The Productivity Commission's A Better Way to Support Veterans report regarding compensation and rehabilitation for veterans
indicates -
• Despite some recent improvements to the veterans’ compensation and rehabilitation system, it is not fit for purpose — it requires fundamental reform. It is out of date and is not working in the best interest of veterans and their families, or the Australian community.
• In 2017 18, the Department of Veterans’ Affairs (DVA) spent $13.2 billion supporting about 166 000 veterans and 117 000 dependants (about $47 000 per client). And while the veteran support system is more generous overall than other workers’ compensation schemes, this does not mean it is an effective system.
• The system fails to focus on the lifetime wellbeing of veterans. It is overly complex (legislatively and administratively), difficult to navigate, inequitable, and it is poorly administered (which places unwarranted stress on claimants). Some supports are not wellness focused, some are not well targeted and others are archaic, dating back to the 1920s.
• The institutional and policy split between Defence and DVA also embeds perverse incentives, inefficient administration and poor accountability, and results in policy and implementation gaps.
• A future veteran support system needs to have a focus on the lifetime wellbeing of veterans. It should be redesigned based on the best practice features of contemporary workers’ compensation and social insurance schemes, while recognising the special characteristics of military service. This will change the incentives in the system so more attention is paid to the prevention of injury and illness, to rehabilitation and to transition support.
• The split in responsibility between Defence and DVA for the lifetime wellbeing of veterans also needs to be addressed. While the first best option is for responsibility for veteran policy to be transferred to the Department of Defence, given a lack of trust and confidence by veterans in Defence to exercise this policy role, and strong opposition to the change, this is not realistic or feasible at this stage.
• New governance, funding and cross agency arrangements are required to address the problems with the current system. – A single Minister responsible for Defence Personnel and Veterans is needed to ensure policy making for serving and ex serving personnel is integrated. – An advisory council to the Minister should be established to provide advice on the lifetime wellbeing of veterans. – A new independent statutory agency — the Veteran Services Commission (VSC) — should be created to administer and oversee the performance of the veteran support system. – An annual premium to fund the expected costs of future claims should be levied on Defence. – A ‘whole of life’ veteran policy under the direction of the Minister for Defence Personnel and Veterans needs to be developed by DVA, Defence and the VSC. This should include more rigorous cross-agency planning processes (including external expertise). – Responsibility for preparing serving veterans for, and assisting them with, their transition to civilian life should be centralised in a new Joint Transition Authority within Defence.
• DVA’s Veteran Centric Reform program has some good objectives and is showing some signs of success. It should be closely monitored to ensure it is rolled out successfully and adjustments should be made, where necessary, to accommodate the proposed reforms.
• The current system should be simplified by: continuing to make it easier for clients to access; rationalising benefits; harmonising across the Acts (including a single pathway for reviews of decisions, a single test for liability and common assessment processes); and moving to two compensation and rehabilitation schemes by July 2025. – Scheme 1 should largely cover an older cohort of veterans with operational service, based on a modified Veterans’ Entitlements Act 1986. Scheme 2 should cover all other veterans, based on a modified Military Rehabilitation and Compensation Act 2004, and over time will become the dominant scheme.
• Veterans’ organisations play an important role in the system. DVA could better leverage this support network by commissioning services from them, including for veterans’ hubs. Engaging with these organisations when there is no peak body is not easy for government. Should a national peak body be established that represents the broad interests of veterans, the Australian Government should consider funding it.
• The Gold Card runs counter to a number of the key principles that should underlie a future scheme — it is not wellness focused or needs based. It can also be inefficient (by encouraging over servicing). It should be more tightly targeted and not be extended to any new categories of recipients. An independent review of DVA’s fee setting arrangements for health services is also required.
• The way treatments and supports are commissioned and provided to veterans and their families also needs to change. The VSC would more proactively engage with veterans and their families (taking a person centred approach, tailoring treatments and supports) and have greater oversight of providers than under current arrangements. This approach will require more extensive use of data and a greater focus on outcomes.
• Expanding non liability coverage to mental health care was a positive step. However, a new Veteran Mental Health Strategy that takes a lifetime approach is urgently needed. Suicide prevention should be a focus of the Strategy, informed by ongoing research and evaluation.
• Families of veterans have access to a number of support services provided by DVA, including access to Open Arms counselling services, respite care, and the Family Support Package. Eligibility for the Family Support Package should be extended. The VSC would have close engagement with families, providing them with more individualised support. Further research is needed to better understand the mental health impacts of service life on families and how they can be best supported.The Commissions Recommendations and findings are
Objectives and principles Understanding the objectives of the veterans’ compensation and rehabilitation system is important for assessing how well the current system is performing and what an improved system would look like. A robust set of objectives and principles are needed to underpin a contemporary system to meet the needs of tomorrow’s veterans.
ECOMMENDATION 4.1 OBJECTIVES AND PRINCIPLES FOR THE VETERAN SUPPORT SYSTEM The overarching objective of the veteran support system should be to improve the wellbeing of veterans and their families (including by minimising the physical, psychological and social harm from service) taking a whole-of-life approach. This should be achieved by: • preventing or minimising injury and illness • restoring injured and ill veterans by providing timely and effective rehabilitation and health care so they can participate in work and life • providing effective transition support as members leave the Australian Defence Force • enabling opportunities for social integration • providing adequate and appropriate compensation for veterans (or if the veteran dies, their family) for pain and suffering, and lost income from service related injury and illness. The principles that should underpin a future system are: • wellness focused (ability not disability) • equity • veteran centric (including recognising the unique needs of veterans and their families resulting from military service) • needs based • evidence based • administrative efficiency (easy to navigate and achieves timely and consistent assessments and decision making) • financial sustainability and affordability. The objectives and underlying principles of the veteran support system should be set out in the relevant legislation.
FINDING 4.1 The Commission acknowledges that there are different risks, hardships and requirements of operational and peacetime service, and these are recognised in remuneration, allowances and honours. However, in principle, the basis for providing support should be need, not how or when an injury or illness was acquired. For compensation and support, the distinction between different types of military service should be removed where it is both practicable and cost effective to do so. Prevention The Australian Defence Force (ADF) is committed to providing a safe and healthy working environment for its members and it has achieved significant reductions in serious injuries and illnesses since 2011 12. Nonetheless, more can be done to give the ADF better tools to help it achieve its commitment to improved work health and safety.
FINDING 5.1 There are no compelling grounds to change the current arrangements under which Australian Defence Force members are subject to Commonwealth work health and safety legislation. In fact, the introduction of the Work Health and Safety Act 2011 (which took effect on 1 January 2012) has been instrumental in helping to significantly improve work health and safety outcomes in the Australian Defence Force.
FINDING 5.2 Since Defence introduced Sentinel (a work health and safety incident reporting system) in 2014, it has expanded its coverage, improved the ease of use of the system for serving personnel and put in place processes to ensure that reported incidents are acted on. However, despite these efforts, underreporting of work health and safety incidents in Sentinel (other than for serious, defined events that must be notified to Comcare) continues to be an issue.
