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In my previous incarnation as a practising family doctor, I spent part of my time looking after the joint service Royal Army Educational Corps at the Defence School of Languages at Beaconsfield in south Buckinghamshire. In the morning I looked after the armed forces and in the afternoon I saw their families in my civilian practice. It seems to me that even now there is too much of a dislocation between the health care given to the personnel and that given to the families. I shall give just one example. All over the country, service families come to MPs’ surgeries with the same problem. A family member is put on an NHS waiting list for treatment. The family is then moved to another part of the country and they go to the bottom of the waiting list there. They can be perpetually on a waiting list, penalised for being a member of a service family and never getting the health care they need. It cannot be beyond the wit of Government and the civil service to construct a scheme that means that service family members are not disadvantaged in that way. It is preposterous that every week constituents come and
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tell Members about the same problem, but nothing happens. I want to make a special plea to the Minister to make representations to the Department of Health to come up with some method to ensure that those people do not continue to be disadvantaged in that way.

Mr. Ingram: I agree with the hon. Gentleman’s general sentiment and we are aware of the problem. Indeed, efforts have been made to find an answer. Given the hon. Gentleman’s experience, perhaps he could suggest how we could overcome the issue of clinical judgment. How can we impose on doctors a decision different from the one that they want to make?

Dr. Fox: I am not sure that that is what needs to be done. It would be easy, in the system of maximum waiting times that the Government have introduced, to transfer patients from one list to another on the basis of how long they have waited, not even taking into account the medical circumstances and prioritisation that should take place. It should not be beyond the wit of Government to devise such a scheme. My hon. Friend the Member for Forest of Dean (Mr. Harper), the shadow Minister for armed forces families’ welfare, is considering that, and the Government might like to talk to him about some of our ideas on that issue. We would be willing to share them with the Government.

Mr. James Arbuthnot (North-East Hampshire) (Con): My hon. Friend has just made an extremely interesting point that almost exactly parallels the experience that the Defence Committee found in the education service. Children with a statement would need another statement done when they moved to a different authority. The message for Ministers is that they need to make a special effort to talk to other Departments whose work has such a direct impact on the armed forces.

Dr. Fox: My right hon. Friend is correct and has saved me from making that exact point. The issue cuts across several Departments, which is why the Leader of the Opposition has appointed my hon. Friend to his post. We require proper co-ordination across Government to deal with service families. Educational attainment and issues such as statementing are as important as NHS waiting lists. If we are serious about addressing the welfare issues that affect service families, top of our priority list must be proper co-ordination between Departments to ensure that they are not penalised in education, health or any other sphere because of their relationship to service personnel.

Mr. Lancaster: My hon. Friend is right to make the link between support for families and retention. May I draw his attention to the way in which the Royal Air Force is dealing with the issue? The traditional welfare officer, who was probably a senior RSM type and not very approachable, has been done away with. Instead, the RAF is actively recruiting professional civilians to fulfil that role, with a much greater response from families.

Dr. Fox: It would be a very good thing if relationships on the ground could be improved, but my point is that we need co-ordination at Government level. There has to be better integration between
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Departments in Whitehall, and they must have a better understanding of the problems that we are discussing today. This is not a party issue: rather, it is a structural problem inside Government that needs to be dealt with as a priority.

The Minister talked about health care for our armed forces, and the question of why we do not have independent military hospitals arises regularly. It is worth pointing out to those who ask that question that a district general hospital treats about 120,000 patients every year, whereas the Army has fewer than 100,000 members in total. We must accept that the reality is that that makes it impossible for defence medicine to be carried out as it used to be.

Having said that, however, I want to return to what the Minister said about military-managed units. The difference between those units and ones that are exclusively military is very important, as General Sir Richard Dannatt made very clear. On 13 March, he said:

That is what the Opposition want, but on the very next day—14 March—the Prime Minister told the House that,

The two assertions are not compatible: the Prime Minister’s concept is fundamentally different from the one put forward by the Chief of the General Staff. The Government must decide whether or not they believe in exclusively military units. The Opposition strongly urge them to understand the importance of having units that are not just military managed but are exclusively military. I hope that the new Prime Minister—whoever that may be—will make that a priority.

Another specific point that I want to make is that our defence medicine runs the risk of falling behind best practice in other parts of the world. In particular, I bring to the Minister’s attention the problem of traumatic brain injury as it affects our armed forces in theatre. He will know that improvements in the quality of body armour mean that more troops are likely to survive blast injuries, but also that they have increased the risk of concussion and other traumatic brain injury.

In the US, protocols have been brought in already to test those who have suffered blast injuries both when they are in theatre and when they leave it. I am advised that the MOD has said that it will wait to see the results of the US programme before introducing similar protocols here, but there is already a large body of medical evidence that the US approach is the clever thing to do. If we wait to get the US results, we risk repeating what happened with post-traumatic stress, when we waited a long time after the end of the Vietnam war before recognising it as a disorder. The quicker we can bring the protocols into play, the better, and the smaller the number of injuries likely to escape detection.

