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Dr. Fox:
I have indeed visited some of the newest accommodation, which is of exceptionally good standard, but the hon. Gentleman pointedly referred to single accommodation, which indicates that too much accommodation still remains substandard. There is no
point in a Government who have been in office for more than a decade saying that it was the preceding Government who caused the problems; this Government have had plenty of time, taxation and public money to put the problem right faster than they have done.
Andrew Miller: Does not the hon. Gentleman recognise that the estates built in the 1960s and 1970s need continuous maintenance, as my right hon. Friend the Minister said? Under the project developed by the Conservative Administration, that maintenance did not happen, so we inherited an enormous backlog. The task is huge and, like the railway problem, it cannot be tackled overnight.
Dr. Fox: It is an interesting definition of overnight that after more than 10 years the Government are still unable to get to grips with the problem properly. I am the first to admit that improvements are being made—we have all seen them—but the fact remains that the problem is still far too great and the quality of accommodation far too low in far too many parts of the country. To say that the Government have not had time to deal with it is one of the lamest excuses I have heard.
Mr. Ingram: In my opening comments I indicated a substantial increase for accommodation in our budget. How much more would the hon. Gentleman provide?
Dr. Fox: The Minister knows his parliamentary technique, but he well knows that as the Opposition have no idea when the election will be called and what the state of public finances and our commitments will be then, we will never get involved in those budgetary debates. We look to the Government currently in charge, who are raising taxes from the current UK working population and have responsibility for the armed forces, to discharge their duty properly while they are in office. When we come into office, which will not be a day too soon, we shall make sure that we deal with the issues at far greater speed than the Government have, in their “overnight” 10 years.
The medical issue of greatest concern for military personnel and their families is the quality of care they receive if they are injured on operations. As I have a medical background, when I visited the Shaibah logistics base I looked intensively at the quality of care being provided. I concur with the Minister: the quality of care would not have been out of place in most district general hospitals in the UK. I spoke to an NHS surgeon who had been seconded to Shaibah and had decided to join the Army as a consequence of being able to treat his patients when he wanted without interference from managers and with no Government-applied targets. He said into the bargain that in the three years they had been operating in Shaibah there had not been a single case of MRSA. Perhaps the NHS might want to learn from the excellent record of those working in our forward bases.
I note that the Select Committee on Defence is visiting Selly Oak hospital today to examine the provision of care. During my visit to the hospital I was highly impressed by the quality of medical care, although the House is obviously well aware from cases highlighted in
the media that other elements of the care were criticised by families. I fully accept that injured personnel must be treated where there is access to a wide range of specialist services—orthopaedic, burns, plastic, reconstruction and so on.
The reduced size of our armed forces makes separate military hospitals utterly unviable, but there is absolutely no reason why we cannot have exclusively military units at Selly Oak. A military-managed unit is not enough. We want service personnel to be able to recover from their injuries securely, in the knowledge that those around them understand what they have been through, which cannot happen when there is a mixture of military and civilian patients. It is not good enough. Such conditions are particularly important for those who have suffered mental as well as physical trauma.
The Parliamentary Under-Secretary of State for Defence (Derek Twigg): As the hon. Gentleman knows, I have previously said in the House that we and the chiefs of staff are considering the development of a military ward as part of the new building at Selly Oak in Birmingham, but can we be clear about the Conservative view? Is the hon. Gentleman saying that if there were empty beds on such a ward and there was an emergency or an urgent need for beds, civilians would never be allowed to occupy them?
Dr. Fox: In a real emergency, it would obviously be up to the managers of the hospital to consider the situation in terms of the overall well-being of patients. We are saying that there is a difference between what the Government are suggesting—a military-managed unit—and what we want, which is that normally such a unit would be exclusively for military personnel. It is difficult for us to predict what might happen in exceptional circumstances, but it is clear that the Government are proposing a unit that has a mix of patients and is managed by the military. The Opposition want a unit that is exclusively for military patients. That distinction is important because there has been confusion between what the chiefs of staff have said and what the Prime Minister said in the House.
