagine that would be something that's asked about very often.

Ms Anderson : Yes.

Senator MOORE: So you're hoping to make that an online service, of course, because that means easy access?

Ms Anderson : That's right.

Senator MOORE: And also through places like RSLs and support organisations? I would think there'd be some anecdotal knowledge anyway in those places, if you went to where your local veterans are, but it just seems to be common sense. But the other service, where you actually can arrange people to fly in, I don't think that's well known. I mean, I know it's not common, and it wouldn't be something that would be your first step, but if veterans knew that, if the need was there, it would be. I don't think they know about that.

Dr Gardner : This is a complex area.

Senator MOORE: It sure is.

Dr Gardner : I know Biloela well; I was medical superintendent out in Clermont for some years, long ago.

Senator MOORE: I'm sure you provided the services when you were out there.

Dr Gardner : Absolutely. Part of the problem is that the distribution of veterans in Australia is not uniform. In fact, deeply hidden on our website is a very good map, which Ms Anderson's unit is responsible for, which shows the concentration of veterans by Primary Health Networks.

Senator MOORE: In the Sunshine Coast, there's a very large number.

Dr Gardner : Sunshine Coast, Bribie Island, Bundaberg area are DVA central. The practitioners who work there know and understand the DVA systems and ,if there is a problem in a veteran getting access, they know who to call, they know our prior approvals system and they know what we can do. And there are amazing things we can do if it's clinically appropriate, and passes what I call the smell test—it's the right thing to do for an entitled veteran. In Biloela, for example, there aren't many specialists. You've got to go to the big smoke.

Senator MOORE: Rocky?

Dr Gardner : And even in Rockhampton, there's not a great deal of help there.

Senator MOORE: Nor in Townsville or Brisbane.

Dr Gardner : Getting back to the earlier point you raised about psychiatry: yes, that is a potential problem, certainly in the north, as Senator Gallacher talked about. But there are also some other areas that are of emerging concern, which do worry veterans, and they write to me about it. These include areas to do with orthopaedics; obstetrics and gynaecology, especially in the area of reproductive assistive technology; eyes; and urological surgery. And the problem there—and it gets back to that issue that you raised about fees—is that nobody in Australia, say, in the urological surgery area, charges the scheduled fee.

Senator MOORE: No, I don't think they do.

Dr Gardner : And there are at least four in Australia who charge $25,000 for an operation that the fee structure says should be worth $4,000 to $5,000. And I personally get involved, and we have about 100 roughly—the numbers vary—contractor health practitioners who work part-time for DVA handling health requests from veterans and others, including for above-fee deals. If it's clinically appropriate and there are special appropriate circumstances, we can and do approve those above-fee rates. But, of course, I can get from $4,000 or $5,000 to $8,000 without much trouble, but there's no way I can get to $25,000. But, again, if there was outstanding clinical outcomes for those people then we could look at it. But we know from the figures of the College of Surgeons that their figures are no better.

The other thing which hasn't been mentioned but quickly we should mention is, as you probably know, our GP fees, all our medical fees have been frozen for a long time now. It's a sore point within the colleges and the AMA. However, we do pay above the standard rate. We pay 115 per cent for GPs but, on top of that, they can access the coordinated veteran care program, which can pay more than $1,000 a year per veteran that they enrol in that program. So you can't just look at the dollars per consult; it's a package. For specialists, we pay 135 per cent of the scheduled fee for consultations and 145 per cent for procedures. These figures are still way below the current AMA schedule fees but it does mean that—

Senator MOORE: But above the standard Medicare?

Dr Gardner : Way above. It does mean that a lot of practitioners will still accept veteran clients. I say they're happy but they take our treatment cards because they know they're getting 145 per cent instead of 100 per cent. But there are geographic problems and there are specialty problems in those five specialties I mentioned. Our secretary and the chief operating officer and first assistant secretary health and community services are working in that space to try and broker sensible solutions.

