Select Committee on Defence First Report

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

89   Q 158 Back

90   Modern Forces for the Modern World: A Territorial Army for the Future, Volume 1 Back

91   Q 156 Back

92   Q 157 Back

93   Ev p 37 Back

94   Q 159 Back

95   Q 160 Back

96   Q 174 Back

97   Q 161 Back

98   Q 42 Back

99   Ev p 35 Back

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Prepared 11 February 1999