RECOMMENDATION 5.1 IMPROVE REPORTING OF WORK HEALTH AND SAFETY INCIDENTS Defence should assess the feasibility and cost of incorporating the information on the Sentinel database with information from the Defence eHealth System. In the longer term, when Defence commissions the next generation of the Defence eHealth System, it should include the capture of work health and safety data as a system requirement. The Department of Defence and Department of Veterans’ Affairs should assess the feasibility and cost of incorporating information from the Sentinel database with information from the Department of Veterans’ Affairs’ datasets, which would provide insights into the cost of particular injuries and illnesses.
RECOMMENDATION 5.2 SUPPORTING A NEW APPROACH TO INJURY PREVENTION Defence should use the injury prevention programs being trialled at Lavarack and Holsworthy Barracks as pilots to test the merit of a new approach to injury prevention to apply across the Australian Defence Force (ADF). Defence should adequately fund and support these programs, and ensure that there is a comprehensive and robust cost–benefit assessment of their outcomes. If the cost–benefit assessments are substantially positive, injury prevention programs based on the new approach should be rolled out across the ADF by Defence.
RECOMMENDATION 5.3 PUBLISH ANNUAL NOTIONAL PREMIUM ESTIMATES Beginning in 2019, the Australian Government should publish the full annual actuarial report that estimates notional workers’ compensation premiums for Australian Defence Force members (currently produced by the Australian Government Actuary).
RECOMMENDATION 5.4 FORMALISE DEFENCE RESPONSIBILITY TO SUPPORT ADF MEMBERS In line with the proposed Australian Defence Veterans’ Covenant, the Australian Government should amend Defence’s outcomes to include an additional objective, explicitly acknowledging that — due to the unique nature of military service — Defence has a responsibility to respect and support members of the Australian Defence Force having regard to their lifetime wellbeing.
Rehabilitation
Significant reform is required to the way Defence and the Department of Veterans’ Affairs (DVA) procures, organises and monitors rehabilitation services. Changes are also required to rehabilitation arrangements in the transition period to ensure continuity of care.
FINDING 6.1 Defence has a strong incentive to provide rehabilitation services to Australian Defence Force (ADF) members who have a high probability of redeployment or return to duty, but a weaker incentive to rehabilitate members who are likely to be transitioning out of the ADF. This is because ex serving members become the responsibility of the Department of Veterans’ Affairs (DVA) and Defence does not pay a premium to cover liabilities. Access to rehabilitation supports can also be disrupted during the transition period. DVA pays limited attention to the long term sustainability of the veteran support system (in part because the system is demand driven) and this reduces its focus on the lifetime costs of support, early intervention and effective rehabilitation.
RECOMMENDATION 6.1 PUBLIC REPORTING ON ADF REHABILITATION The Australian Defence Force Joint Health Command should report more extensively on outcomes from the Australian Defence Force Rehabilitation Program in its Annual Review publication.
RECOMMENDATION 6.2 EVALUATION AND REPORTING OF DVA REHABILITATION The Department of Veterans’ Affairs should make greater use of its rehabilitation data and of its reporting and evaluation framework for rehabilitation services. It should: • evaluate the efficacy of its rehabilitation and medical services in improving client outcomes • compare its rehabilitation service outcomes with other workers’ compensation schemes (adjusting for variables such as degree of impairment, age, gender and difference in time between point of injury and commencement of rehabilitation) and other international military schemes.
RECOMMENDATION 6.3 COMMISSIONING AND INTEGRATION OF REHABILITATION SERVICES Defence and the Department of Veterans’ Affairs should engage more with rehabilitation providers, including requiring them to provide evidence based approaches to rehabilitation, and to monitor and report on treatment costs and client outcomes. Changes are also required to the arrangements for providing and coordinating rehabilitation immediately prior to, and immediately post, discharge from the Australian Defence Force (ADF). Rehabilitation services for transitioning personnel across this interval should be coordinated by the Joint Transition Authority (recommendation 7.1). Consideration should also be given to providing rehabilitation on a non liability basis across the interval from ADF service to determination of claims post service. Transition to civilian life after military service While most veterans make a relatively smooth and successful transition to civilian life, some find transition a difficult and stressful time. Neither Defence nor DVA has clear responsibility for all aspects of veterans’ transition and services. To improve military to civilian transition, and to clarify roles and responsibilities, the Commission is recommending creating a new authority responsible for transition preparation and support.
FINDING 7.1 The Departments of Defence and Veterans’ Affairs offer a range of programs and services to support veterans with their transition to civilian life. While many discharging members require only modest assistance, some require extensive support — especially those who are younger, served in lower ranks, are being involuntarily discharged for medical or other reasons, and those who have skills that are not easily transferable to the civilian labour market. Despite considerable change in recent years, stewardship of transition remains poor and supports have not improved in ways that are tangible to veterans.
RECOMMENDATION 7.1 ESTABLISH A JOINT TRANSITION AUTHORITY The Australian Government should recognise that Defence has primary responsibility for the wellbeing of discharging Australian Defence Force members, and that this responsibility may extend beyond the date of discharge. It should formalise this recognition by creating a ‘Joint Transition Authority’ within Defence. Functions of the Joint Transition Authority should include: • preparing serving members and their families for the transition from military to civilian life • providing individual support and advice to veterans as they approach transition • ensuring that transitioning veterans receive services that meet their individual needs, including information about, and access to, Department of Veterans’ Affairs’ processes and services, and maintaining continuity of rehabilitation supports • remaining an accessible source of support for 12 months after discharge • reporting publicly on transition outcomes to drive further improvement.
RECOMMENDATION 7.2 CAREER PLANNING AND FAMILY ENGAGEMENT FOR TRANSITION Defence, through the Joint Transition Authority (recommendation 7.1), should: • ensure that Australian Defence Force members prepare a career plan that covers both their service and post service career, and update that plan at least every two years • prepare members for other aspects of civilian life, including the social and psychological aspects of transition • reach out to veterans’ families, so that they can engage more actively in the process of transition.
RECOMMENDATION 7.3 TRIAL A VETERAN EDUCATION ALLOWANCE The Department of Veterans’ Affairs should support veterans to participate in education and vocational training once they leave the Australian Defence Force. It should trial a veteran education allowance to provide a source of income for veterans who, after completing their initial minimum period of service or having been medically discharged, wish to undertake full time education or vocational training. Initial liability assessment Having liability accepted for an injury, illness or death is the first step in most claims for compensation, treatment and rehabilitation in the veteran support system. The way initial liability is assessed varies by Act and by type of service. These variations are no longer justified and should be reduced or eliminated where feasible.
RECOMMENDATION 8.1 HARMONISE THE INITIAL LIABILITY PROCESS The Australian Government should harmonise the initial liability process across the three veteran support Acts. The amendments should include: • making the heads of liability and the broader liability provisions identical under the Veterans’ Entitlements Act 1986 (VEA), the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 (DRCA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) • applying the Statements of Principles to all DRCA claims and making them binding, as under the MRCA and VEA.
FINDING 8.1 Allowing accrued rights for repealed versions of the Statements of Principles (SoPs) under the Veterans’ Entitlements Act 1986 is contrary to the purpose of the SoP system, which is to reflect the latest sound medical scientific evidence.
