Select Committee on Defence Minutes of Evidence


Examination of Witnesses (Questions 1200-1219)

SURGEON VICE ADMIRAL IAN JENKINS CVO QHS, LIEUTENANT GENERAL KEVIN O'DONOGHUE CBE, SURGEON COMMANDER DAVID BIRT, BRIGADIER ALAN HAWLEY OBE, WING COMMANDER MICHAEL ALMOND AND COLONEL STEVE HOWE CBE

22 OCTOBER 2003

  Q1200  Mr Cran: In Iraq?

  Lietenant General O'Donoghue: Yes, it is fully manned in Iraq, all of the operational deployments are fully manned. The definition of full manning, I cannot give you numbers of regulars and numbers of reserves because it is an amalgam, it is a regular and reserve balance, it is the use of NHS teams. The definition of fully manned is enough capability to deliver what is required according to defence planning assumptions, you will accuse me of copping out. If we cannot get enough regular anaesthetists over the next two or three years I have to find a different way of doing it.

  Q1201  Mr Cran: I have heard a definition and I think that requires a whole other investigation to actually establish what all of those words meant. Alas I have to say we do not have the time but we are on your side.

  Lieutenant General O'Donoghue: There are two bits of work going on, one is the deployable medical capability requirement work done by me and by the single services to sort out what the requirement is, what the readiness for that requirement has to be and so how much of it has to be regular and how much of it can be at 30 days readiness At the same time slightly behind that is the manpower strategy which is looking at the sort of things we have been talking about, have we got people trained correctly, and a great variety of things, such as can we use nurses in some areas where we do not at the moment. There is a lot of work in hand due to report in February.

  Mr Cran: Doubtless we will be investigating again.

  Q1202  Mr Roy: Can I clarify something, you said that the manning levels were okay when you needed them, however if you needed them in the future you do not know whether they would be, will you be looking at that over the next year? Have you used up your kudos in the last few months and does that change in a year's time?

  Lieutenant General O'Donoghue: We have not used it all up. There are some rules about the use of reserves, you cannot redeploy reserves too quickly, you can of course deploy regulars.

  Q1203  Mr Roy: What is "too quickly"?

  Surgeon Vice Admiral Jenkins: It is nine months out of 27 for war fighting and it is 12 months out of 36 for non-war fighting. I know it is the same but there is a subtle difference.

  Lieutenant General O'Donoghue: The regulars you can deploy all of the time but the difficulty with that is they get fed up and leave.

  Q1204  Mr Viggers: Whilst we respect the manner in which you are getting by in the present situation at the end of the day there is an establishment for key specialties like general surgery, orthopaedic surgery and general medicine can you give us a snapshot of the current manning in those keys areas?

  Surgeon Vice Admiral Jenkins: Orthopaedic surgery or general surgery is give or take 50% of the consultant requirement. With anaesthetists we have a gap of 70% of consultant anaesthetists on the old manning assumptions, with physicians we have 35% of the total number that we should have of trained independent practising consultant physicians. While we have people in the senior levels of high training we are using some of our advanced specialist trainees in consultant lines where they can be supervised by the other consultants and that is how we are going to get by.

  Q1205  Mr Viggers: A number of initiatives have been put forward to enhance retention, do you get the impression these are working? Statistically are you improving the situation?

  Surgeon Vice Admiral Jenkins: Some of them are very new initiatives and it is very early to say. What is happening is that for consultant training, we demand a three year return of service before the person has completed their time. What I do not know with the numbers of specialist in training at the moment is how many of those people are deciding to stay on beyond that three year period, it is a bit early to give you statistics at the moment although they are monitored now because it is critical to us. Generally speaking we in the military have no difficulty in encouraging young people to go into professional training, our difficulty is retaining them after the three year return to service point. As I say anaesthetics is the most critical speciality.

  Surgeon Commander Birt: In terms of keeping on training military training is something which is very attractive, it is much more adaptable to the individual and where it is training in general since the culmanisation—a dreadful word—of registrar training in the NHS people have tended to train in the region and not moved about in military training where you can move about and get wider experience and that seems to retain registrars during the training period. What happens after the three year return of service, is it more difficult to stay in the military for reasons other than the professional side, they enjoy the military, the people they work with and the experience of deployment, you have to look at wider issues rather than just pay and conditions, the job they do in the Military District Hospital Unit and the NHS side of it.

  Q1206  Mr Viggers: Of those personnel who are deployed how many medical staff were employed on administrative duties?

  Lieutenant General O'Donoghue: That is a question I do not think I can answer. We would need to send you a note. Do you mean medical military like commanding a hospital. I think we will have to send you a note, I do not have that.

  Q1207  Mr Jones: Can I ask about medical reservists, we have seen press comments about Operation TELIC and people resigning, it would be interesting to know what your views are on that and what mechanisms you are putting in place to retain people as reservists? Are there any lessons out of Operation TELIC or other operations that you learned?

