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22 May 2008 : Column 5P


Thursday 22 May 2008



Support for Armed Services

The Petition of the Canvey Island Royal British Legion and Castle Point and others,

Declares that our Service men and women, past and present, are the bravest and best in the world and they deserve a better deal from the Government.

The Petitioners therefore request that the House of Commons implores the Government for the introduction of a decent Armed Services compensation scheme, decent health, welfare and support for ex service men and women and a scheme to give greater support to the bereaved families of those service men and women who do not return.

And the Petitioners remain, etc. —[Presented by Bob Spink , Official Report, 3 March 2008; Vol. 472, c. 1562 .] [P000136]

Observations from the Secretary of State for the Ministry of Defence:

The Government is fully committed to meeting its duty of care to members of the Armed Forces and veterans who serve the country with such commitment and distinction, as well as to their families. Much has been achieved already but the Government recognises that more can and should be done. Current Service Chiefs, who are in the best position to judge, have made clear that the Military Covenant is not broken.

As recognised by the Royal British Legion, the Government has overseen a far-reaching programme of improvements including to Service pay, accommodation, health and welfare provisions, force protection, personal equipment arid to arrangements to support inquests, including a number of significant developments over the last 6 months.

The Government fully recognises the importance of providing adequate compensation for those injured in operations or training. It has in place a comprehensive system of compensation for Service personnel disabled, or those widowed, as a consequence of service. Only two and a half years ago, it introduced new pension and compensation schemes that greatly improved death-in-service benefits and widows' pensions, as well as providing lump sums for injury, which can, for the first time, be claimed while in service.

The new Armed Forces Compensation Scheme (AFCS) makes payments according to a comprehensive graduated tariff, in line with other established models such as the Criminal Injuries Compensation Scheme. The use of a tariff-based system delivers consistent, equitable lump sum awards for similar injuries. This is in addition to the monthly tax-free, index-linked Guaranteed Income Payment (GIF) which is paid for life upon discharge to those more seriously injured. The GIF is not capped and it can amount to many hundreds of thousands of pounds over a lifetime.

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We recognise that there have been concerns about the use of balance of probabilities as the standard of proof for the AFCS. This is the accepted approach in other Schemes and in the civil courts and in no way removes the onus on the Department to release any records that it holds relevant to the circumstances of an injury. We have seen no evidence to indicate that the current burden and standard of proof are preventing individuals whose injury is due to Service from receiving compensation. The position is similar with regard to time limits where, contrary to some media reporting, claimants have 5 years to submit claims as compared to 3 years in civil litigation cases. There is also provision to extend the time limits for claiming for certain late onset illnesses.

The AFCS is a modern scheme based on best practice, but when it was being developed, it was not envisaged that we would be seeing severe multiple injury cases of the type that are now unfortunately occurring. We have reviewed the rules that apply in cases where an individual suffers more than one injury in a single incident and have increased the lump sum benefits for those with the most serious multiple injuries (tariffs 1-4). This means that those who qualify for 100 per cent. of the GIF (the seriously injured) now receive 100 per cent. of the tariff value for all injuries sustained in a single incident, up to the maximum lump sum award of £285,000. This change to the Scheme's multiple injuries rules is specifically designed to reinforce the focus of resources on the most seriously injured, and has the full support of the Service Chiefs of Staff.

The Government is clear that medical support to Service personnel on operations is vital; there is no question of UK forces deploying without appropriate support. Before the mid-1990s, our dedicated military hospitals provided the core for training our medical services. But it had become clear by that date that, with the reductions in the size of our Armed Forces, the through-put of military patients provided neither the volume nor the range of cases essential to train our medical personnel for essential operational roles. Our medical personnel need the level of exposure that can only be provided in a large NHS hospital where military through-put is supplemented by civilian cases.

The Royal Centre for Defence Medicine at Selly Oak Hospital in Birmingham represents the very best of the NHS. Its clinical excellence is widely recognised and its military-managed ward is now operational, which helps Service patients feel part of the military family whilst in hospital. Selly Oak has been widely praised, with the head of the Army, Chief of General Staff, General Sir Richard Dannatt, saying that “there is nowhere better”. It will be replaced in 2010 by a new-build hospital which will treat Service personnel in wards that take further forward our military-managed concept.

The Government fully recognises that it also has the responsibility for meeting the needs of veterans injured as a result of their service, or their widows in the case of death. It does so through top class resettlement, seamless medical transition to the NHS, generous pensions and compensation as well as free welfare support and advice. The Government will continue to honour this commitment but ex-Service organisations have long been regarded as an important additional source of welfare and the Government welcomes the work that is done together in partnership - each offering what it is best able to provide.