Senator MOORE: I think that's a space everyone's working in. Basically, as you pointed out, the gold card and the access with the higher payments is one of the things lots of other particular groups with needs are very envious of. Still, even with that support, the gaps are very high.

Dr Gardner : We had a woman in Sydney last year, a young female veteran who had significant reproductive health issues. There was not a single specialist within an hour's drive of where she lived in suburban Sydney who would take the gold card in full payment for her services. We were able to do the right thing and help her, and pay for the services she needed but we could not do it on the card system.

Senator MOORE: I take it that you, Doctor and also the department, have made this situation very clear to the government?

Dr Gardner : This is a difficult area because it's government policy.

Senator MOORE: Absolutely. We understand that.

Dr Gardner : We do raise the issue when we can.

Senator MOORE: You have the data, you have the information, and all the department can do is provide information. I wanted to get on record that you have done so.

Dr Gardner : We worked with the AMA last year, where they did a survey.

Senator MOORE: They did a big survey.

Dr Gardner : Warwick Hough from the AMA did the survey, which basically said: are you continuing to see veteran patients—yes or no? Have you changed the numbers? If the government was to relax the indexation pause, would you see more and take more? The answer was yes, yes, yes.

Senator MOORE: And we know the government received that survey. Ms Anderson, could you provide any data you have that indicates people who have contacted you by geographic location and even by issue. And I think the trials that you're putting in place will reflect that as well. The work you're doing around mental health, have you got a timing for when that will be completed? The work you're doing around looking at psychiatrists and where they are, could you would tell me about that particular process you're going through.

Ms Anderson : That work is under way at the moment.

Senator MOORE: Just put it on notice, and also that you're doing the Allied Health review.

Ms Anderson : Certainly.

Dr Gardner : The president of the College of Psychiatrists, Dr Kim Jenkins, is on one of our veteran mental health consultative reference groups. That was done at the request of the college, which wrote to the minister of the day and asked this be re-established. That is now working.

Senator MOORE: Thank you, because that's really important. That came up consistently in the Senate inquiry.

Senator GALLACHER: Is someone able to answer some questions on the Prime Minister's Veterans' Employment Program that was announced in November of 2016?

Ms Foreman : That's right.

Senator GALLACHER: So you established an industry advisory committee. The Prime Minister's Veterans' Employment Awards is to be held on 28 March this year?

Ms Foreman : That's right.

Senator GALLACHER: How many nominations have been received for the Veterans' Employment Awards?

Ms Foreman : There are nine awards. We called for nominations for seven of those awards, and we received 91 nominations for those seven categories. The winners of the other two categories are chosen from the winners of the first seven categories, so we did not call for nominations.

Senator GALLACHER: Are there guidelines about how you actually nominate? Are there criteria?

Ms Foreman : Yes. That was available on the website.

Senator GALLACHER: Unfortunately, I didn't see the website.

Ms Foreman : For example, for the Veteran Employee of the Year Award, information on eligibility and the criteria were published on the Prime Minister's Employment Award categories website. Would it help if I took you through one example?

Senator GALLACHER: Yes.

Ms Foreman : The Veteran Employee of the Year category was open to veteran employees who have been working in an organisation for a minimum of two years. Nominations for that award can only be made by the employing organisation. So that is the eligibility. The criteria that are used to assess that award include: achievements within the organisation, including specific outcomes that are achieved; demonstrated evidence that the nominee's military skills are valued and have been utilised in their current employment; and supporting evidence from the nominee's supervisor, management or board on their contribution.

Senator GALLACHER: So it's quite comprehensive. There are seven categories? What are those?

Ms Foreman : The first is Leadership in the Recruitment of Veterans. The second is Veteran Employee of the Year. The third is Veterans Employer of the Year for Large Businesses. The fourth is Veterans Employer of the Year for Small to Medium Sized Businesses. The fifth is Veterans Employer of the Year - Public Sector Organisation—

Senator GALLACHER: And each of those categories is underpinned by some guidelines and nomination criteria.

Ms Foreman : That's right.

