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Those who criticise the care given to military patients without recognising the excellent treatment that the vast majority of them receive do a huge discredit to the armed forces and NHS medical personnel. They directly affect their morale, and they would do well to think more carefully about the ramifications of their unbalanced reporting and commentary. I wish to emphasise that
point because it is serious: such criticism impacts on those who provide outstanding service at a very difficult point of delivery.
I want specifically to address the recent criticism of the treatment that our personnel receive in theatre. It has been said that the standard of care in theatre is worse than it was 40 years ago. That is not true. The standard of todays medical support is vastly higher than what was provided in the Falklands warlet alone in the Vietnam war. It has been alleged that wounded British troops are being evacuated from the battlefield more slowly than 40 years ago; that is a false allegation. It is not a fair comparison. No country, including the United States, can match the Vietnam time scales in Afghanistan because the distances are far greater. But it is not a simple question of flight time. We have adapted our procedures in Afghanistan to send advanced medical care to the casualty, rather than wait for the casualty to be brought to the field hospital. In no other conflict, and as far as I am aware in no other Army, is a consultant-led medical team routinely deployed to the casualty scene so that advanced care can be delivered at the casualty site and during evacuation. Combined with huge advances in medical technology and treatment, it means that casualties are now surviving injuries that would certainly have killed them 40 years ago.
Dr. Andrew Murrison (Westbury) (Con): As the Minister knows, I have a particular interest in this issue. What would he say to Lieutenant-Colonel Parkerto whom he may be referringwho has said that treatment in Afghanistan is excessively slow and has catalogued a range of shortcomings, of which he has first-hand and expert experience, in the medical care that he and others are able to provide to our troops there and in Iraq? The Minister talks of his commitment to our troops in action. Clearly, the perception on the front line is very different, and I am surprised by his complacency.
Mr. Ingram: I do not accept the allegation of complacency. That is an outrageous comment. I recognise the role played by the hon. Gentleman in Iraq or AfghanistanI cannot remember where he servedbut I do not accept the charge of complacency. I have set out what we do, which is better than what was done even a few short years ago. The quality and dedication of our medical teams is of the highest standard, and there is no question about that. Criticisms have been made, and they now have to be addressed. If they stack up, we will have to find answers to them. I was out of the country last week in the Falklands, but I know that my hon. Friend the Under-Secretary, who has direct responsibility in that area, was on the case immediately. He may wish to comment further when he winds up.
We are not complacent and we have no intention of allowing degradation in the medical services. If anything, we have recovered what we inherited to make it even better. No one is really critical of the quality of care. Bad examples may arise, but overall the quality of care in theatre and on return home is of a very high standard. Can it be improved? Yes, it can, and we will not stint in our efforts to do that.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab):
Selly Oak hospital trust and the medical defence unit are in my constituency. I welcome my right hon.
Friends firm words about the disservice done to NHS and military staff by comments made by journalists and politicians. They should be very careful, because from what I have seen the service is responsive to any criticisms. Those people should pay more tribute to the input that the NHS has had to the medical services of the MOD, which should not be forgotten.
Mr. Ingram: My hon. Friend makes a strong point. On my recent visit to Selly Oak, I was struck by the quality of the NHS staff, all of them dedicated to dealing with trauma cases that they would rather not see, and all the associated issues. We are trying to deliver the best, both in theatre and at home.
Dr. Julian Lewis: Will the Minister give way?
Mr. Ingram: No, I wish to make some progress on the medical theme.
The MODs defence medical rehabilitation centre at Headley Court is the premier facility for the rehabilitation of injured service personnel. There is nothing quite like it in the NHS, and both the facilities and the staff who work there are second to none. Personnel with less serious injuries may also be referred to one of the MODs 15 regional rehabilitation units in the UK and Germany, which provide accessible, regionally based assessment and treatment, including physiotherapy and group rehabilitation facilities.
Over the years there has been a growing awareness of the need to care for military patients mental health as well as their physical health. We put a high priority on increasing awareness, providing effective diagnosis and ensuring professional treatment of psychological illnesses. Our mental health services provide community-based health care. There are now 15 military departments of community mental health across the UK, plus satellite centres overseas to provide out-patient care. We have made significant progress in that area and I know that my hon. Friend the Under-Secretary, who has responsibility, is constantly reviewing and updating our delivery of mental health care to serving personnel and veterans.
Another important area is the care and attention paid to the families of our serving personnel. Our service personnel on operations need to be reassured that the needs of their families are being met. I have already mentioned the improvements to service families accommodation and I want to give a few more examples. We have invested £250 million in education for service children, both at home and in service schools overseas. We have partnered the Department for Education and Skills to make sure that children moving between schools get the best possible deal. We are changing the structure of the services so that moving house becomes less frequent, and we are changing Government policy so that schools are legally required not to disadvantage children from military families who are in transition from one school to another. Last month I announced a new service life insurance scheme which offers guaranteed life insurance to our personnel and their families. We remain committed to reviewing our support for service families so they get the best possible assistance.