I hope that the Minister will reconsider his approach to this matter, and that he will return to the House and tell us that the US programme can be adopted by the UK in the near future. If we fail to do so, we run the
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risk that people will suffer long-term psychological or physical damage that could be prevented. It would be a failure of the Government’s duty of care if American troops were able to avoid such damage yet British troops were not.

I turn now to the issue of overstretch.

Mr. Bernard Jenkin (North Essex) (Con): Before my hon. Friend moves on from post-traumatic stress, does he share my concern that there is not enough support when they return from theatre for service personnel who may be suffering from that disorder? Is it not extraordinary that the Government do not take a more hands-on approach to the problem in respect of personnel who remain in the armed forces, and in respect of those who leave and who have suffered injury?

Dr. Fox: My hon. Friend makes an extraordinarily important point that gives me an opportunity to praise the fine work of organisations such as Combat Stress. However, the treatment for mental illness available in this country is generally completely substandard, and I have campaigned for a long time for better health services here. They remain the Cinderella of the health care system, and the flaw is often that we ask mentally ill people to get in touch with the facilities that are available, even though, almost by definition, they lack the insight or ability to access those services. It is therefore incumbent on our welfare and medical services, whether in the military or outside, to make sure that they extend a helping hand to the people who may be suffering, instead of waiting for those people to make contact. Given that studies in the US show that up to 12 per cent. of Iraq veterans return with some sort of psychological disturbance, we must make dealing with those who suffer from post-traumatic stress or other psychological illnesses a priority right across our health services.

The problem of overstretch is one that we have discussed many times in this House. The Government produced the strategic defence review at the beginning of their period in office. Many people considered it to be a very good review, and in my view it is one of the two best reviews that have been compiled since the second world war. From the SDR emerged the defence planning assumptions, but the trouble is that the Government have exceeded those assumptions for the past five years and the Opposition maintain that the Government have not increased defence funding in line with that.

In a written answer of 16 April, the Secretary of State for Defence made an interesting statement. He said:

When will that happen? The Under-Secretary will respond to the debate, and I hope that he answers that question. If the Government believe that they are returning to levels of deployment that are within planning assumptions, the House has a right to see the evidence, and the time scale within which that might occur. The Opposition believe that the operations in Afghanistan and Iraq have never been funded fully by
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the Treasury and that, as a consequence, there has been salami slicing in the rest of the armed forces.

When the Under-Secretary gets to his feet this evening, I hope that he will tell the House what is the Government’s estimate of the cumulative cost of operations in Afghanistan and Iraq to date. Perhaps he would even like to answer that question now, as I am sure that someone is scuttling away to get the answer at this very moment.

A number of practical problems have arisen as a result of overstretch, and we have discussed them many times in this House. For example, there is no excuse for the length of time that it took to get the requisite amount of body armour into theatre. There can be no excuse either for the slow progress that was made towards getting the correct number of armoured vehicles into theatre, or for the continuing lack of helicopters to which those of us who visit—and my colleagues have made many visits—constantly allude.

Mr. Nicholas Soames (Mid-Sussex) (Con): Does my hon. Friend agree that one of the problems with planning operations is that the Ministers no longer listen to defence chiefs’ advice as they used to? The planning for the Afghanistan operation left troop numbers woefully short. Does he agree that Ministers should have listened more carefully to the military advice?

Dr. Fox: It would be with some fear that I disagreed with my hon. Friend about anything, but I am sure that he is right about this matter. Many of us who have followed the Afghanistan operation from the beginning have felt that Government planning has tended towards the rosy end of expectations. When Ministers were advised that matters might turn out less optimistically, they ignored that advice, largely for political reasons. The fact that we have had to make two reinforcements in Afghanistan is testimony to exactly the point that my hon. Friend makes.I fear that in the months ahead we may see further deployment of British troops for precisely the reasons he gives.

Tony Baldry: There is another point that the Government need to take into account. We have to make sure that our NATO allies play fair with us. In Afghanistan so many other NATO countries have so many caveats that it is always UK troops who have to step up to the plate, and as the costs of operations fall where they lie the UK Army has to meet the lion’s share, which means that there is a double hit in terms of overstretch.

Dr. Fox: As my hon. Friend knows, I have made that point in the House on a number of occasions, and I have recently discussed it with our colleagues in Washington, Canada and Germany, because there is no doubt that it goes to the core of NATO’s continued existence. If NATO is to continue as an effective alliance, we need effective burden sharing. Communal security means communal burden sharing, so we need to look at a number of elements.