Senator GALLACHER: They are all in order and within the guidelines that you have?

Ms Foreman : That's right.

Senator GALLACHER: You've got 91 nominations for nine categories, seven of which are—what are the other two?

Ms Foreman : The other two are Outstanding Contribution by an Individual to Veterans' Employment and Outstanding Contribution by an Organisation to Veterans' Employment.

Senator GALLACHER: Fantastic. Where will the event be held?

Ms Foreman : In the Great Hall in Parliament House.

Senator GALLACHER: Are we inviting a plethora of people? Are they going to fill it up?

Ms Foreman : We are.

Senator GALLACHER: How many people have been invited?

Ms Foreman : We're working through that at the moment.

Senator FAWCETT: Are you looking for an invitation?

Senator GALLACHER: I very rarely take invitations to dinner. It's not that I'm against anything; it's something to do with my waistline! So you're working through a list. You obviously don't know how many people have RSVP'd?

Ms Foreman : No.

Senator GALLACHER: That would be, what, a 400-person dinner?

Ms Foreman : Around 400 to 500, yes.

Senator GALLACHER: That's the Great Hall. Is there a budgeted cost for that?

Ms Foreman : Yes, there is.

Mr Harrigan : The department was funded in the last budget an amount of $247,000 to conduct the awards event. That includes costs associated with work leading up to the event, holding the awards event itself and some follow-on work after the event. The industry advisory committee which has been formed to oversee the program, and also the awards event, is undertaking some sponsorship for the awards. That will add to the funding available and already provided by government and allow the event to cater for numbers in the order of 400 to 500.

Senator MOORE: Does that funding include travel costs for nominees?

Mr Harrigan : That is something the industry advisory body is looking at, yes. In terms of those who are either selected as a finalist in one of the categories or an overall winner, which will be announced on the night, we are factoring in an allowance for accommodation and flights to bring those individuals to Canberra if they don't reside here.

Senator GALLACHER: Excellent. I have to take it back—I do occasionally go to a dinner in the Great Hall and I have been to the Prime Minister's science awards, and that was obviously a bipartisan invitation list. Is it intended to invite the opposition to this?

Mr Harrigan : The invite list is something that we're working through with the minister's office at the moment, and obviously there will be a need to consult with the Prime Minister's office as well.

Senator Payne: I am sure appropriate representatives will be invited.

Senator GALLACHER: The Ex-service Organisation Industry Partnership Register—has anyone got any detail on that? That was due to go live last year.

Ms Foreman : We did some research—we used ORIMA to help us do some research with the ESOs and with industry. That research has just concluded, and we are about to discuss that with the industry advisory committee in the immediate future.

Senator GALLACHER: So it was due to go up at the end of last year, but it hasn't happened?

Mr Harrigan : We hadn't officially committed to a delivery date. I gave evidence at the last hearing to Senator Moore that we need to make sure that any investment we make in this register is worthwhile, which is why we went out and conducted some research—talking to employers, veterans and ESOs—before we make a decision on proceeding down that path of developing the register. I mentioned at the last hearing that Defence itself has what it calls the Engage portal, which offers some benefits and support to the ex-service organisations as well. So what I would like to do is make sure that we can't use some of the functionality within that tool to address the same connections we might be looking to build here between employers and ESOs.

Senator GALLACHER: How many ex-service organisations have registered interest in participating? Do you have any of those figures?

Mr Harrigan : The latest figure we have is 18.

Senator MOORE: What's the pool number for that? That's 18 out of how many?

Mr Orme : That's, 'How long's a piece of string?'

Senator MOORE: I know.

Mr Orme : There are multiples, but the key ESO representatives are represented on our ex-service organisation roundtable, plus there are another 10 or so larger, well-known ESOs. But it's a significant number.

Senator MOORE: I'm just interested in how many of the eligible groups are engaged in some way—so at this stage it's 18, but you would consider this to be an early stage in the process?

Mr Harrigan : I would say early—and I think those 18 that have expressed an interest are those who we'd consider more active in developing employment programs for veterans.

