Examination of Witnesses (Questions 1220-1231)
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
Q1220 Mr Hancock: One of the issues
we found in this inquiry is that people at the top table have
been telling a different tale to the people who were on the ground
doing the fighting or repairing the injured. There has not been
a consistency between what you have been told at your debriefings
and what you told us, not just you. I am not getting at you today,
it is consistently a thread through this that we have been able
to challenge time and time again, the evidence being produced
by leaders of our armed forces as against what their service personnel
have told us when they have given evidence to the Committee, and
this, once again, is a classic example of just that. Can you tell
us no medical outcome suffered because of a lack of equipment?
Here we have a senior anaesthetist in the army telling us he could
have saved the leg had the right equipment been there.
Brigadier Hawley: On my command
I included not just the commanding officers unit but I had all
senior consultants in their different specialties. In addition
every single day I visited one or other of the hospitals. Every
single day that I was deployed I was there. I had my command surgeon
with me as well and he had free remit to go wherever he wished.
The only thing I put upon him was I wanted an audit done of the
clinical outcomes because I needed to know if we were failing
in one area or another, to do that he had to engage himself with
all of the consultant colleagues. At no stage was it ever flagged
up to me there was that sort of problem. It was flagged up to
me there was likely to be a problem unless we had this bit of
equipment here or there, that was the information that was needed
in order to re-prioritise with the logistic chain to make sure
that equipment came out.
Q1221 Mr Hancock: Perhaps you can
tell us for the record if a vascular repair kit is an essential
piece of kit to have in a battlefield hospital?
Surgeon Vice Admiral Jenkins:
It has to be seen in the right context.
Q1222 Mr Hancock: I want to know
if this is a pretty important piece of kit to be available to
a surgeon in a battlefield situation treating wounded personnel,
yes or no? Is it pretty important that should be there?
Surgeon Vice Admiral Jenkins:
It should be available but so should the surgical skill to undertake
the procedure, obviously the facility in which to do it and the
safety in which to do it.
Q1223 Mr Hancock: They reckoned they
had the skill.
Surgeon Vice Admiral Jenkins:
We do not know what level it was, how many penetrating injuries
there were to that vessel, whether it needed to be diverted, by-passed
or a graft put across. On deployment we would not have a vast
variety of different vascular synthetic repair kits. If it was
just a matter of joining the ends together I think most surgeons
could have done that.
Q1224 Mr Jones: Can I ask a question,
I know surgeons are not slow in coming forward in my experience,
is there a procedure, since you are debriefing individuals on
a clinical basis, where consultants or any medical people can
feed in concerns on equipment or any other concerns? What is the
process of them feeding into your debriefing that you held in
Birmingham?
Brigadier Hawley: TELIC was not
my first operation. This sort of debriefing and clinical auditing
process started in Rwanda, I was doing it in Afghanistan in Kabul.
We did exactly the same thing because we are aware that we have
a constituency of officers here, Regular and TA, who come with
a wealth of experience and qualifications and a sensible commander
would draw upon that pool of expertise and that will help him
to shape the overall plan, that is what we did in TELIC.
Q1225 Mr Jones: I accept all that.
Can you tell me what the procedure for an individual consultant
is?
Brigadier Hawley: You go to the
consultant adviser who is a professional head, a senior experienced
surgeon, anaesthetist or whatever and each consultant has the
right of access to that defence consultant adviser through the
DCA and the Surgeon General.
Lieutenant General O'Donoghue:
It is those defence consultant advisers who tell us what equipment
has to go, it is not a question of them advising us and us making
decisions, they tell us what to put in the modules and where those
modules should be.
Q1226 Mr Hancock: I would like to
ask one question about whether or not we had dedicated medical
rescue helicopters dedicated for that task?
Brigadier Hawley: No, we did not.
Within the divisional area we ran a system with the Americans
where we would use available helicopters, either American or British
for allied coalition casualties and PW casualties according to
the clinical need. We did not, the Americans did, we had a number
of them come to our field hospitals carrying British casualties
but the British did not.