RECOMMENDATION 8.2 IMPROVE THE RMA’S RESOURCING AND TRANSPARENCY The Australian Government should provide additional resources to the Repatriation Medical Authority (RMA) so that the time taken to conduct reviews and investigations can be reduced to closer to six months. Following any investigation, the RMA should routinely publish a full bibliography of the peer reviewed literature or other sound medical scientific evidence used to create or update the relevant Statement of Principles. Stakeholders interested in how different pieces of evidence were assessed and weighed can continue to request the RMA’s briefing papers under s.196I of the Veterans’ Entitlements Act 1986.
RECOMMENDATION 8.3 ABOLISH THE SPECIALIST MEDICAL REVIEW COUNCIL The Australian Government should abolish the Specialist Medical Review Council. The process for reviewing Repatriation Medical Authority decisions on Statements of Principles should instead be expanded to incorporate independent external medical specialists, where necessary.
RECOMMENDATION 8.4 MOVE MRCA TO A SINGLE STANDARD OF PROOF The Australian Government should remove the distinction between types of service when determining causality between a veteran’s condition and their service under the Military Rehabilitation and Compensation Act 2004 (MRCA). This should include: • amending the MRCA to adopt the reasonable hypothesis Statement of Principles for all initial liability claims • requesting that the Australian Law Reform Commission conduct a review into simplifying the legislation and moving to a single decision making process for all MRCA claims, preferably based on the reasonable hypothesis process. Claims management and processing There are significant and ongoing problems with the way DVA administers claims. DVA is attempting to fix these problems under its Veteran Centric Reform (VCR) program, which began in 2016. VCR has had some successes, most notably the introduction of an online claims system, but issues including slow and poor quality claims assessments remain. Close monitoring of the effective rollout of the VCR, both in terms of timeliness and outcomes is required.
RECOMMENDATION 9.1 PUBLIC PROGRESS REPORTS ON RECENT REVIEWS The Department of Veterans’ Affairs should report publicly by December 2019 on its progress implementing recommendations from recent reviews (including the 2018 reports by the Australian National Audit Office and the Commonwealth Ombudsman). FINDING 9.1 MyService, in combination with a completed Early Engagement Model, has the potential to radically simplify the way Australian Defence Force members, veterans and their families interact with the Department of Veterans’ Affairs (DVA), particularly by automating many aspects of the claims process. But achieving such an outcome will be a complex, multi year process. To maximise the probability of success, Defence, DVA and Services Australia will need to: • continue to work closely in a collegiate and coordinated fashion • retain experienced personnel • allocate sufficient funding commensurate with the potential long term benefits.
FINDING 9.2 The Department of Veterans’ Affairs is failing to ensure that its staff consistently apply its own internal guidelines for communicating with clients. This leads to poor outcomes for clients and undermines confidence in the Department.
RECOMMENDATION 9.2 APPROPRIATELY TRAIN STAFF The Department of Veterans’ Affairs should ensure that staff who are required to interact with veterans and their families undertake specific training to deal with vulnerable people and in particular those experiencing the impacts of trauma.
FINDING 9.3 The Department of Veterans’ Affairs needs to negotiate a sustainable and predictable departmental funding model with the Department of Finance based on expected claims and existing clients. This should incorporate the likely efficiency savings from the Veteran Centric Reform program via initiatives such as MyService.
FINDING 9.4 The Productivity Commission does not, at this stage, support automatically deeming initial liability claims at the end of a fixed period. Progress on the Veteran Centric Reform program in the Department of Veterans’ Affairs should continue to significantly improve the efficiency of claims processing and management. Should these reforms fail to deliver further significant improvements in the timely handling of claims, then the need for statutory time limits should be reconsidered.
RECOMMENDATION 9.3 ENSURE QUALITY OF CLAIMS PROCESSING If the Department of Veterans’ Affairs’ quality assurance process identifies excessive error rates (for example, greater than the Department’s internal targets), all claims in the batch from which the sample was obtained should be recalled for reassessment.
FINDING 9.5 External medical assessors provide useful diagnostic information about veterans’ conditions and are a necessary part of the claims process for the veteran support system. However, they should only be called upon when strictly necessary and staff should be provided with clear guidance to that effect.
FINDING 9.6 Under the Department of Veterans’ Affairs’ stewardship, the Veteran Centric Reform (VCR) program has some good objectives and has produced some early successes. However close supervision and guidance will be required to ensure VCR is rolled out successfully. Regular progress reporting and ongoing assurance reviews will facilitate this outcome. Reviews of claims Most decisions made by DVA to provide (or not provide) compensation or support to veterans can be challenged through administrative review processes. However, there are a number of issues with the existing processes which warrant reform and a common approach is required for all claims.
FINDING 10.1 Current review processes are ensuring that many veterans receive the compensation or support that they are entitled to under the law, albeit sometimes with significant delays. The majority of cases that are reviewed externally result in a change to the original decision made by the Department of Veterans’ Affairs.
FINDING 10.2 The Veterans’ Review Board and Administrative Appeals Tribunal are not providing sufficient feedback from their review processes to the Department of Veterans’ Affairs (DVA) to better inform decision-making practices. Further, DVA is not incorporating the limited available feedback into its decision making processes. This means that opportunities for process improvement are being missed.
RECOMMENDATION 10.1 IMPROVE AND USE FEEDBACK FROM ADMINISTRATIVE REVIEWS The Department of Veterans’ Affairs (DVA) should ensure that successful reviews of veteran support decisions are brought to the attention of senior management for claims assessors, and that accurate decision making is a focus for senior management in reviewing the performance of staff. Where the Veterans’ Review Board (VRB) identifies an error in the original decision of DVA, it should state the cause for varying or setting aside the decision on review (including whether new information was provided by the applicant or if DVA’s original decision misapplied the law). DVA and the VRB should establish a memorandum of understanding to report aggregated statistical and thematic information on claims where DVA’s decisions are varied through hearings or alternative dispute resolution processes. This reporting should cover VRB decisions, as well as variations made with the consent of the parties through an alternative dispute resolution process. This information should be collected and provided to DVA on a quarterly basis and published in the VRB’s annual report. DVA should respond by making appropriate changes to its decision making processes to improve accuracy.
FINDING 10.3 While many veterans are managing to negotiate the current pathways for reviews of decisions made under the various veteran support Acts, there are unjustified differences and complexities in the rights of review available to claimants under each Act.
FINDING 10.4 The Veterans’ Review Board has functions that overlap with those of the Administrative Appeals Tribunal. The Department of Veterans’ Affairs is relying on the Board’s external merits review as a standard part of the process for addressing many claims, rather than using it occasionally to resolve difficult cases.
RECOMMENDATION 10.2 SINGLE REVIEW PATHWAY The Australian Government should introduce a single review pathway for all veterans’ compensation and rehabilitation decisions (including decisions under the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988). The pathway should include: • internal reconsideration by the Department of Veterans’ Affairs. In this process, a different and more senior officer should clarify the reasons why a claim was not accepted (partially or fully); request any further information the applicant could provide to fix deficiencies in the claim, then make a new decision with all of the available information • review and resolution by the Veterans’ Review Board, in a modified role providing alternative dispute resolution services only (recommendation 10.3) • merits review by the Administrative Appeals Tribunal • judicial review in the Federal Court of Australia and High Court of Australia.