Dr. Fox: If the Minister wants to tell me that the Government’s intention is that when the new unit is established at Selly Oak it will be exclusively for military patients, except in exceptional circumstances, that will be a welcome advance in the Government’s position.
Derek Twigg: Let us be clear. The chiefs of staff have not yet made a decision about the military ward; it is something that Ministers are happy to consider, but we are waiting for their decision. Is the hon. Gentleman saying that in no circumstances whatever will civilians be allowed into such a ward? Can he be clear about that?
Dr. Fox:
The Minister is introducing a red herring. I have already said that it is impossible to say what would happen in a medical emergency. However, what the
country wants is clear: treatment for our service personnel in appropriate circumstances. In my view, those appropriate circumstances are exclusively military units in NHS facilities. That is a perfectly reasonable thing to want. Ministers might now and again like to take decisions and govern rather than waiting for the chiefs of staff. Why cannot Ministers take the decision to do what large parts of the House and the country want?
Derek Conway: My hon. Friend brings his professional expertise to bear in a powerful criticism of the Government. Some of the interventions he has taken show just how rattled they are. The Minister may laugh—
Derek Twigg indicated dissent.
Derek Conway: Those who serve in the armed forces may not find it quite so funny.
Is my hon. Friend aware of the pressures on injured Territorial Army personnel from delays in medical treatment? What does he think about mental health provision generally, and in particular for TA personnel, who do not return to garrison towns but to their individual communities, where they feel far more exposed? Sadly, as far as the Government are concerned, this all appears to be just a matter to giggle about.
Dr. Fox: I am delighted that my hon. Friend raised that important point. Mental health facilities for the armed forces are key. As a country we do not deal with mental health problems as well as we should; in many cases the treatment we offer is disgracefully inadequate in the world’s fifth richest country. Armed forces mental health staff are even more under strength than their civilian counterparts. According to the Government’s figures, the Army requires 15 psychiatrists but has only six, and requires 53 mental health nurses but has only 43—yet service personnel are returning from the conflicts raging in Iraq and Afghanistan with mental health traumas ranging from depression and anxiety to post-traumatic stress disorder. At the start of this year, nearly 2,000 personnel returning from Iraq and Afghanistan had been diagnosed with mental health conditions. Let us remember that conditions such as post-traumatic stress disorder can take many years to manifest themselves.
Over the past four years, the Ministry of Defence has spent more than £10 million employing the Priory Group to treat service personnel, but even if there is success in the acute phases, the real problem lies in chronic illness, which my hon. Friend alluded to in his question. That is where charities such as Combat Stress come into the equation. Combat Stress is an ex-services mental welfare society that specialises in the treatment of mentally ill veterans. It keeps its administrative and fundraising expenses to a minimum and in my view is one of the most deserving charities in the country. Many people will be listening to the debate, but I am sure that if the audience numbers are not as high as we would like, our friends in the media will communicate the necessary information to the public. The website for Combat Stress is www.combatstress.org.uk and donations can be made online. A donation of £20 buys an hour of nursing care and £150 pays for an hour of psychiatric counselling. My plea to the public is to be generous.
Tragically, the suicide rate among Falklands veterans is utterly unacceptable. We must do anything that we can—through a combination of the public and the voluntary sectors—to reduce that in the future. As my hon. Friend says, there are particular problems with the way in which we treat reservists. On return from deployment, they do not have the comfort of being with their comrades for a defined period of time in the way that the regulars do. They need to be especially closely monitored and we are currently failing to do that. The negative signal that the Minister of State admitted is being sent out by the cut in the Territorial Army budget will do nothing to give the impression that those reservists are fully valued for the service that they give our country.
Mr. Ellwood: My hon. Friend began his remarks by talking about the events that took place 25 years ago in the Falklands, and he has just mentioned the number of suicides among people who served in that conflict. Is it not a worrying statistic that more than 300 of those service personnel have committed suicide, which is more than the number of people who were killed in the initial conflict? That shows that this country—this Government—must do far more to look after our service personnel, who do so much in very extreme circumstances.