It is clear that public opinion in Britain, America, Canada and the Netherlands—the countries with the heaviest load in the south of Afghanistan—is offended
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by the fact that so many caveats are attached to so many of the other forces operating in the country, even though they are our allies and partners in the operation. For example, the idea that some troops should not operate after dark seems nonsense to a country such as the UK. Not only do we have courageous and professional forces operating in Afghanistan, but our costs in terms of fatalities and casualties are much greater than for other countries.

It is important that there is a wider debate in NATO, and I regret that the Riga summit in November missed a huge number of opportunities. It should have dealt with NATO’s role, decision-making structure and funding. Proper burden sharing is needed, and there are questions about how NATO should undertake greater expeditionary activity and who should bear the costs, as well as who should be responsible for the defence of continental Europe. Those issues are parts of the burden that must be shared and we should be clear about all of them. An incoming Conservative Government would regard them as a priority, and we are actively discussing them with all our NATO partners to ascertain whether there is common ground for a wider look at how we carry out that burden sharing. All my colleagues on the Conservative Benches believe that if we cannot achieve better burden sharing it will be deeply damaging for NATO in the future.

Mr. Kevan Jones (North Durham) (Lab): It is easy for the hon. Gentleman to perpetuate such myths for media attention and headlines, but what does he think the problem in Afghanistan actually is? General Richards appeared before the Defence Committee on Tuesday afternoon and when he was asked about caveats, said clearly that they were not an issue. Will the hon. Gentleman comment on that?

Dr. Fox: That is one of the few occasions on which anyone in the military in Afghanistan has said such a thing. When I have spoken to the military, they have said that caveats are a major issue in Afghanistan. Indeed, not only are they are a major military issue but, more important, they are a major political problem in NATO, as has been said. They affect public willingness in countries making the biggest military contribution in terms of personnel and expenditure. Funding and fighting are linked in NATO, so because we do more of the fighting we have to do more of the funding. Until those political problems are sorted out, it will be increasingly likely that public opinion in the countries making the biggest financial contribution will be that those countries are in an alliance where not everyone is pulling their weight. Given NATO’s geopolitical importance, it is vital that we stop that mindset taking hold.

Mr. Arbuthnot: I asked General Richards the question on Tuesday. I think I asked, “Is there anything you’d like to say about caveats, or has it all been said?” and I think his answer was, “Well, actually it’s all been said.” [ Interruption. ] There is a major issue: the Germans are required to consult and to obtain the permission of the Bundestag for everything they do militarily, so if they have difficulties with further troop deployments, would not it be possible for them to be encouraged to increase dramatically the amount of work and resources they are putting into improving the police force in Afghanistan, which is now the second greatest threat the Afghan people face?

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Dr. Fox: That there is such a clear difference between the Opposition and the Government in the interpretation of what was said merely reflects the realities of politics under new Labour. We need to be sensitive in this debate to the fact that attitudes towards the military in other countries can be very different from those in the UK. Countries with conscript armies, for example, find things more difficult politically, as do countries with coalition Governments. Although we sometimes have differences of view in the UK, in general there is broad consensus on military matters and foreign policy. We should not take a punitive approach to those countries, saying, “This is what will happen if you don’t contribute more.” We need to draw up a menu of ways in which they can contribute that takes into account the political realities and traditions of their country. Clearly, however, there must be burden sharing in one way or another. The current conditions cannot continue, because they cause much frustration and resentment among some of the most important NATO partners.

I am a great supporter of NATO; it is the one organisation that has truly worked in a multilateral way and I desperately want it to continue to succeed. Dealing with the some of issues that my right hon. Friend and others raised must be of the utmost priority.

Mr. Ellwood: Will my hon. Friend give way?

Dr. Fox: If my hon. Friend will permit me, I want to make some progress.

The Minister talked about January’s surplus and deficit figures for trained strength and manpower requirements. I can help him by giving him some news. He mentioned a 5,000 deficit in January, but I can give him the figures for March, which show that the deficit has increased to 6,240. The Navy is 1,780 below strength, the Army is 2,500 below strength and the RAF is 1,900 below strength, so the position is somewhat worse than he said.

I am giving those figures for a specific reason, however, as I want to hear the Minister’s view about the problems that may affect numbers in the future, especially in relation to South African and foreign and Commonwealth personnel. The right hon. Gentleman will be aware that when the South African President signs a Bill into law, more than 900 service personnel—mostly in the Army, which is already 2,500 under strength—will be unable to serve. They make a huge contribution to our special forces, but the control the South African Government would assert will be incompatible with the soldiers’ oath of allegiance to the Queen. The Government have been investigating the matter for some time. Will they tell us what they intend to do? We cannot simply stand by and watch the strength of the Army drop by another 900.

What impact will the decision about South African personnel have on other Commonwealth personnel? Will a precedent be set? What effect might it have on numbers? That is one of the most important points that the Minister needs to address. Things are happening quickly and they will have a major impact, so we need to know exactly what the Government’s plans are.

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