RECOMMENDATION 10.3 VETERANS’ REVIEW BOARD AS A REVIEW AND RESOLUTION BODY The Australian Government should amend the role and procedures of the Veterans’ Review Board (VRB), so that: • it would serve as a review and resolution body to resolve claims for veterans • all current VRB alternative dispute resolution processes would be available (including party conferencing, case appraisal, neutral evaluation and information gathering processes) together with other mediation and conciliation processes. Where an agreement cannot be reached, a single board member should determine the correct and preferable decision to be made under the legislation and implement that decision. When the Veteran Centric Reform program is complete and the Veteran Services Commission is established, this determinative power should be removed. Cases that would require a full board hearing under the current process, or where parties fail to agree on an appropriate alternative dispute resolution process or its outcomes, could be referred to the Administrative Appeals Tribunal. Parties to the VRB resolution processes should be required to act in good faith.
RECOMMENDATION 10.4 REVIEW OF ONGOING ROLE OF VETERANS’ REVIEW BOARD The Australian Government should conduct a further evaluation in 2025 of the performance of the Veterans’ Review Board in its new role. In particular, the evaluation should consider whether reforms have reduced the rate at which initial decisions in the veteran support system are subsequently varied on appeal. If the evaluation finds that the Board is no longer playing a substantial role in the claims process, the Australian Government should abolish the Board and bring its alternative dispute resolution functions into the Department of Veterans’ Affairs or its successor agency. Governance and funding Under the current governance arrangements, no single agency has responsibility for the lifetime wellbeing of veterans. Strategic policy in the veteran support system appears to be largely reactive, with changes often making the system more complex and expensive. Also, the veteran support system, which has large contingent liabilities, is funded on a short term basis, and long term costs are not taken into account when policy decisions are made. New governance and funding arrangements are required for the veteran support system for future generations of veterans and their families.
RECOMMENDATION 11.1 ESTABLISH A VETERAN SERVICES COMMISSION The Australian Government should establish a new independent statutory authority — the Veteran Services Commission (VSC) — to administer the veteran support system by July 2022. It should report to the Minister for Defence Personnel and Veterans, but be a stand alone agency for veteran services (that is, separate from any department of state). The functions of the VSC should be to: • achieve the objectives of the veteran support system (recommendation 4.1) through the efficient and effective administration of all aspects of that system • make all claims determinations under the veteran support legislation • calculate, collect and administer a premium on Defence (recommendation 11.2) • manage, advise and report on outcomes and the financial sustainability of the system, in particular, the compensation and rehabilitation schemes • enable opportunities for social integration • fund, commission or provide services to veterans and their families. An independent board should oversee the VSC. The board should be made up of part time Commissioners appointed by the Minister. Board members should have a mix of skills in relevant fields (such as other compensation schemes, project management or providing services to veterans), and some members should have experience in the military and veterans’ affairs. The board should have the power to appoint the Chief Executive Officer (who should be responsible for the day to day administration of the VSC). The Australian Government should amend the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 to abolish the Repatriation Commission and Military Rehabilitation and Compensation Commission upon the commencement of the VSC.
RECOMMENDATION 11.2 LEVY A PREMIUM ON DEFENCE The Australian Government should move towards a fully funded system for veteran supports. This would involve the Veteran Services Commission levying an annual premium on Defence to fund the expected future costs of the veteran support system entitlements that were generated during the year. The premium should cover the costs of all compensation, rehabilitation and treatment benefits available to veterans or their families, as well as covering the cost associated with operational deployments. The Australian Government should provide a level of funding to Defence to cover the reasonable costs of the premium. Any funding above the initial level should be considered on a case by case basis by the Government, in line with existing Budget rules, to avoid undermining the premium’s financial incentives. As the Military Rehabilitation and Compensation Act 2004 (MRCA) will form the basis of the future veteran support system, the Government should also fully capitalise all existing MRCA liabilities (that is, back to 1 July 2004). Existing liabilities under the Veterans’ Entitlements Act 1986 and the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 should be calculated and regularly reported as separate notional line items, acknowledging their implied call on future Budgets.
FINDING 11.1 Moving responsibility for veteran support policies and strategic planning into the Department of Defence is, in the Commission’s view, the best option for improving the lives of veterans and their families, as it aligns incentives and accountability structures and gives Defence an ‘enlistment to the grave’ responsibility for the wellbeing of Australian Defence Force personnel. Nevertheless, given the strong opposition and lack of trust and confidence by veterans in Defence’s capacity to take on such a policy role, the Commission acknowledges that this proposal is not realistic or feasible at this stage.
RECOMMENDATION 11.3 IMPROVING POLICY OUTCOMES Ministerial responsibility for veterans’ affairs should be permanently vested in a single Minister for Defence Personnel and Veterans. In the absence of veterans policy being placed in the Department of Defence (finding 11.1), the Department of Veterans’ Affairs (DVA) should focus on building its capacity for independent strategic policy advice in the veteran support system. DVA should commence this process immediately. Following the establishment of the Veteran Services Commission (recommendation 11.1), the functions of a retained DVA could include: • strategic policy and planning for the veteran support system • legislative responsibility for the three main Acts • engagement, coordination and support for ex service organisations • training and professional development of advocates • major commemorative activities and events (in line with recommendation 11.5) • coordination of research and evaluations • some secretariat functions for small portfolio agencies. In addition, DVA should work with Defence and the Veteran Services Commission to create a robust process for the development of integrated ‘whole of life’ policy, under the direction and close oversight of the Minister for Defence Personnel and Veterans. Defence, DVA and ultimately the VSC should establish inter departmental steering committees and policy taskforces to further strengthen cross agency cooperation and coordination, and use experts from appropriate disciplines to provide multidisciplinary advice.
RECOMMENDATION 11.4 CREATE A MINISTERIAL ADVISORY COUNCIL The Australian Government should establish an advisory council to the Minister for Defence Personnel and Veterans, to provide advice on the lifetime wellbeing of veterans and the best practice design, administration and stewardship of services provided to current and ex serving members and their families. The advisory council should consist of part time members with diverse capabilities, including individuals with experience in military or veterans’ affairs, health care, rehabilitation, aged care, social services and other compensation schemes.
RECOMMENDATION 11.5 MOVE WAR GRAVE FUNCTIONS INTO THE WAR MEMORIAL To consolidate the agencies maintaining Australia’s memorials to its veterans, the Australian Government should transfer primary responsibility for the Office of Australian War Graves to the Australian War Memorial. Responsibility for major commemoration activities and ceremonies should remain with the Department of Veterans’ Affairs. Advocacy, wellbeing supports and policy input Veterans’ organisations play an important role in the veteran support system. However, there is scope for the Australian Government to better leverage this support to make it more effective and relevant to the veteran community. To achieve this there needs to be much greater clarity around why government funds advocacy and wellbeing supports provided through veterans’ organisations.