Senator GALLACHER: Is it correct that the industry advisory committee in October forwarded a report to the department with recommendations?

Ms Foreman : The report went to the Minister for Veterans' Affairs and the Prime Minister.

Senator GALLACHER: And we are waiting for a response, are we?

Ms Foreman : It's with government at the moment.

Senator GALLACHER: So none of the recommendations have been implemented because it hasn't been replied to as yet?

Ms Foreman : The report has not been released. However, the industry advisory committee continue to work on the themes that they've nominated that they want to do further work on.

Senator GALLACHER: Have you received any feedback, or are you saying the recommendations haven't been released?

Ms Foreman : That report has not been released.

Senator GALLACHER: Okay, so you wouldn't have had any feedback?

Ms Foreman : Yes. The chair has had conversations with the minister that we are aware of, but we weren't party to those discussions.

Senator MOORE: The last minister.

Ms Foreman : Yes.

Senator MOORE: It is in a flux, and we know that. We're just hoping that, when the next minister is appointed, this will be on the agenda.

Senator GALLACHER: We have still got a minister, haven't we—or not? So it's with the minister—a minister.

Senator Payne: We do indeed have a Minister for Veterans' Affairs.

Senator GALLACHER: Deputy Prime Minister McCormack, isn't it?

Senator Payne: Indeed, he is the Deputy Prime Minister.

Senator GALLACHER: Well, that finishes me on that.

Senator MOORE: This question is really short; it's just an update on the Saluting Their Service grants. How many applications were in the October round?

Mr Corke : At this stage, we only have data for the round which closed on 30 September; so that's 1 July to 30 September. That's the current round which is being processed. There's another round running which is not yet complete.

Senator MOORE: The question is on the October round, so would that be the one that's not yet complete?

Mr Corke : That's the one that has just started—unless you're referring to the fact that there was a round that was run from July to September; October was when they were notified.

Senator MOORE: When they may have got the money? Okay. We'll ask questions on that one.

Mr Corke : On that one, there were two groups of grants. There are the commemorative grants, which are the grants for up to $4,000; there were 183 grants issued, and a total of just under $450,000. Then there are the major commemorative grants, which are for projects that are significant, usually from a state or national government perspective, naturally they are over $4,000; there were 11 of those, and the total amount was just under $220,000 awarded.

Senator MOORE: Can you tell me how many applications were received in both those categories?

Mr Corke : I'd have to take that on notice.

Senator MOORE: That's fine. Can the department advise what the process is for determining successful grants?

Mr Corke : The grants are submitted to the department. They are assessed by officials within the department, which then go on to a committee which includes the Repatriation Commissioner plus a number of senior ESOs, who then make a recommendation on each of the applications. Those recommendations are submitted to the minister then for a decision as the delegate.

Senator MOORE: So you have the initial screening through the department; they then go to a committee, with a range of people on it with expert knowledge, which considers all of them; the committee makes recommendations; then it goes to the minister for decision?

Mr Corke : Yes.

Senator MOORE: Is any consideration given to location? As to the criteria, is location a consideration?

Mr Corke : Not in terms of geographical location, but location type things would come into question as to whether or not the activity is accessible to a sufficient part of the population. An example would be a request to do a memorial located on a military base and not accessible to the public; it's less likely to succeed than one somewhere else.

Senator MOORE: Were any changes made by the minister or the ministerial office to the grant round prior to the approval? So, basically, between the recommendation and the decision, can you tell me whether there were any changes—whether the recommendations were accepted or whether some missed out that were recommended by the committee?

Mr Corke : I would have to get back to you on that one. I don't believe so.

Senator MOORE: It would just be a matter to take on notice, if you could get that and see if that did occur—and that would be subject to availability, releasing that information. But it is really the first bit, as to whether there were changes, that I would really like an answer on. As to the round that has started now, when is that to be concluded?

Mr Corke : I'll have to take that one on notice. We run it as a rolling round—

Senator MOORE: I know.