  Lieutenant General O'Donoghue: A lot of the bad press was while they were still out in Iraq. I understand that that from the Army only 17 medical reservists have put their papers in since Operation TELIC, that is not very many. After any conflict one would expect a number to put their papers in, I do not know of the Navy and Air Force figures, I am not aware of a problem. Meeting them coming back at the airports as they came back in there was not a general air of dissatisfaction at all, there was an air they had done a good job and they were pleased to be used in the role for which they trained.

  Q1208  Mr Jones: I agree with that. We went to Safwan and talked to some nurses there who obviously reiterated the point, they thought that the experience was valuable but the thing that came over was it was this indetermination of how long the tour was going to last, is that an issue that was borne out by other people?

  Lieutenant General O'Donoghue: That is right. As far as the specialists are concerned at the moment we are now looking at a six or eight week turnaround for consultants who need, as the Surgeon General said, to keep their hand in and keep practising. What we need to do in the future is apart from the actual period of war fighting, where people have to be there and stay, is offer greater flexibility. Some consultants would welcome more than one deployment of six weeks in a twelve month period others would prefer, perhaps on the GP side, to shutdown their practice for six months, three months whatever it is. If we can offer some flexibility that will make life a lot easier.

  Q1209  Mr Jones: Is that creating any problems with the hospital trusts? In terms of Operation TELIC that was a lot longer than we thought, I would be interested to know what your views are in terms of consultants? I know from my experience with the Royal Marines it varies from hospital to hospital trust, the policy of releasing reservists for training which they have to do to be part of a combined unit. Is there any work done to try and even that out to ensure you get a uniformity across trusts?

  Lieutenant General O'Donoghue: We are certainly looking at a new way of doing business. We need to sort out two things, one is that we need to get our people out for military training and deployment and on the other hand the trusts, the chief executives need, if we are not all going to war, a greater degree of surety about how much effort the military is going to offer to that trust. There is work in hand to see if we cannot even that out and offer both sides a better way of doing business and a more predictable way of doing business. Going back to TELIC, I am not aware of any real concerns amongst the trusts, nothing has come back to me through the Department of Health. Certainly those trusts who lost military people or who cleared wards because they thought they were going to take patients have been recompensed by the military by some twelve million pounds in the last financial year and it looks like 19 million in the coming year, and that was for pulling in locums from private medicine. I am not aware of any huge dissatisfaction other than the comment that there ought to be a better way of doing it. I agree we are looking at that.

  Surgeon Vice Admiral Jenkins: Can I mention something that is more provocative, some of my colleagues might not agree with me, there is a problem historically. As you know TA field hospitals are recruited, obviously, on a geographical location basis. If you were a hospital chief executive, and going back again to the conversation you had with our reserve colleagues about mobilising formed units, if you suddenly found that because you are the centre of the cell and if all of the NHS want to go because they are part of the cell you would have a huge problem. From their point of view they would prefer to learn if you want so many general surgeons and so many anaesthetists and the trust chief executives would see how best they can mobilise their reservists within their own environment so that it does not disrupt them too much. This is all emerging thought processes.

  Q1210  Mr Jones: Is that something if we go into more expeditionary warfare that there is going to be more use of reservists and that is going to be increasingly an issue for hospital trusts?

  Surgeon Vice Admiral Jenkins: Yes.

  Lieutenant General O'Donoghue: Full manning, whatever that is, will make that a lot easier. At the moment we are drawing in quite a small pool of specialists.

  Q1211  Mr Harvard: Can I turn to equipment and supplies. Our understanding is that some of the 170 urgent operational requirements were for medical support, what medical support was procured through the UOR process? Was all that medical support procured through this route delivered on time? Did it work?

  Lieutenant General O'Donoghue: Yes, you are right. We spent £35 million on UORs. As I mentioned earlier because of the strategic level planning we had a pretty good idea of what medical equipment and drugs were needed and they were put together in medical packs. The orders were we were allowed to talk in general terms to industry about how quickly they would react in November and we were allowed to place the orders in December. All of the equipment that we had on order was with the Medical Supplies Agency in Ludgershall by 15 March, some sooner but it was all there by 15 March. They assembled it into modules and it was shipped out to theatre. Some of those modules were not necessarily complete but where they offered an operational capability if not the total operational capability they were dispatched and the bits that were missing were sent later. I am not aware, and I turn to the Brigadier who was in command in theatre, that any equipment that was critical was not in place on time.

  Brigadier Hawley: I would agree with that. From where I was no one informed me of any clinical care that was compromised by a lack of equipment. I have to say that it was very tight. There were a number of factors that combined to produce this rather tight, fraught situation, one of which was the release of money for UORs, this coincided with two things, first of all the new process of medical equipment modules, as you heard the General said, modules of specific capability, anaesthetic, resuscitation, paediatric, accident and emergency, they were in the process of being built and procured and the deployment cut right into that. The second thing is the change in responsibility for medical supply, it was right on the cusp of that change, that moved from a medical function to a logistic function. The systems in theatre needed some pretty fancy foot work on deployment in order to fix. It worked but I have to be honest and say that it only just worked. It subsequently has got much better but at the time when we were involved in the war fighting phase there was not much spare.