RECOMMENDATION 12.1 REFRAME SUPPORT FOR VETERANS’ ORGANISATIONS The Department of Veterans’ Affairs should reframe its support for organisations that provide services for veterans by clearly differentiating between: • claims advocacy — the delivery of advocacy on behalf of claimants by accredited advocates • wellbeing supports — the commissioning of a broad set of welfare supports or services delivered by and on behalf of the veterans’ community (replacing the notion of welfare advocacy) • policy input and influence — the provision of support to assist veterans’ organisations to engage meaningfully in policy considerations. • grant funding — for the general support of innovative programs and significantly worthwhile community initiatives for the veterans community.
RECOMMENDATION 12.2 DVA SHOULD PROVIDE ASSISTANCE WITH PRIMARY CLAIMS One of the core functions of the Department of Veterans’ Affairs, and when established, the Veteran Services Commission, should be to assist veterans and their families to lodge primary claims. Claims advocacy assistance from veterans’ organisations should remain available to any veteran who seeks it.
RECOMMENDATION 12.3 FUND A CLAIMS ADVOCACY PROGRAM The Department of Veterans’ Affairs (DVA) should fund professional claims advocacy services in areas where it identifies unmet need. Services should be delivered through ex service and other organisations in a contestable manner similar to the National Disability Insurance Scheme Appeals Program and the National Disability Advocacy Program. DVA should also take a more active role in the stewardship of these services.
RECOMMENDATION 12.4 ACCREDITATION OF ADVOCATES The Department of Veterans’ Affairs (DVA) should ensure that all claims advocates who act on behalf of a claimant in primary claims or appeals are accredited under the Advocacy Training and Development Program (ATDP). DVA should monitor and adjust the delivery of the ATDP in response to stakeholder feedback, including by providing more flexible training programs.
RECOMMENDATION 12.5 FUND LEGAL ASSISTANCE AT THE AAT The Department of Veterans’ Affairs (DVA) should fund legal advice and representation for claimants in the veteran support system on a means tested and merits tested basis. The Attorney General’s Department should alter the Administrative Appeals Tribunal (AAT) Costs Procedures such that, if a veteran succeeds on appeal in the AAT for cases under the Military Rehabilitation and Compensation Act 2004 and the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988, a presumption is created that 100 per cent of the veteran’s party party costs (measured using the Federal Court Scale of Costs) are paid by DVA. Scope should remain to: • reduce this costs order to account for unsuccessful grounds of appeal • increase this costs order to one of indemnity if DVA has unreasonably rejected earlier offers to compromise or otherwise unduly delayed proceedings. In line with the beneficial intent of the veteran support legislation, and in line with the current legislation, there should be no power for the AAT to award costs against a plaintiff. The Veterans’ Entitlements Act 1986 should be amended to permit costs awards for cases that reach the AAT.
RECOMMENDATION 12.6 PROGRAM FOR FUNDING WELLBEING SUPPORTS The Department of Veterans’ Affairs should develop a funding framework for commissioning of wellbeing supports through veterans’ and other organisations. In particular, this should include guidelines for funding services and supports delivered by volunteers and paid staff in veterans’ hubs. The funding could cover information and training programs for volunteers and paid staff.
RECOMMENDATION 12.7 FUNDING POLICY ADVICE FROM VETERANS’ ORGANISATIONS In addition to the ministerial advisory council proposed in recommendation 11.4 the Australian Government should consider: • a funding contribution for a national peak body of veterans’ organisations, which could provide advice on veterans’ policy issues • the establishment of appropriate reference groups to advise on mental health, rehabilitation, transition, supports for families and lifelong wellbeing issues, including in relation to the varying needs of veterans of different ages and circumstances • reviewing the role or necessity for the Ex Service Organisation Round Table in light of alternative, more targeted, approaches. The compensation package The compensation package is complex — with offsetting provisions applying between the three main compensation Acts, and a system of superannuation invalidity and life insurance operating alongside the compensation system. Reform is needed to simplify the system and improve equality between veterans.
RECOMMENDATION 13.1 HARMONISE THE DRCA WITH THE MRCA The Australian Government should harmonise the compensation available through the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 (DRCA) with that available through the Military Rehabilitation and Compensation Act 2004. This should include harmonising the processes for assessing permanent impairment, incapacity and benefits for dependants, as well as the range of allowances and supplements. Existing recipients of DRCA permanent impairment compensation and benefits for dependants should not have their permanent impairment entitlements recalculated. Access to the Gold Card should not be extended to those eligible for benefits under the DRCA.
FINDING 13.1 The principle of not providing two sources of income replacement to the same veteran is sound. There is no case for changing the current offsetting arrangements between government funded superannuation payments and incapacity payments.
RECOMMENDATION 13.2 SIMPLIFY THE ADMINISTRATION OF INVALIDITY PENSIONS The Department of Veterans’ Affairs (DVA) should work closely with the Commonwealth Superannuation Corporation (CSC) to streamline the administration of superannuation invalidity pensions, including by: • moving to a single ‘front door’ for invalidity pensions and veteran compensation • moving to a single medical assessment process for invalidity pensions and veteran compensation • developing information technology systems to facilitate more automatic sharing of information between DVA and CSC. To give DVA the necessary legal authority to participate in a single ‘front door’, the Australian Government should amend section 36 of the Governance of Australian Government Superannuation Schemes Act 2011 to allow the CSC to delegate authority to DVA (or the Veteran Services Commission (VSC)). These reforms should be undertaken immediately and incorporated into the operational design of the VSC. If by 2025 the interface between the VSC and CSC has not improved significantly, the VSC should be given the function of processing claims and administering payments for superannuation invalidity pensions under the Defence Forces Retirement Benefits Act 1948, the Military Superannuation and Benefits Act 1991 and the Australian Defence Force Cover Act 2015.
RECOMMENDATION 13.3 REPLACE INVALIDITY PENSIONS WITH INCAPACITY PAYMENTS The Australian Government should close off access to invalidity pensions under the Australian Defence Force Cover Act 2015 (ADF Cover Act) for new applicants (existing pensioners would not be affected). Medically discharged veterans (who joined on or after 2016) should have access to incapacity payments under the Military Rehabilitation and Compensation Act 2004 if the condition leading to their medical discharge causes them incapacity. The death benefits for dependants under ADF Cover should remain the same but the Australian Government should amend the eligibility for reversionary pensions so that dependants of medically discharged veterans who were in receipt of incapacity payments are now also eligible for a reversionary incapacity payment. These reforms would not affect current recipients of invalidity pensions.
RECOMMENDATION 13.4 REHABILITATION FOR INVALIDITY PAYMENT RECIPIENTS The Australian Government should amend the provisions for invalidity pensions under the Military Superannuation and Benefits Act 1991 to include a requirement for veterans to, if deemed appropriate after an assessment of the veteran, attend rehabilitation to obtain invalidity pensions. This would align with the approach taken to incapacity payments under the Military Rehabilitation and Compensation Act 2004 (MRCA). Invalidity pensions should be made available during the rehabilitation process. This would not affect those who are already receiving invalidity pensions. Optional rehabilitation should also be offered to those claiming for invalidity pensions under the Defence Force Retirement and Death Benefits Act 1973. The rehabilitation services should be administered by the Department of Veterans’ Affairs (and then the Veteran Services Commission) as part of the rehabilitation that is offered to those under the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 and the MRCA. Compensation for an impairment There are a number of changes that could be made to permanent impairment payments under the Military Rehabilitation and Compensation Act 2004 that would simplify the payments, improve access and equity. The veteran permanent impairment and incapacity payments, and dependant benefits include many provisions that are unique to the veteran compensation system — they do not have parallels in other workers’ compensation schemes. And there is little rationale for a number of these payments. They also add complexity, lead to inequities and can hinder the rehabilitation focus of the veteran support system. Subject to final determination by the Australian Government, most of these provisions do not lead to large increases in compensation — removing or improving these provisions is unlikely to have a substantial effect on the compensation received by veterans.