I understand that during business questions there was a question raised about the MODs refusal to purchase more helicopters. It may be worth commenting on that. It is another charge that is without foundation
when examined in detail. It reminds me that the Daily Mail used to be called the Forgers Gazette, because it used to make up stories and let the perception take the place of reality. The story was that the MOD shunned a chance to hire more helicopters. The Minister of State with responsibility for defence procurement, my noble Friend Lord Drayson, wrote to the newspaperthe letter has not yet been published, and it remains to be seen whether it will be. The letter states:
On the basis of military advice we rejected the option to lease helicopters as these would be much less useful than new platforms, not just for current operations but also for the long-term.
I repeat, that decision was taken on military advice. The Minister of State also says that
we are spending £230M making 14 extra Merlin and Chinook helicopters available to our forces.
So we are purchasing better equipment than that which was offered for lease.
The article also made two false claims about helicopter availability. It said that Apache helicopters were unable to fly on 31 May because they had used up their flying hours, but that was not the case. They were engaged in operations at that time. Nor was a garrison unable to be supplied with mortar rounds by helicopter. The garrison was resupplied by helicopter following the engagement. I make those points because I wish that Opposition Members would question the veracity of what is said in the newspapers.
Mr. Ingram: No, I will not give way. I have been very generous in giving way, and I just ask hon. Members to question the veracity of stories before they run with them. A simple query to the MOD would help.
Support to our people extends to those families who have to live through the tragedy of a loved one being killed on operations. They deserve and receive our deepest sympathies. Sadly an unacceptable backlog of inquests has built up. We have tackled that with the Ministry of Justice, as announced in the statement to the House yesterday by the Minister of State, Ministry of Justice, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman). In addition I have written to the Scottish Executive, in the form of Kenny MacAskill, the Justice Minister, suggesting an early meeting to discuss the scope for holding fatal accident inquiries in Scotland where appropriate. At present, the law in Scotland prohibits the holding of such inquiries if the death occurred outside Scotland. Hopefully, the Scottish Executive will agree to a change in the law.
I am conscious that no member of the Scottish National party is in his place. I received howls of outrage when I said, when winding up a debate a few weeks ago, that they were interested only in sensationalism, undermining our work and the break-up of Britain. They claimed that they were concerned about our armed forces, but not one of them has bothered to turn up for this debate today.
Wherever we operate, civilian personnel are adding significant value. Civilians contribute to defence in a huge variety of ways and, increasingly, they support
military commanders deployed in operational theatres. They are essential to the smooth, successful running of operations. I take this opportunity to recognise their important contribution and thank them for their often unnoticed service.
Britains defence depends on people more than anything else. We are fortunate to have such committed and professional personnel in our armed forces and civilian staff. This Government will continue to ensure they have the support that they need to do the important and dangerous tasks that we ask of them.
Dr. Liam Fox (Woodspring) (Con): May I begin by adding my condolences and those of my colleagues condolences to the sympathy that the Minister extended to all the families of personnel killed recently in Iraq and Afghanistan? The thoughts and prayers of the whole House are with them in their suffering.
Like the Minister and some other parliamentary colleagues, I spent the past week or so in the Falklands. The visit was a poignant and moving reminder of the courage, resourcefulness and commitment of all our armed forcesand of the members of the Merchant Navy, whose contribution to the conflict is often overlooked. It was a reminder to us all that freedom does not come for free and may require substantial sacrifices.
The men and women who serve in our armed forces are unique. They are expected to be separated from their families for long periods, increasingly on a repeated basis. They are asked to risk life and limb for the security of their country and its people, and they are asked to make literally life-or-death decisions on the spur of the moment. No other group in our society is asked to do all those things and, sadly, that is something that our current society seems to forget all too often.
What do our armed forces expect in return for their sacrifices? They expect to be properly trained and equipped for the tasks that they undertake, and that the Government will not ask them to do more than they are willing to pay for. They expect that their families will be properly looked after, especially in their absence. They expect that the Government will always maximise the chance of success of any mission, and minimise the risk to those on the front line. In addition, they expect that they will be properly treated if they are injured. That is not too much to ask in return for the risks that they take, but all too often their expectations remain unfulfilled.
The backdrop to this debate and to the others that we have had in recent times is that our armed forces are overstretched and undermanned. When the Government came to office, they published the excellent strategic defence review, which still holds good today. From that came the defence planning assumptions, and from that the Treasurys budget for the MOD. Yet the defence planning assumptions have been exceeded for the past five years, so much so that they are largely fantasy now. That is the root of the problem. In April this year, the armed forces were undermanned by 5,850 personnel, according to Government requirementsthe Army by 2,520, the Navy by 1,860, and the RAF by 1,460. The recent National Audit Office report also identified especially alarming manning shortfalls in pinchpoint trades, with
intensive therapy nurses being 70 per cent. undermanned, and accident and emergency nurses 68 per cent. undermanned.