Dr. Fox: My hon. Friend is absolutely right in his specific point, but there is also a generic point that applies to our society as a whole. Our society, in common with a number of Anglo-Saxon societies, does not deal with mental health issues appropriately. There is too much stigma attached to mental health issues—something that does not apply to any other illness of any other type. That encourages late presentation of illness and, consequently, our outcomes are poorer. There is a particular problem in the case of those who have served in the armed forces, who are often reluctant to seek psychiatric help from a general practitioner or a civilian psychiatrist because they believe that those people will not understand the originating trauma that they have been through.
We need to look at a co-ordinated way of improving all our mental health services. That is the last great public service reform that needs to be carried out in this country. We need to look at how we treat our armed forces in developing further the psychiatric services in the military. There will always be a culture gap; those who have been in the armed forces will always be suspicious of how well those in civilian services understand their problems. Perhaps the only way to deal with that is to recognise that we must have yet another expansion of military psychiatric services, as well as of civilian ones. We need to deal with that as a country. I honestly do not believe that this is a party political issue. It is a cultural, deeply ingrained issue which we need to deal with in a much more open and sympathetic way.
Mr. Don Touhig (Islwyn) (Lab/Co-op): Does the hon. Gentleman agree that those who have trained to become general practitioners are taught about mental illnesses for only a limited amount of time? Does he agree that if somebody went to their GP with a mental problem, it would be a good idea if the GP were to ask, “Were you ever in the services?” and act as a signpost to point that person not only to a proper consultant, but to organisations such as Combat Stress and the Veterans Agency, which can give the kind of embracing support that the military can provide?
Dr. Fox: The right hon. Gentleman makes an excellent point. It is important in two ways. First, a relatively small proportion of GPs have any training in psychiatry and, secondly, an even smaller number will have any background in the armed forces. It therefore seems perfectly sensible for the Ministry of Defence to liaise with the national health service and ensure that doctors are reminded that there are other services available for veterans who suffer from mental health problems. Far better co-ordination between the two would be a positive development following today’s debate. The point is well made.
Andrew Miller: While the hon. Gentleman is in a bipartisan mood—and following the intervention from the hon. Member for Bournemouth, East (Mr. Ellwood) about the Falklands—will he acknowledge that this is not a new problem? Historically, there has been a shortage. Based on his comments about the way in which mental health has been stigmatised in society, he will know that there has been a problem historically in relation to the military. Work is currently going on. The response that he gave to my right hon. Friend the Member for Islwyn (Mr. Touhig) reflects a joining together of ideas based on an acceptance that mental health should not be stigmatised as it has been in the past.
Dr. Fox: The way in which mental health issues are dealt with in our country has been one of my political interests for some time, but we need more than a bipartisan approach in the House of Commons. The situation requires far-reaching changes in our attitudes to mental health on the outside. All politicians in all parties would do well to dedicate themselves to that.
The hon. Gentleman also alluded to another issue: it can take some time for things to appear. The PTSD problem was denied during the Vietnam war. Only some time later did it come to be accepted that it was a genuine medical entity that needed to be dealt with. I appeal to Ministers to look at what is happening in the United States in respect of traumatic brain injury. The Minister of State quite rightly pointed out that the quality of the body armour that we have today means that servicemen and women may survive injuries that would previously have been fatal. Our society will have to adjust to the consequence that there will be many more long-term disabled people following current conflicts. Another pertinent issue is the increased risk of concussion faced by those who survive blasts that might previously have been fatal. The United States is introducing protocols for its armed forces, which involve assessing the results of blast injury in theatre and again on coming out of theatre.
During Question Time, or in a previous debate—I apologise for not remembering which—the Minister gave an assurance that the Government would look into that matter. Perhaps we can be given more details today about what exactly is happening. A lot of service personnel were needlessly lost because of the length of time it took in the Vietnam conflict to recognise that PTSD was a real entity. How tragic it would be if we lost other service personnel because we did not understand how much of a problem traumatic brain injury is. It would be doubly unacceptable if the United States put in place protective measures to identify those problems in the
case of their service personnel, but we did not do so in the United Kingdom. In future, we would find that to have been a bad decision which was unacceptable from the point of view of the duty of care.