RECOMMENDATION 14.1 A SINGLE RATE OF PERMANENT IMPAIRMENT COMPENSATION The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to remove the requirement that veterans with impairments relating to warlike and non warlike service receive different rates of permanent impairment compensation from those with peacetime service. The Department of Veterans’ Affairs should amend tables 23.1 and 23.2 of the Guide to Determining Impairment and Compensation to specify one rate of compensation to apply to veterans with warlike, non warlike and peacetime service. This should be achieved via a transition path, with the compensation factors merging to a single rate over the course of about 10 years. Prior to setting the single rate the Australian Government will need to balance the lifetime fiscal implications of the change with the benefits needed by veterans, as well as the transitional arrangements that will be necessary to implement a single rate.
FINDING 14.1 The requirements that a condition be permanent and stable before final permanent impairment compensation is granted, under the Military Rehabilitation and Compensation Act 2004, are needed to prevent veterans from being overcompensated for impairments that are likely to improve.
RECOMMENDATION 14.2 INTERIM COMPENSATION TO BE TAKEN AS A PERIODIC PAYMENT The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to remove the option of taking interim permanent impairment compensation as a lump sum payment. The Act should be amended to allow interim compensation to be adjusted if the impairment stabilises at a lower or higher level of impairment than what is expected within the determination period. The Department of Veterans’ Affairs should adjust its policy on assessing lifestyle ratings for interim permanent impairment to more closely reflect the lifestyle rating a veteran would expect to receive once the condition has stabilised.
RECOMMENDATION 14.3 INTERIM COMPENSATION TO BE FINALISED AFTER TWO YEARS The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to allow the Department of Veterans’ Affairs the discretion to offer veterans final permanent impairment compensation if two years have passed since the date of the permanent impairment claim, but the impairment is expected to lead to a permanent effect, even if the impairment is considered unstable at that time. This should be subject to the veteran undertaking all reasonable rehabilitation and treatment for the impairment.
FINDING 14.2 There is little rationale for providing additional non economic loss compensation to veterans for having children. The current payment is unique to the veteran compensation system, and leads to inequities and complexities.
RECOMMENDATION 14.4 ELIGIBLE YOUNG PERSON PERMANENT IMPAIRMENT PAYMENT The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to: • remove the permanent impairment lump sum payments made to the veteran for dependent children and other eligible young persons • increase the rate of permanent impairment compensation by about $37 per week for veterans with more than 80 impairment points. This should taper to $0 by 70 impairment points.
RECOMMENDATION 14.5 IMPROVE LIFESTYLE RATINGS The Department of Veterans’ Affairs should review its administration of lifestyle ratings in the Military Rehabilitation and Compensation Act 2004 to assess whether the use of lifestyle ratings could be improved to more closely reflect the effect of an impairment on a veteran’s lifestyle, rather than being a ‘tick and flick’ exercise.
RECOMMENDATION 14.6 TARGET INCAPACITY PAYMENTS AT ECONOMIC LOSS The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to: • remove the remuneration loading added to normal earnings for future claimants of incapacity payments • provide the superannuation guarantee to veterans on incapacity payments who: – were members of the ADF Super or Military Superannuation and Benefits Scheme when they were in the military – are not receiving an invalidity pension through their superannuation – have been on incapacity payments for at least 45 weeks – are not receiving the remuneration loading.
RECOMMENDATION 14.7 REMOVE THE MRCA SPECIAL RATE DISABILITY PENSION The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to remove the option of taking the special rate disability pension. Veterans who have already elected to receive the special rate disability pension should continue to receive the payment.
FINDING 14.3 Changes to eligibility for the service pension and other welfare payments mean that the package of compensation received by veterans on the special rate of disability pension is reasonable. Despite strong veterans’ representation on this issue, there is no compelling case for increasing the rate of the pension.
RECOMMENDATION 14.8 REMOVE AUTOMATIC ELIGIBILITY FOR MRCA DEPENDANT BENEFITS The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 (MRCA) to remove automatic eligibility for benefits for those dependants whose partner died while they had permanent impairments of more than 80 points or who were eligible for the MRCA Special Rate Disability Pension.
RECOMMENDATION 14.9 COMBINE MRCA DEPENDANT BENEFITS INTO ONE PAYMENT The Australian Government should amend the Military Rehabilitation and Compensation Act 2004 to: • remove the additional lump sum payable to wholly dependent partners of veterans who died as a result of their service • increase the wholly dependent partner compensation by the equivalent value of the lump sum payment (currently about $115 per week) for partners of veterans where the Department of Veterans’ Affairs has accepted liability for the veteran’s death.
RECOMMENDATION 14.10 HARMONISE THE FUNERAL ALLOWANCE The Australian Government should amend the Veterans’ Entitlements Act 1986 (VEA) to align its funeral allowance with the Military Rehabilitation and Compensation Act 2004 funeral expenses benefit for veterans who: • were receiving the special rate of disability pension • were receiving the extreme disablement adjustment pension • were receiving an allowance for being a multiple amputee • were a former prisoner of war • died of service related causes. Other groups eligible for the VEA funeral allowance should remain on the existing benefit. Streamlining and simplifying additional payments Many of the payments available to veterans are outdated (some have not changed since the 1920s), do not meet their intended objectives and result in another layer of complexity in the veteran compensation system. The additional payments are mostly small and the benefits do not always outweigh the costs of the added complexity. The following recommendations are about simplifying, streamlining or updating additional payments so they better meet their objectives.
RECOMMENDATION 15.1 SIMPLIFY DFISA The Australian Government should amend the Social Security Act 1991 and relevant arrangements to exempt Department of Veterans’ Affairs adjusted disability pensions from income tests for income support payments that are currently covered by the Defence Force Income Support Allowance (DFISA), DFISA Bonus and DFISA like payments. The Australian Government should remove the DFISA, DFISA Bonus and DFISA like payments from the Veterans’ Entitlements Act 1986.
RECOMMENDATION 15.2 SIMPLIFY AND HARMONISE EDUCATION PAYMENTS To align education payments across the veteran support system, the Australian Government should: • amend the Veterans’ Entitlements Act 1986, the Military Rehabilitation and Compensation Act 2004 and the Social Security Act 1991 to extend the education payments available for those under 16 years of age to those between 16 and 19 years of age and in secondary school — including allowing people to receive Family Tax Benefit while receiving this payment • amend the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 to remove education payments for those older than 19 years of age (or older than 16 and not in secondary school). Those who pass a means test will still be eligible for the same payment rates under the Youth Allowance • amend the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 to adopt the Military Rehabilitation and Compensation Act Education and Training Scheme.
