APPENDIX 4
Further Memorandum from the Ministry of
Defence (31 October 2000)
Following my letter of 23 June 2000 providing
information on the medical standards for entry to the Armed Forces,
you asked for further clarification of the policy adopted by each
of the Services, in particular with regard to psoriasis.
As I advised in my previous letter, the medical
standards for entry to the Armed Forces are set out on a tri-Service
basis in the Joint Service Publication (JSP) 346. The JSP is issued
by the Surgeon General's Department as guidance to the three Services.
Each Service may apply the guidance flexibility to meet its own
requirements. The prime consideration when examining applicants
for entry is whether or not they are medically fit to undertake
the type of employment they seek.
So far as dissemination of medical standards
is concerned, a copy of JSP 346 and amendments is issued to all
Service and civilian medical practitioners required to examine
applicants for entry to the Armed Forces. The JSP states that
examining medical officers must consider each applicant on his
or her own merit and encourages them to apply their clinical judgement
individually. They are also advised to seek specialist opinion
where appropriate. Further single Service guidance is provided
by the RN and RAF in additional publications on recruiting medical
standards. The RN also runs biannual courses and the Army holds
annual conferences for examining medical officers. Medical examination
of applicants has been centralised by the Army at four units in
the UK which means that, if necessary, cases of doubt can be discussed
with medical colleagues before a final decision is made.
I can confirm that the Army adopts a stricter
policy on psoriasis than the other two Services and bars anyone
who has, or has a history of, psoriasis. The reasons for this
are that individuals need to be able to withstand the rigors of
initial training and subsequent military operations, and to perform
their tasks without risk to their own or others' health and safety.
Soldiers may be required to serve in adverse conditions which
may exacerbate psoriasis. Severe attacks can be debilitating and
could prevent sufferers from carrying out their military duties,
thereby potentially putting themselves and their colleagues at
risk. Furthermore, some deployments to isolated areas may have
limited medical facilities and it could be difficult to provide
the necessary medical treatment.
I can also confirm that being clear of psoriasis
at the time of a recruiting medical examination would not mean
that an applicant was fit for service; acceptance would depend,
as in all cases, on an individual's medical history. As the Professor
of Dermatology from Manchester has advised the Committee, it is
recognised that stress can exacerbate psoriasis. Whilst this does
not imply that psoriasis sufferers are more prone to stress than
any other group in society, it does confirm that psoriasis sufferers
have additional medical concerns to deal with when exposed to
stress. Initial Army training and subsequent service can be highly
stressful—both physically and mentally—and it is because
of this, and the duty the Army has to care for both new recruits
and serving personnel, that it excludes those applicants who have
a history of psoriasis.
As the Committee is aware, the RN and RAF may
accept some applicants with psoriasis, depending on the severity
of the condition and the type of employment sought. Those who
have previously been rejected by the Army would be considered
on their merits, as in all other cases. Applicants must declare
if they have had an application rejected by one of the other Services
and where an applicant to the RN or RAF has previously been rejected
by the Army on medical grounds, the medical notes would be obtained
and submitted to the RN or RAF medical directorate for advice.
As I advised in my earlier letter, JSP 346 is
kept under constant review and is regularly updated. However,
the Committee will be interested to know that the Department is
proposing to carry out a formal tri-Service review of the policy
on recruiting medical standards. I will provide further information
about plans for the review, including the timescale, when these
are available.
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