Q1227 Mr Hancock: Would it surprise
you to know that in one incident when we were hit by friendly
fire one soldier was killed and others were injured it took 90
minutes to get any assistance for them to get out by air, is that
a common occurrence or is that uniquely bad situation?
Brigadier Hawley: I think call
time is very much dependent on the overall tactical situation
as well and the air corridors will clearly reflect what is happening
on the ground. It would be impossible to comment on whether that
was reasonable or not. In terms of whether it was unusual, probably
not, but on the other hand that is why we have road transport
so you will get round when the net is closed down.
Q1228 Mr Hancock: According to a
report we were sent one of those young persons who was seriously
injured, his injuries went from serious to critical in the time
it took and at one stage half the brigade staff were trying to
find a way of getting these personnel evacuated. That does not
sound very good, does it, if the procedures required half of the
active brigade staff to be chasing round to get people evacuated.
There was another surprise when we went to the helicopter base
and spoke to Commanders and RAF officers in charge of the helicopters
there and speaking to the crews and some of them on occasion found
there was not a lot for them to be doing. If I can go on to what
the Government said in their strategy for the future in December
1998. The Defence Medical Services would have a fully manned,
trained, equipped, resourced and capable organisation with high
morale capable of providing timely and high quality medical care
to our Armed Forces on operations and in peacetime. Five years
on have we achieved anything like they have set out?
Surgeon Vice Admiral Jenkins:
No, that still remains the aim and we are heading in that direction.
Q1229 Mr Hancock: Are we on target?
Do we set ourselves milestones to achieve those activities and
have we met any of them or are we failing on any of them?
Lieutenant General O'Donoghue:
We are failing on manpower, we are quite definitely failing on
manpower. Recruiting is buoyant, the retention we talked about
I think is stable but we need to look for other ways to attract
people to stay in beyond their three year point. We need to look
at other ways to give greater predictability of deployment for
our TA specialists. We are doing something about the equipment
after some years of drought in equipment funding. We are still
heading in the right direction. There is a thing called the Defence
Health Programme which attempts to capture the totality of the
activities of the DMS. In that there are a series of objectives,
a number of them, about 60, and each one has an accountable officer
and each one has the metrics in which to measure either milestones
or quantities. We are on track with that programme.
Q1230 Mr Hancock: Can I ask the Surgeon
General about the issues of real lessons from TELIC over the next
twelve months what would you say is your number one priority arising
out of that?
Surgeon Vice Admiral Jenkins:
From the immediate lessons learned I would personally say that
it is strengthening and training the medical command administrative
structure. As I have alluded to, notwithstanding your suggestion
as an exception to this, I believe in terms of clinical delivery
we have a system in place whereby we can deliver what is required
of us. We have identified there needs to be a much stronger, perceptive,
proactive command structure on the ground, and I say this not
because Alan is here, because his contribution was outstanding,
we need a stronger, more robust process, and that is something
that we are addressing. I have to say in relation to your previous
question one of other things we need is this major question about
dedicated, tactical air medical helicopters, that did come out
of the conference that I mentioned earlier on. Whether that is
feasible or affordable is another debate, it is certainly something
that colleagues of mine highlighted, they would like to see casualties
delivered to them faster.
Q1231 Mr Hancock: Have we thought
of asking those people who were unfortunate what they thought
about what happened to them at the time, the way they were treated
immediately afterwards and then say a month on, and some of them
still sadly going through treatment, have we bothered to ask them,
any of them or a selection of them to give you their opinions
of the treatment they received and what they found happened was
fair or could have been dramatically improved?
Surgeon Vice Admiral Jenkins:
It is only one example, but I think a relevant one, at my conference
a casualty, a Royal Marines Lance Corporal, who was very badly
burned, it was on near-live television, he was blown up in a building,
he was at that conference and he had no criticism. He was highly
supportive of the medical care. This is one example, as you know
there are single examples of everything good and bad. That is
just one example of a clinical audit process, if you like. There
are others which we are looking into that we do have to define
clinical outcomes.
Mr Crausby: We have gone considerably
over our time, we were concerned for time nevertheless it has
been a useful session. Can I take the opportunity to say that
the Committee are most grateful for your help. Thank you very
much, I think we gained a great deal from that session.
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