Mr Corke : and we then draw a line—

Senator MOORE: I'm just trying to think: if we got them in October, the next round would open before Christmas, I'm pretty sure—

Mr Corke : Yes.

Senator MOORE: and then it would be determined and then go through the same process?

Mr Corke : With a view to having it processed before the end of the financial year.

Senator MOORE: Thank you very much.

Mr Lewis : On the location issues, Senator Gallacher earlier was asking about armistice. I don't know whether you wanted armistice grants?

Senator MOORE: They're specialist armistice grants, aren't they? They're another round, aren't they?

Mr Lewis : This goes to your question, because Mr Corke is across that as well.

Mr Corke : So as it stands, at the moment, you are aware that—

Senator GALLACHER: I'm just trying to balance the amount of time we've got left.

Mr Lewis : We'll take it on notice.

Senator GALLACHER: Obviously we will put stuff on notice. Can we now go to the Veterans and Veterans Families Counselling Service and On the Line.

Senator MOORE: Thank you.

Senator GALLACHER: Obviously you've got a contractor who does what—I think the company is called On the Line?

Dr Hodson : Yes, it is.

Senator GALLACHER: Is that only for after-hours services or is that for in-house services?

Dr Hodson : Basically the contractor does after-hours east coast and then west coast. They also monitor our social media for a number of platforms.

Senator GALLACHER: You would be familiar with this media article which says that basically that the department isn't keeping data on call abandonment rates and wait times. Would that be correct? Is that article factually correct? You don't keep data on whether a contractor is doing their job or not?

Dr Hodson : I think the article was actually about whether or not some FOI information was actually released. In reality, for the service, under the contract we have a number of KPIs that we monitor regularly. Probably for us, the most important KPI is the amount of time to answer a call. I can provide on notice the actual list of KPIs that we monitor. We do monitor the rate of use of that line. It has increased in the last financial year. Because of the increase, we have increased that line by 1.5 FTE in the current contract year, which was $182,000 extra to meet the extra demand. So we have a fairly ongoing process of monitoring the performance of the line. And when necessary we increase the money in the contract to meet the demand.

Senator GALLACHER: We would appreciate on notice if you could share with us the KPIs in this contract. But what does it actually look like? If I was ring up now, would I wait five minutes or 10 minutes or would I get an answer straight away? Or you don't know?

Dr Hodson : Eighty-five per cent of people would be answered in under 90 seconds. The problem is—

Senator GALLACHER: Irrespective of whatever time you ring?

Dr Hodson : The issue is there are peaks and troughs across the day and there are so many workforce there at any one time. We have KPIs to say we want it answered within a certain point in time. If you ring up and you do not immediately get through, you are given the option to either leave a message and be called back or to wait. There is a cycle whereby you first of all told, 'This is what the line is for'. If you are an absolutely emergency, you should be ringing triple 0, and they tell them that. Then they say, There is a wait at the moment. We can either call you back, or you can wait'. Then there are a series of points where the message replays. I would have to put it on notice—but at, say, three minutes, five minutes. There is actually a board and they have a central manager who monitors the number of people, and once it gets out to a certain point in time, people start to go red and they start to try and re-engage people. In a call centre environment it is hard, because at times you've got callers coming in, you've also got callers actually on the line and doing counselling. The average call length is about 25 minutes but for most people who call in on average they will be on at least 25 minutes. So for the call centre it is a balancing act.

Senator GALLACHER: How many people would be in a call centre at any one time?

Dr Hodson : The call centre we use has a range of—they support not just us but a number of—

Senator GALLACHER: So it is not linked to physical people; FTEs is a full-time equivalence.

Dr Hodson : Yes.

Senator GALLACHER: You could have three people doing that one third of the time; is that right?

Dr Hodson : Yes. We actually have a guaranteed number of people who can answer for our service at any one time. And that's—

Senator GALLACHER: What I am trying to get at is if there are only 10 people in there, and 85 per cent of calls are picked up after 90 seconds and you have 10 people ringing and you are on the phone for 25 minutes with each customer, someone could be waiting a fair length of time.