RECOMMENDATION 15.3 CONSOLIDATE SUPPLEMENTS INTO UNDERLYING PAYMENTS To help simplify the system, smaller payments should be consolidated where possible or removed where there is no clear rationale for them. The Australian Government should remove the DRCA Supplement, MRCA Supplement and Veteran Supplement, and increase clients’ payments by an amount equivalent to the removed supplement. The Australian Government should remove the Energy Supplement attached to Department of Veterans’ Affairs’ impairment compensation, but other payments should remain consistent with broader Energy Supplement eligibility.
RECOMMENDATION 15.4 REMOVE AND PAY OUT SMALLER PAYMENTS To streamline and simplify outdated payments made to only a few clients, they should be paid out and removed. The Australian Government should amend the Veterans’ Entitlements Act 1986 to remove the recreation transport allowance, the clothing allowance and the decoration allowance and pay out those currently receiving the allowances with an age adjusted lump sum.
RECOMMENDATION 15.5 HARMONISE ATTENDANT AND HOUSEHOLD SERVICES The Australian Government should amend the Veterans’ Entitlements Act 1986 (VEA) to remove the attendant allowance and provide the same household and attendant services that are available under the Military Rehabilitation and Compensation Act 2004 (MRCA). Current recipients of the VEA allowance should be automatically put on the same rate under the new attendant services program. Any further changes or claims would follow the same needs based assessment and review as under the MRCA.
RECOMMENDATION 15.6 HARMONISE VEHICLE ASSISTANCE The Australian Government should amend the Veterans’ Entitlements Act 1986 Vehicle Assistance Scheme and section 39(1)(d) (the relevant vehicle modification section) in the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 so that they reflect the Military Rehabilitation and Compensation Act 2004 Motor Vehicle Compensation Scheme. Health care An efficient and effective veteran health system needs to target the right services to the right people in terms of need (financially or in terms of health requirements). Some of the eligibility criteria for the veteran health system need to be re targeted so that those in most need receive the most care. DVA also needs to improve its monitoring of client outcomes and service providers’ effectiveness.
FINDING 16.1 The veteran health system, as currently administered by the Department of Veterans’ Affairs (DVA), is largely about funding health care — DVA has little visibility of health outcomes for veterans. • Funding the treatment of service related conditions, as is done through the White Card, is well justified — it appropriately targets veterans with health needs and is similar to workers’ compensation healthcare entitlements. • The Gold Card, however, runs counter to a number of the key principles that should underlie a future scheme. It is not needs based (because it is not targeted to service related health needs), wellness focused (there can be an incentive to remain unwell), or financially sustainable (by potentially encouraging over servicing). • DVA has some good initiatives that are more focused on improving the wellness of veterans, such as Coordinated Veterans Care — although the targeting of this program could be improved (recommendation 16.1).
FINDING 16.2 The Veteran Services Commission, in line with other workers’ compensation scheme administrators, would take a lifetime, person centred, evidence based approach to health care. It would also proactively manage health care providers and be focused on health outcomes.
RECOMMENDATION 16.1 ELIGIBILITY FOR COORDINATED VETERANS’ CARE The Department of Veterans’ Affairs should amend the payments for the Coordinated Veterans’ Care program so that they reflect the risk rating of the patient — higher payments for higher risk patients and lower payments for lower risk patients. Doctors should be able to request a review of a patient’s risk rating, based on clinical evidence.
RECOMMENDATION 16.2 PUBLIC REPORTING ON ACCESSIBILITY OF HEALTH SERVICES The Department of Veterans’ Affairs (DVA) should improve its public reporting on accessibility of health services. It should report: • accessibility complaints data in more detail, including the number of complaints (so as to develop a time series to monitor the trend), and complaints by service and location • the use of contingency arrangements, including requests for, and approval of, prior approval by providers to charge higher fees • the number of providers who have indicated to DVA that they will no longer accept cardholders as clients.
RECOMMENDATION 16.3 INDEPENDENT REVIEW OF FEE SETTING ARRANGEMENTS The Department of Veterans’ Affairs should commission an independent review into its health fee setting arrangements. This review should look at the merits of adopting workers’ compensation style fee arrangements, including the use of co payments and options for monitoring fees over the longer term. The review should also consider and advise on future governance arrangements for the ongoing setting of fees.
RECOMMENDATION 16.4 BETTER TARGETED ELIGIBILITY FOR THE GOLD CARD The Australian Government should amend the Veterans’ Entitlements Act 1986 to remove eligibility for the Gold Card for anyone other than veterans with severe service related impairments. Unless they qualify through having severe service related impairments, this would remove eligibility from: • all dependants • veterans over 70 years old with qualifying service • veterans on the service pension who meet the means test • veterans on the service pension who are also receiving a disability pension above the general rate, or who have between 30 and 60 MRCA impairment points. The Australian Government should provide financial compensation to dependants who lose eligibility for the Gold Card. All current Gold Card holders should retain their eligibility.
RECOMMENDATION 16.5 NO FURTHER EXTENSIONS OF GOLD CARD ELIGIBILITY Eligibility for the Gold Card should not be extended to any new categories of veterans, dependants or other civilians who are not currently eligible for such a card. All current Gold Card holders should retain their eligibility. Mental health and suicide prevention Timely access to effective mental health information and services can be critical to improving the mental health and wellbeing of veterans and their families. There has been a heightened focus on veterans’ mental health and suicide in recent years and a range of new policies, programs and research, but little is known about outcomes.
FINDING 17.1 The Departments of Defence and Veterans’ Affairs offer a range of programs and services to support serving personnel, ex serving personnel and their families with their mental health. There have also been a number of reviews and inquiries into the mental health of serving and ex serving personnel. Despite this, the suicide rate for veterans is higher than the general population. Suicide has caused more deaths for contemporary Australian Defence Force (ADF) personnel than overseas operational service — between 2001 and 2016, there were 59 deaths of ADF personnel on deployment and 373 suicides in serving, reserve and ex serving ADF personnel. Veteran mental ill health can also have flow on adverse effects on family members, friends, colleagues and others.
RECOMMENDATION 17.1 IMPROVE AWARENESS OF DVA MENTAL HEALTH SERVICES To ensure that veterans and their families are aware of the services that the Department of Veterans’ Affairs (DVA) provides (including Open Arms and counselling through the White Card), DVA should develop relationships with, and advertise its services through, mainstream mental health service providers (such as Beyond Blue, the Black Dog Institute and Lifeline).
FINDING 17.2 All veterans are entitled to mental health care funded by the Department of Veterans’ Affairs through a non liability White Card. However, the extent to which the non liability White Card has, in practice, increased the number of veterans who are able to access mental health treatment, and the appropriateness of the treatment they receive, is unclear.
RECOMMENDATION 17.2 MONITOR AND REPORT ON OPEN ARMS’ OUTCOMES The Department of Veterans’ Affairs (DVA) should monitor and routinely report on Open Arms’ outcomes. • It should first develop outcomes measures that can be compared with other mental health services. • Once outcomes measures are established, DVA should review Open Arms’ performance, including whether it is providing accessible and high quality services to veterans and their families, and publish all such reviews.