The Armed Forces Pay Review Body stated that there are more than 80 operational pinchpoint trades18 in the Royal Navy, 24 in the Army and 41 in the RAF. The harmony guidelines, which determine the frequency of deployment and separation from families, are broken so regularly as to render them meaningless.
Jim Sheridan (Paisley and Renfrewshire, North) (Lab): I do not wish to be pedantic, but the hon. Gentleman has repeatedly used the term undermanned. He should remember that there are women in our armed services.
Dr. Fox: That remark is so trivial and puerile that it is not worthy of a response.
All the problems that I have set out are made fundamentally worse by a Government who are fighting two major conflicts but refusing to fund them in full. No one could have put the problem more clearly than our outgoing Prime Minister, who said in his HMS Albion speech that defence spending had stayed
constant at roughly...2.5 per cent. of GDP
we add in the extra funding for Iraq and Afghanistan.
In other words, even though we are now fighting two major conflicts in Iraq and Afghanistan, the Government expect to expend the same proportion of our national income on our defence forces as they did in 1997, when we were not involved in those conflicts. The consequence of failing to fund in full the wars in Iraq and Afghanistan is that our armed forces are being systematically salami-sliced. The incoming Prime Minister is the man responsible for the underfunding and he must understand that he cannot increase our armed forces commitments without also increasing the resources to do the job.
How has all that affected our armed forces personnel? I turn first to the question of equipment. The Governments failure to ensure that sufficient equipment was available on time for the war in Iraq is well documented, not least in the tragic case of Sergeant Roberts. I remind the House that the board of inquiry into his death said:
During the summer of 2002, constraints were placed on military activities (including procurement) which might have negatively impacted on negotiations with the United Nations.
In September 2002, the then Secretary of State for Defence was asked to agree 16 urgent operation requirements, but he agreed only to 12. The procurement of enhanced combat body armour was not agreed at that time, owing to political considerationsdespite a clear warning that 2nd Royal Tank Regiment was 40 per cent. short of enhanced combat body armour for 1,015 troops. In other words, to avoid accusations that they had already agreed to go to war with Iraq, the Secretary of State for Defence delayed the order of vital body armour, with the direct result that Sergeant Roberts was killed unnecessarily. That remains one of the darkest stains on the record of the current Governmentand of course no Minister paid the price for that scandal.
However, that was not the only way in which our forces were being disadvantaged. When the individual
helicopter programmes were amalgamated in the overarching future rotor capability process, the overall budgets were reduced by £1.4 billion. In other words, when the Government introduced a single helicopter programme they used smoke and mirrors to reduce the budget, at a time when we were involved in two major conflicts. Spending on helicopter equipment has fallen from £662 million in 2001-02 to just £183 million in 2005-06, yet all hon. Members who have been to Iraq or Afghanistan will have heard complaints about the shortage of helicopters and the lack of lift capacity. The only people who appear not to hear that message when they visit are Ministers.
What of the Royal Navy? At a time of difficulty with recruitment and retention, what messages are we sending out? Since 1997, our frigate and destroyer fleet has been cut from 35 to 25, and our submarine attack fleet from 12 to eight. In addition, it is widely rumoured that an additional six ships will be mothballed, which would mean that almost half the fleet of 44 warships was mothballed. The six ships in question are four type 22 frigatesthe Cumberland, Chatham, Cornwall and Cambletonand two type 42 destroyers, the Exeter and the Southampton. The latter is due to relieve HMS Edinburgh in the Falklands in the coming days. All those reductions are based on the strategic falsehood that, because ships are now more technologically capable, numbers no longer matter. It ignores the basic truth that, however sophisticated a ship, it can be in only one place at a time.
The welfare of service families is of crucial importance. The surest route to a retention crisis is to create unhappy servicemen and women, and the easiest way to do that is to create unhappy service families. The quality of service housing has been shown to be deeply inadequate and the Minister of State admitted as much, although he said that changes were under way. The quality of service childrens education has been a key concern, with improvements delayed by administrative problems. That is simply not good enough.
The interaction between the armed forces and the NHS remains disgracefully inadequate. When they move to different parts of the country, service families on NHS waiting lists must rejoin the new waiting list at the bottom and start all over again. That happens time and time again, and it is scandalous. After 10 years and huge increases in public expenditure the Government have yet to deal satisfactorily with that basic problem, and the House demands that something be done now.
Andrew Miller: I acknowledge the problems about the quality of accommodation for service personnel, although I seem to recall that it was the hon. Gentlemans Government who flogged off half the defence estate. My question is a practical one. Has he seen some of the new developments, for example at Culdrose in the south and Faslane in the north, where modern single living accommodation is available, and does he agree that it matches the standards appropriate for our personnel?
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