Dr Hodson : I've been to the call centre. It's much more than 10 people. They do—

Senator GALLACHER: Okay.

Dr Hodson : It's a big centre, with multiple people and multiple lines.

Senator GALLACHER: So you're paying a rate for full-time equivalent, but it's up to them how many people are in the pool and how they manage that.

Dr Hodson : Yes.

Senator GALLACHER: By the sound of it, they do other work at the same time.

Dr Hodson : They also contract for a number of other key national organisations—Mensline, ReachOut. There are a couple of key providers nationally that will do this for all of our work. This line goes to contract. Basically, every so often, we refresh and test the market, and we'll be in that cycle very shortly.

Senator GALLACHER: When would this go to open tender?

Dr Hodson : We need to go back to market this year.

Senator GALLACHER: Are the KPIs that are part of that tender process transparent and visible to anybody in the marketplace?

Dr Hodson : We will put in that request for tender the KPIs that we are looking for. I will maybe let general counsel answer this one. I understand that each of the companies are careful about what their KPI price points are. From a Commonwealth perspective, we have to be careful about that. I will let Carolyn answer this, because she's better at this part of the business than I.

Ms Spiers : Senator, going to tender, as you would appreciate, we will have specifications in the tender documentation. We will have a draft contract prepared, and we expect prospective tenderers to address the specs in the documentation and indicate areas where they might have concerns with the contract. Anyone that wanted to see the detail of the tender process, or the tender details, would have to obviously register on AusTender, because they're downloadable in that sense. You're right to say that they're available publicly, but it's for people who take the time to go onto AusTender for that process and download and register.

Senator GALLACHER: I normally drop out when it says that your call will be recorded for training purposes. You don't have that sort of level of menu on this?

Dr Hodson : No, but what it does say very clearly—and all suicide support lines in Australia have the same standard—that if you tell us there is a risk we will do our best to tell someone about it. There are certain safety protocols that must be run through from an ethical duty of care, but the wording of that messaging is actually very careful, because it is also about trying to keep people on the line.

Senator GALLACHER: Have you received complaints about access to the service?

Dr Hodson : Not formal complaints but we have had social media around this issue which we have been trying to address.

Senator GALLACHER: Does that mean that someone put it on Facebook or have started a website et cetera?

Dr Hodson : We have on social media had the question, 'What is the information at the start of the online process?' and we answered that on social media.

Senator GALLACHER: So they put it on your website?

Dr Hodson : We have a Facebook page. We engage with our community with the Facebook page quite regularly. There is a whole range of issues we discuss. It's a good way to share information with our community, and when they raise concerns with us we respond to those concerns.

Senator GALLACHER: Would you be able to say how many people have raised that on the Facebook page?

Dr Hodson : I could take that on notice.

Senator GALLACHER: What was the specific nature? Were you saying that it was in relation to the content of the advice or the content of the menu?

Dr Hodson : There was an issue raised around if someone who rang into the service threatened someone, would we take action if we thought there was a credible risk to the public or a person's health. We responded that, yes, we would, because we have a duty of care to people. It's very up-front when you access a mental health service that, if you tell us you are going to harm yourself or harm someone else—just like every GP and health provider in Australia—we will take action.

Senator MOORE: That's standard practice.

Dr Hodson : You have to, because you have to protect people—and you're protecting the individual and everyone around them.

Senator MOORE: How long has On the Line had the contract? When was the last tender process?

Dr Hodson : It was in 2010. It is a six-year cycle, and we've come to the end of the cycle.

Senator MOORE: Is the contract document from the 2010 round still available?

Dr Hodson : Yes.

Senator MOORE: Would it be on AusTender? No, they'd drop off after they're completed, wouldn't they? Can we get a copy of the tender for 2010?

Mr Lewis : One element we will be looking at as part of the tender process we're about to run, though, is not just the KPIs but having those KPIs publicly available.