RECOMMENDATION 17.3 EVIDENCE BASED TREATMENT FOR VETERANS MENTAL HEALTH It is important that veterans who seek mental health care can access the right (evidence based) care. The Department of Veterans’ Affairs should: • publish a list of practitioners who have completed Phoenix Australia’s trauma focussed therapy and cognitive processing therapy training • make mental health a priority area within the veteran research plan (recommendation 18.3).
FINDING 17.3 The current (2013–2023) Veteran Mental Health Strategy has not been very effective and has been superseded by recent policy changes (notably the introduction of non liability access to mental health care for veterans). Defence also has its own Mental Health and Wellbeing Strategy. A single Strategy would facilitate an integrated approach to veteran mental health and wellbeing across their lifetime.
RECOMMENDATION 17.4 A NEW VETERAN MENTAL HEALTH STRATEGY The Departments of Defence and Veterans’ Affairs, with input from the Prime Ministerial Advisory Council on Veterans’ Mental Health, should urgently develop a new single strategy for veterans’ lifetime mental health. The new Strategy should: • cover mental health activities in each of the life stages of military personnel — recruitment, in service, transition and ex service • ensure there are activities in each life stage that address the needs of those who are mentally healthy (promotion and prevention activities), at risk (early intervention) and have a mental illness (treatment) • ensure systems are in place to identify and support at risk individuals and that there is an identified focus on the prevention on suicide • ensure the needs of family members of veterans, including those of deceased veterans, are appropriately identified • be evidence based, incorporating outcomes from trials and research on veterans’ mental health needs • set out priorities, actions, timelines and ways to measure progress • commit the Departments of Defence and Veterans’ Affairs to publicly report on the progress towards the goals of the Strategy. The National Mental Health Commission should have oversight of the new Strategy and publicly report on its implementation and outcomes. Data and evidence The gaps in information about veterans are significant and there is limited evidence on the effectiveness of services provided to veterans. This inquiry was hampered by the lack of data and the poor linking of data. Reform is needed to improve data held on veterans and to build an evidence base on what does and does not work.
FINDING 18.1 There is a lack of robust data, evidence and research on many crucial aspects of the veteran support system. This impedes the design and delivery of effective supports for veterans and their families.
RECOMMENDATION 18.1 OUTCOMES AND PERFORMANCE FRAMEWORKS The Department of Veterans’ Affairs should develop outcomes and performance frameworks that provide robust measures of the effectiveness of services. This should include: • identifying data needs and gaps • setting up processes to collect data where not already in place (while also seeking to minimise the costs of data collection) • using data dictionaries to improve the consistency and reliability of data • analysing the data and using this analysis to improve service performance.
RECOMMENDATION 18.2 MORE HIGH QUALITY TRIALS AND REVIEWS The Department of Veterans’ Affairs should conduct more high quality trials and reviews of its services and policies for veterans and their families by: • evaluating services and programs (in ways that are commensurate with their size and complexity) • publishing reviews, evaluations and policy trials, or lessons learned • incorporating findings into future service design and delivery.
RECOMMENDATION 18.3 DEVELOP AND PUBLISH A VETERAN RESEARCH PLAN The Departments of Defence and Veterans’ Affairs should set research priorities on issues affecting the health and wellbeing of veterans, publish the priorities in a research plan and update the research plan annually.
RECOMMENDATION 18.4 EXPERT COMMITTEE ON VETERAN RESEARCH The Departments of Defence and Veterans’ Affairs should establish an Expert Committee on Veteran Research. The Committee should have part time members appointed on the basis of skills and experience. Members should have a mixture of skills in relevant fields, such as military and veterans’ affairs, health care, rehabilitation, aged care, family support and other compensation systems. The functions of the Expert Committee on Veteran Research should include: • providing input into the development of the research priorities and research plan • monitoring the outcomes of the research plan • promoting the use of research in the veteran support system • ensuring the Departments of Defence and Veterans’ Affairs publicly report on research outcomes and progress towards the goals outlined in the research plan. Bringing it all together One of the key drivers for this inquiry was the complex legislative framework underpinning the veteran compensation system. The Commission is proposing simplifying the system by moving to two schemes, while minimising disruption to existing claimants. Importantly, our proposed changes will mean there will be one scheme and one Act in the long term. Although legislative simplification is not a solution for all the issues facing the veteran support system, and some complexity will remain, this approach sets up Australia to have much better, fit for purpose compensation and rehabilitation arrangements for the future. An expanded range of supports for family members of veterans, including for those of deceased veterans, is required. The needs of family members should be better assessed and the responses more targeted to those specific needs. A more individualised approach is likely to achieve better outcomes.
RECOMMENDATION 19.1 TWO SCHEMES FOR VETERAN SUPPORT By 2025, the Australian Government should create two schemes for veteran support — the current Veterans’ Entitlements Act 1986 (VEA) with some modifications (‘scheme 1’) and a modified Military Rehabilitation and Compensation Act 2004 (MRCA) that incorporates the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 (DRCA) (‘scheme 2’). Eligibility for the schemes should be modified so that: • veterans who only have a current or accepted VEA claim for liability at the implementation date will have all their future claims processed under scheme 1. Veterans on the VEA special rate of disability pension would also have their future claims covered by scheme 1 • veterans who only have a current or accepted MRCA and/or DRCA claim (or who do not have a current or accepted liability claim under the VEA) at the implementation date will have their future claims covered under scheme 2. Other veterans on MRCA or DRCA incapacity payments would have their future claims covered by scheme 2 • remaining veterans with benefits under the VEA and one (or two) of the other Acts would have their coverage determined by the scheme that is the predominant source of their current benefits at the implementation date. If this is unclear, the veteran would be able to choose which scheme they would be covered by at the time of their next claim. Veterans who would be covered under scheme 1 and are under 55 years of age at the implementation date should be given the option to switch their current benefits and future claims to scheme 2. Dependants of deceased veterans would receive benefits under the scheme that the relevant veteran was covered by. If the veteran did not have an existing or successful claim under the VEA at the implementation date, the dependants would be covered by scheme 2. Veterans who would currently have their claims covered by the pre 1988 Commonwealth workers’ compensation schemes should remain covered by those arrangements through the modified MRCA legislation.
RECOMMENDATION 19.2 AN EXPANDED FAMILY SUPPORT PACKAGE The Australian Government should:
• amend the family support provisions in the Military Rehabilitation and Compensation Act 2004 (MRCA) to remove the requirement for veterans to have undertaken warlike service • amend the Veterans’ Entitlements Act 1986 and the Safety, Rehabilitation and Compensation (Defence related Claims) Act 1988 to provide the same (or equivalent) family support provisions as the MRCA. The Department of Veterans’ Affairs should amend the Family Support Package to extend: • eligibility to families of veterans without warlike service and families of veterans receiving the veteran payment • eligibility for counselling services to parents and eligible children of veterans who have suffered a service death or a suicide related to their service, and families of veterans not under a rehabilitation plan • the range of supports to cover all counselling services for partners, widow(er)s, eligible children and parents. For these family members, session limits and the requirement for an identified need should be removed and replaced with an appropriate cap on total payment.