  Q1212  Mr Harvard: The reason for asking the question is the Chief of Defence Logistics said no UORs were prosecuted if they could not be delivered at the six month point, which was 31 March. What we were trying to find out is did you then not order something simply because it was not going to come within the timetable and, if so, what were those things? Whilst it was tight you had nifty footwork and you did not experience a problem in relation to that?

  Lieutenant General O'Donoghue: No. There are two key lessons to come out of it, one is that the medical supply squadron needs to be deployed earlier, it did deploy within the first two weeks but it needs to be out there really very much sooner. That has been taken on board. The second point is that we had to procure too much equipment by UOR, we need to have more on the shelf. Just-in-time is fine but we do not want to procure too much equipment which then sits on the shelf and gets out of date. But we do not have the balance right at the moment and we are spending money on that.

  Q1213  Mr Harvard: The balance is very difficult to achieve, we wanted to know your experience?

  Lieutenant General O'Donoghue: It was not right for TELIC, we are now spending money to make sure that for future deployments it is right.

  Q1214  Mike Gapes: To follow that up, did the Defence Medical Service personnel have all of the specialised equipment available to them that they would need if there had been a possible chemical or biological attack?

  Lieutenant General O'Donoghue: Yes, they had the chemical modules and the biological modules. They had collective protection.

  Brigadier Hawley: I think it is fair to say there were two modules, one was the old scale and one was the new scale. As I mentioned this is on the cusp of change between those two modules. In terms of collective protection and environment in which casualties could be treated and that was done and was deployed and we had extra equipment if I decided to deploy it.

  Q1215  Mr Viggers: The 1988 Strategic Defence Review announced a range of equipment improvements, how well did these enhancements work during Operation TELIC?

  Lieutenant General O'Donoghue: The Argus was probably the finest role three facility anywhere out there, the Americans were all queuing up to come to the Argus, it is an excellent PCRF. Some of the other equipment measures we talked about were known about, they were held as UORs but the balance was not right. We need to procure some of those quicker. With one exception all of the measures proposed in SDR have either been completed, they are on track or they have slipped off to the right for obvious reasons, a lack of manpower or funding. The one exception was the ambulance train.

  Q1216  Mr Viggers: What about the two hospital ships?

  Lieutenant General O'Donoghue: We have a hospital ship, its replacement is in the equipment programme. The second one is off to the right, it is a funding issue.

  Q1217  Mr Roy: We are told that the Surgeon General recently held a conference to discuss what went right and what went wrong, can you give us an outline of the findings of that conference?

  Surgeon Vice Admiral Jenkins: We held a medical conference, it was a clinical, scientific conference on 14 October in Birmingham and there were over 250 people there, regulars and reserves, and a number of civilians as well. Many of whom, if not the majority, had been deployed and many of those who were deployed, some sitting at this table now, produced scientific papers for us to learn the clinical lessons. What I can tell you is this, and I am not being complacent in saying this, I can categorically assure you that clinical outcomes were uncompromised. Yes there were problems with supply, equipment and everything else, mobilisation of reserves, support and this and that and the other but the clinical outcomes were first class. I can put my hand on my heart and say that nobody suffered inappropriately because of a lack of medical requirement. That was the outcome of the conference. That was broken down to all of the sub specialties which were deployed, planning and everything else to go with it, it was a broadly comprehensive programme which concentrated on clinical delivery and clinical provision and clinical outcome.

  Q1218  Mr Roy: Away from the clinical lessons, I am thinking of Operation TELIC, what went well and what did not go so well? How will we find out if you have recognised them?

  Lieutenant General O'Donoghue: I will ask Colonel Howe to speak in a minute. We have a lessons identified list, it is quite a long list and some are quite small and others, such as the balance of equipment, are more significant. From that list we will pick up other things that did not go so well or the things that might not have gone so well had the circumstances been different. What went well is, as the Surgeon General said, that it worked. Nobody was disadvantaged in any clinical outcome.

  Q1219  Mr Hancock: Can I raise an issue with you, I apologise for being late, I was held up somewhere else, I had a member of the armed forces ring my office and subsequently following that phone call they wrote a detailed letter to the Committee and some questions I understand have been raised. I would like to read this one bit to the Admiral, it is very telling in what you just said. This man was a Major in the army and a Chief Superintendent in the police in normal life. "On my return flight I sat next to a reserve medical Major, he is a consultant anaesthetist in Newcastle General and he was emotionally upset by an operation he had participated in on a young United Kingdom infantry soldier, the soldier was shot by a negligent discharge by a colleague. The soldier received four bullets wounds into the upper leg. The doctor was particularly angry that if his team had had a vascular repair kit, which they did not have, they would have been able to redeem that young soldier's leg, as it happened they had to take his leg off". How do you square with what you just said, Admiral, with what two people on the ground have written to this Committee and said?

  Surgeon Vice Admiral Jenkins: If I can have the details of the case I will answer your question and I will have it investigated.


 
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