Senator MOORE: It would just be good for completeness to have a look at what the tender said in 2010 and when this one becomes public, to compare them. We wouldn't ask you about that now, because it's still in confidence, but once it's public we might have some questions.

Dr Hodson : It is an extremely important service that we have. We have 6,000 people call the service every year. I suppose one of the things for us—and it's why we have been monitoring and have injected more money into it recently as we've noticed that the call rates have increased—is that it is a balancing act of keeping the service affordable but, at the same time, making sure it's responsive in meeting the needs we have. We also have a number of regular repeat callers, and it's often men. Men sometimes won't present initially, and it's such an important service where we can actually use it as a soft entry point into more complex counselling. They might ring the de-identified line a number of times, but eventually we work hard to translate that into coming into care. So I suppose it is a key service that we actually monitor very carefully.

Senator MOORE: How would you know that?

Senator GALLACHER: Do you analyse those 6,000 calls?

Dr Hodson : Yes, we spend a fair bit of time with On the Line looking at the trends, whether it's men or women who are calling in, and how we market, because it then affects the marketing of the line to the different types of people we're trying to bring into the 24-hour support.

Senator MOORE: I want to get to one last question.

CHAIR: Four minutes.

Senator MOORE: How would you know that people are ringing in a number of times through the de-identified process to come to a state where you'd know they're identifying?

Dr Hodson : Interestingly, some people even ring at the same time in order to try to get the same—

Senator MOORE: A pattern caller.

Dr Hodson : A pattern caller, and they'll call with the issue and they'll also call when they know that certain counsellors might be on.

Senator MOORE: They build a relationship?

Dr Hodson : They build a relationship. Telephone counselling is a very valid first way to bring people into care.

Senator MOORE: Thank you. The last couple of questions are around the Commonwealth Superannuation Corporation, and they're all on the same thing.

CHAIR: You have to be snappy—three minutes, Senator Moore.

Senator MOORE: There's no-one coming to the table.

CHAIR: Very snappy responses, please.

Mr Lewis : We're not the CSC, of course.

Senator MOORE: Well, I'm going to put the question out, because I don't know who can answer it. What, if any, conversations have been had between the department and the Commonwealth Superannuation Corporation about the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry?

Mr Lewis : I was about to answer, because we have regular conversations with the Commonwealth Superannuation Corporation all the time, mainly linked to delivering better services to veterans, particularly in transition. But we haven't been speaking to them in relation to the royal commission.

Senator MOORE: They haven't raised that with you in any of your regular conversations?

Mr Lewis : No.

Senator MOORE: Has the department received any correspondence from the Commonwealth Superannuation Corporation regarding the royal commission?

Mr Lewis : I don't recall any correspondence passing my desk.

Senator MOORE: Has the department received any feedback from clients about the exclusion of the Commonwealth Superannuation Corporation from the terms of reference for the royal commission?

Mr Lewis : Not that I'm aware of.

Mr Orme : There has been some commentary in social media.

Senator MOORE: There has been quite a lot of commentary in social media, but I'm just wondering whether none of that commentary has been referred to the department.

Mr Orme : Not to our knowledge.

Mr Lewis : So far as I recall. We will check this.

Senator MOORE: Just check it.

Mr Lewis : I don't think there's been any correspondence whatsoever that I've received.

Senator MOORE: Thank you.

CHAIR: Senator Gallacher, you have one minute left.

Senator GALLACHER: No, I'm fine. I'm going to go and draft a letter.

CHAIR: You have one minute if you want to get that last question in, seriously, Senator Gallacher. If not, that then concludes the committee's examination of the Department of Veterans' Affairs and also the Defence portfolio. I sincerely thank the minister and officers for their attendance today and, of course, Hansard and Broadcasting staff—thank you very much—and our wonderful secretariat staff, who just make it very easy. Thank you very much. The committee will begin its hearings tomorrow morning at 9 am with the Foreign Affairs and Trade portfolio.

Committee adjourned at 22:59