Those with a mental illness are among the most vulnerable in our society, and how civilised a society we are can be judged by how we treat the most vulnerable. When mental illness results from military action designed to enhance the security of us all and we fail to deal with it, as we often do, it is a national scandal. We should all be ashamed that those who put their lives on the line for our safety are failed by our public services in that regard. A land fit for heroes it certainly is not, in that respect.
As I said, the demands placed on our armed forces are unique. Despite the many problems that they face, they remain the best in the world. It is the absolute duty of any Government to put national security at the top of the political agenda and to ensure that our armed forces are funded, equipped and cared for in a way that reflects their unique contribution to our national life. They deserve better than they are currently getting.
1.40 pm
Mr. Don Touhig (Islwyn) (Lab/Co-op): This debate on armed forces personnel comes just after we have marked the 25th anniversary of the end of the Falklands war. I join colleagues in all parts of the House in paying tribute to the courage of our forces who liberated the Falklands and those who continue to serve our country in Iraq and Afghanistan.
The commemoration of the Falklands conflict puts into focus the way in which we in Britain look at former service personnel—our veterans. Like many others, I was disturbed to read press reports that more veterans of the Falklands war have taken their own lives since 1982 than were killed in the conflict. The South Atlantic Medal Association says that it is almost certain that the suicide toll is greater than the 255 men who were killed in the Falklands. If the figures are correct, it is an indictment of all of us, and it is a wake-up call that we must do more.
There are many and various misconceptions about veterans and the problems that they face. It is important to emphasise that the overwhelming majority of men and women who leave the armed forces settle successfully into civilian life. But not all of them adjust to life outside the service, and in extreme cases that can lead to self-harm and to suicide. Recent statistics show that in a 23-year period—1984 to 2006—there have been 687 suicides among serving men and women in our armed forces: 672 men and 15 women. There appear to be no figures for veterans as a whole, but just one case is one case too many. We should be totally committed to reducing the incidence of suicide and self-harm in the armed forces and among our veterans.
I do not think that I am alone in being dismayed that significant numbers of those who are sleeping rough on the streets of our country are ex-services. Many of them suffer long-term combat-related psychological problems. I welcome the announcement by my hon. Friend the Minister for Veterans at St. Thomas’ hospital in London that the programme of medical assessments set up for Gulf war veterans will be expanded to allow larger numbers of veterans to receive the service.
The medical assessment programme will now offer a mental health consultancy for all veterans who have seen military service since 1982, which includes those who fought in the Falklands campaign 25 years ago. The assessment will cover veterans who are worried that they may have a service-related mental health problem that is not fully understood within the national health service. My hon. Friend’s decision is an excellent one and I sincerely hope it will be extended to all veterans, no matter when they served.
When I was a Defence Minister, I was invited to speak at the British Medical Association conference, but I received a phone call from the Prime Minister giving me the DCM, so I never got to the conference. In any event, in the conference preparations, I suggested that GPs should as a matter of course, whenever someone comes to see them with a psychological problem, ask whether they are ex-services and point them in the direction of organisations such as Combat Stress.
I pay tribute to the hard work that Combat Stress does. I share the view of the hon. Member for Woodspring (Dr. Fox). It is a specialist provider of clinical care and welfare support. It is an excellent organisation that should be supported. I spent a day as a fly on the wall, so to speak, with a Combat Stress caseworker, and I know that the support given is highly regarded by mental health professionals and is critical to improving the lives of ex-servicemen and women. That experience confirmed my view that we have to do more.
There is a view in the Ministry of Defence that veterans who have health problems following their discharge from the services get priority treatment in the national health service. I do not believe that that is the case. The NHS is a wonderful organisation that delivers world-class health care every hour of every day, but I have not seen evidence that ex-servicemen and women take priority.
If we are to recruit and retain the very best men and women to our armed forces, we must provide those exceptional people with exceptional support, which means looking after our people throughout life. As I have said before, the treatment of veterans has a real and direct bearing on our ability to recruit, train and retain the people we need to sustain our current and future operational capabilities.
The National Audit Office published a report in November 2006 entitled “Ministry of Defence—Recruitment and Retention in the Armed Forces”. It stated:
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