Army Medical Services
26. The Secretary of State reaffirmed that the MoD
would "seek to increase substantially —by more than
2,000 soldiers—the manpower available to the volunteer Army
Medical service."[88]
The expansion of the medical services will enable it to provide
up to four Field Hospitals, each of more than 400 volunteers,
for medium-scale operations and up to 11 Field Hospitals for those
at the largest scale.
27. In addition to the increase in the establishment,
the organisational structure of the Royal Army Medical Corps will
be reformed. At present, it is made up of 11 Field Hospitals and
7 Field Ambulances. General Walker argued that the modification
of the structure of the TA's contribution to the Defence Medical
Services arose from the planning assumptions underlined within
the eight missions and the 28 tasks identified within the Strategic
Defence Review.[89]
The resulting modification proposes to retain the 11 Hospitals,
reduce the Field Ambulances to from five to two, create an Ambulance
Regiment and establish five Medical Squadrons.[90]
The Medical Squadrons will be of sub-unit size, comparable with
the size of an infantry company, whereas the Field Ambulances
will be of unit size,[91]
and provide tented hospitals which perform life saving surgery
and stabilise patients for onward transmission. The Ambulance
Regiment will be a regiment that is focussed on driving ambulances
and transporting casualties.[92]
28. We welcome, in principle, the decision to
expand the medical services which are a vital part of the support
service to the Army, but we are concerned that the MoD may be
overambitious in seeking to recruit 2,000 extra volunteer personnel
in these areas. In written evidence to us the British Medical
Association's Armed Forces Committee commented—
As the regular [medical] services have contracted
the role of the reserves has become ever more important. Whilst
the size of the armed forces generally has been reduced in recent
years, the operational role of armed forces doctors has become
more extensive since the end of the cold war. New commitments,
such as Bosnia and aid operations, have been very labour-intensive.
It is the BMA's view that the regular medical services have been
cut too deeply and too quickly. There is also no indication that
the workload is going to lessen. There is a continuing mismatch
between the operational role and the available resources. In light
of this the Government's commitment to the medical reserves is
to be welcomed. However, we are concerned that the Government's
proposals could lead to a major restructuring which could be counter-productive.
For example, we have learnt that the current medical unit in Dundee
is to be scaled down at the same time as it is joined in the city
by medical unit in the same barracks. This may well be a recipe
for the failure of both units. We are concerned that the Government's
proposals go beyond simply providing a back-up to doctors in the
regular forces; it appears to be a response to the severe shortage
of regular doctors in all specialities and we are not convinced
that it is the most appropriate response to their shortage. We
believe that a reliance on the reserves is misplaced. Doctors
in the reserves cannot effectively replace a full complement of
properly trained service doctors. Unlike their colleagues in the
reserves, doctors in the regulars are fully trained for military
operations and are instantly deployable.[93]
The Minister himself conceded that recruiting the
additional members of the medical services would not be a simple
task—
There are no easy answers. Consultants, doctors and
nurses do not drop out of the sky, they have to be trained and
the training periods are lengthy. There is a competitive market
with the National Health Service and with the private sector.
There is a degree of overseas involvement as well, particularly
in the case of nurses and so on ...We are looking at how we can
make it more attractive, how we can get people in. We are looking
at targeting areas that perhaps have not been targeted in the
past. We are looking at providing better training facilities within
the TA. We hope that over a period of time these initiatives will
encourage people to join the TA and make a contribution.[94]
29. Mr Henderson also outlined his Department's programme
for recruitment and told us that there had already been meetings,
at official level, between the Ministry of Defence and the Department
of Health on this issue[95]
and that there had also been discussions between the Secretary
of State for Defence and the Secretary of State for Health.[96]
He further noted the importance of the MoD working with the Department
of Health to meet these objectives. However, Mr Henderson did
sound a note of caution when he conceded that there was "a
bit of conflict" between the two departments.[97]
This Committee is well aware of possible causes for such conflict,
not least well publicised manpower problems experienced within
the NHS. Certainly our representatives from the TAVRAs believed
that for the recruitment to be successful, cooperation both at
a high level and at the working level between the Ministry of
Defence and the Department of Health will be needed. They argued
that—
... if they [NHS employees] know they are being encouraged
by the system that employs them to join, we may well get some
more people in the door. That is where all good messages have
to start, at the top, overtly, frequently and with a great deal
of encouragement.[98]
The British Medical Association agreed with the TAVRAs
that more needs to be done by Government to steer NHS Trusts on
these matters and to ensure that they have the resources to cover
absent members of the reserve forces. It highlighted both potential
and present problems in recruiting from NHS Trusts—
Some Trusts have been unwilling to employ reservists,
or reluctant to release them for the necessary training. Only
last month the BMA received a complaint from a doctor who was
experiencing problems in obtaining time off to undertake reserve
forces training. We also fear that doctors are reluctant to displease
employers by taking on this commitment.[99]
30. The success of the recruitment of medical
reservists is reliant upon the MoD and the Department of Health
formulating coherent recruiting policies and promoting the benefits
of volunteer service. It is essential to greatly improve the level
of liaison between the MoD and the Department of Health on the
recruitment of volunteer medical reservists, in particular at
Ministerial level. We will monitor closely the recruited strength
of the medical services to see if the MoD are successful in their
objectives. We agree with the BMA that increased use of medical
reservists cannot be an alternative to bringing the regular service
back to an appropriate strength. We intend to return to the subject
of the Defence Medical Services in a separate inquiry later in
the year.
88 HC Deb, 17 November 1998, c751 Back
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