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It is our policy that mental health issues should be properly recognised and appropriately handled and that every effort should be made to reduce the stigma associated with them. We have measures in place to increase awareness at all levels and to mitigate the development of PTSD and other stress-related disorders among Service personnel: these include pre-and post-deployment briefing and the availability of support, assessment and (if required) treatment, both during and after deployments. For cases where these preventive measures do not succeed, expert treatment is provided, in line with recognised best practice; this is focused on recovery and rehabilitation. The families of returning personnel are also offered advice to alert them to the possible after-effects of an operational deployment.

Veterans receive good treatment from their GPs but we recognise that many health professionals have limited experience of dealing with ex-Service personnel who have mental health symptoms arising from their Service experience.

Officials from the MOD and the UK Health Departments have therefore been working together to develop a new community-based mental health service. The first of six regional pilots was launched last November and the other pilots at sites across the UK will follow over the next few months. It is intended that the mental health pilots will run for 2 years ahead of evaluation and nationwide roll out. The service is designed to provide regional networks of culturally sensitive expertise in military mental health to support NHS health professionals.

To cover the interim period in other areas, we announced in the summer the expansion of our Medical Assessment Programme (MAP) based at St Thomas' Hospital, London, to include assessment of veterans with mental health symptoms with operational service since 1982. The clinician in charge of MAP, Dr Ian Palmer served as a military medical officer and is a consultant psychiatrist; he is therefore well qualified to provide this service.

Finally, under the War Pensions Scheme, the Department funds War Pensioners undergoing “remedial treatment” at Ex-Services Mental Welfare Society (“Combat Stress”) homes. Founded in 1919, the Society is a respected charity which specialises in helping ex-Service personnel suffering from mental disabilities. MOD gave Combat Stress £2.5 million in fees in 2006-07 and last year agreed to a phased increase in the fees, which rose to 45 per cent. from I January 2008, to enable them to enhance their capability to treat veterans.

The Government announced in November 2007 that the provision of priority medical examination and treatment, subject to clinical need, would be extended to all veterans whose conditions are assessed by their GPs as being due to service. This provision has also been adopted in Scotland and Wales. We are working with UK Health Departments and veterans’ organisations to review existing communication arrangements and reinforce existing advice to ensure that priority medical treatment is properly understood by NHS health professionals and veterans nationwide.

With respect to Service fatalities, we provide comprehensive welfare and pension arrangements; but we recognise the understandable wish of families to
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know what happened to their loved ones and the key part that inquests have to play here. We recognise that there are concerns both about the support given to families with respect to inquests and about the long timescale for some of them.

Inquests are designed to be non-adversarial and as such, legal representation is not usually necessary. If families wish to appoint a solicitor to represent them, they can do so; however, Legal Aid is not normally available for representation at an Inquest, other than in exceptional circumstances, assessed by the Legal Services Commission. While in a small number of cases the MOD will have legal representation, this is normally when potentially complex issues could arise and MOD Counsel can assist the court to elicit as clear and full an understanding as possible of what took place.

The timing of inquests is a matter for the individual coroner. The Ministry of Justice has policy responsibility for the coroners who are appointed and paid for by local authorities. However, we recognise that the MOD has a role, for example with respect to the provision of evidence. To ensure that there are no unnecessary delays in responding to the coroner's requests which would delay the start of the inquest, we have therefore established a dedicated team in MOD to improve our liaison with local coroners. We also now provide travel, accommodation and subsistence payments for two members of the family to attend pre-inquest hearings as well as for the inquest itself.

To avoid backlogs of inquests, extra resources have been made available to both the Oxfordshire and Wiltshire coroners. Those extra resources, and recent policy changes, have made significant improvements. Some 75 inquests were completed in 2007, which is more than were completed in the previous five years together. However, the need to investigate thoroughly the circumstances of the deaths will inevitably mean that inquests continue to take time.

More generally, we welcome the debate about the obligations owed by the Nation to its Armed Forces that the Royal British Legion campaign has encouraged. For our part, we have announced a cross-Government Personnel Command Paper for which we are consulting widely internally and externally, including with Service and ex-Service organisations such as the Royal British Legion. Due to be published later this year, it will outline the steps taken so far and future initiatives to ensure proper support to Service personnel their families and veterans from across Government,.

In parallel, we commissioned a study into how the nation can better recognise its Armed Forces. The study, led by Quentin Davies MP and published on 19th May, considered ways in which we might improve the nation's understanding and appreciation of the Armed Forces; we are studying the report's findings.

Although the Government has a particular responsibility for ensuring that the Military Covenant is honoured, it is also a matter for the Nation as a whole. In particular, there is a wider issue about what more individuals and local communities should be doing to demonstrate their support for the Armed Forces and their appreciation of what they are achieving in very difficult circumstances in Iraq, Afghanistan and elsewhere.

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