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11 Jun 2008 : Column 85WH—continued
South Central SHA informs me that it is working with the South Central ambulance service to improve the current arrangements for pre-hospital medical teams, by implementing processes to activate mobile emergency response incident teams. That will improve the performance of the trauma system, based on previous major incidents in its region and nationally. It has made it clear in its next-stage review vision document that it wants to improve care for trauma patients. The document states:
“Emergency and urgent care will be provided through a network of A&E departments”
“specialist emergency centres for stroke, heart attacks and trauma.”
On major trauma specifically, its acute care clinical pathway group report recommends that major trauma networks be established, with dedicated major trauma centres and bypass protocols for ambulance services.
That brings me to the issue of the hon. Gentleman’s helipad—well, not his helipad but the one in Southampton. Forgive me, but I am not completely au fait with the likely configuration of any major trauma centre in his region. I suspect that one or two hospitals—or maybe more—are competing for that status. Clearly, his point about access to air ambulances is important, even if it is not necessarily a showstopper. I shall say a little more about air ambulances in a moment.
The hon. Gentleman has said that the chief executive of his local hospital has stated that there is a funding problem. However, I have been informed that Southampton University Hospitals NHS Trust is looking at a £17 million- plus surplus this year. The hon. Member for Hemel Hempstead has questioned the projected costs described by the hon. Member for Winchester, which may be worth consideration. If the hon. Member for Winchester is suggesting that the hospital does not have any money, that is just not the case.
Sandra Gidley: We must be careful in talking about a £17 million surplus, because Southampton hospital is also paying off rather a large loan. One should not be mentioned without the context of the other, and that amount of spare money is not floating around the system in Southampton.
Mr. Bradshaw: All that I wanted to do was put on record the fact that Southampton hospital is not in deficit. In fact, it is looking forward to what sounds to me like a healthy surplus this year, and how it decides to spend its surplus is entirely its decision.
I wish to say a little about the funding of air ambulances. We had a lengthy debate on the matter in this Chamber back in February, I think, and I do not intend to cover the same ground in great detail—hon. Members who were not present may like to study the Hansard of the debate. In the past, we have undertaken independent research on the cost-benefit of giving more state funding to air ambulances. Before 2002, there was no statutory requirement on, or guidance about, state funding for air ambulances, all of which were wholly funded by voluntary contributions. That has changed, and since 2002 we have issued guidance that the medical staff provided on air ambulances should generally be funded from public money, and that they need to work closely with their local ambulance trusts. My latest information is that that happens in almost all parts of the country, if not all.
There is another point that we might want to discuss outside the debate or in correspondence. I notice from the correspondence that I have received, from parliamentary questions tabled by the hon. Members for Winchester and for Romsey (Sandra Gidley) and from an early day motion tabled by the hon. Member for Winchester, that there is some confusion about a difference between London and the rest of the country, and I shall try to get more details about exactly what that difference might be. The hon. Gentleman has suggested that there is statutory funding in London for the air ambulance, in the way that I have just described, but that is so in most other parts of the country as well, thanks to the change in the policy that we introduced in 2002.
In February’s debate, I made the point that we constantly review the policy. I mentioned that one of the problems in justifying full public funding for air ambulances is that they do not all have a good record at targeting the right sort of cases. I also said that moving to greater regionalisation of trauma care, with fewer major trauma centres, might tip the balance of cost-benefit in favour of more statutory funding for air ambulances. In that debate, I promised to keep this matter under review. I repeat that undertaking today.
I have forgotten for the moment the other issue that I wanted to mention, so I invite hon. Members to intervene.
Sir George Young: Just to clarify the Government’s position, is the Minister saying that it is not acceptable that critical pre-hospital care should be dependent on volunteers?
Mr. Bradshaw: Critical pre-hospital care is not dependent on volunteers, because any ambulance service or acute service will have a range of reactions to a major incident in its area. I have already described the response provided by the ambulance service, which involves having ever-greater skills on board to provide some of the care. Where necessary, teams of doctors will and should be called out to attend an incident to provide such care.
I have also acknowledged that we still have some way to go in providing optimal care, that, generally, the treatment of major trauma has not advanced as quickly as advances in many other forms of care and that we have not performed as well as some other countries. This is partly to do with the different systems in other countries. The hon. Member for Winchester has made comparisons with Germany and the United States, which have different health structures, more specialist centres, different systems and approaches and far higher funding per head of population on health care than in this country.
Mike Penning: The Minister is being generous in giving way. Can I clarify what he said a few moments ago? Should medical staff on an air ambulance be funded by the PCT or the trust under the NHS? Are the pilot and navigator, or whatever, the charity’s responsibility, and should the personnel dealing with the medical skills side be funded by the NHS?
Mr. Bradshaw: I cannot remember whether the hon. Member for Hemel Hempstead attended the February debate—perhaps one of his colleagues was here. This is not a requirement, and we published guidance on the point in 2002. Our information is that in the majority of cases those medical costs are met from statutory funding, which was previously not the case.
I should like to add one more thing about the role of ambulance trusts and their relationship with BASICS. We looked at that matter in a little bit of detail once we knew that this debate had been scheduled. We understand, having spoken to ambulance trusts, that they have clear systems that allow them and their control staff to call on the expertise of BASICS doctors when an incident demands it. As I have said, I hope that the work that is emerging from all the strategic health authorities in the context of Ara Darzi’s visions will help us to improve the way in which we deal with trauma and all the health care pathways that hon. Members care about.
Mr. Oaten: I am grateful to the Minister for giving way. I hear what he has said on the evidence in respect of how things are working. However, what about this statistic? There were 1,200 requests for individuals to come out, but not all those requests were meet. The evidence shows that individuals were not able to go out on 450 occasions last year. Surely, the Minister acknowledges that there is a gap and that something is wrong.
Mr. Bradshaw: I will study those figures, which I have not seen and do not recognise. I have already acknowledged that we can do more to improve the service provided to people who are involved in trauma before they are admitted to hospital. I promise to write to the hon. Gentleman in response to the particular figures that he has mentioned, but I hope that he acknowledges that, given what I have said, the Government are determined to improve the quality of care for severely injured patients.
I welcome the consensus in this debate that the most effective way to provide the service is through good regional planning and by regional managers and hospital managers working closely with expert clinicians and the local population. I look forward to the recommendations from my noble Friend Lord Darzi’s review and to their successful delivery across the country.
Lance Corporal Compton (Compensation)
10.56 am
Hugh Robertson (Faversham and Mid-Kent) (Con): I welcome you to the Chair, Dr. McCrea. I also welcome the Minister, who is slowly and surely taking his place, and thank him for taking the time to respond to this debate.
I intend to conduct this debate in five sections. First, I shall make some introductory remarks about my interest in the case. Secondly, I shall be clear about what we want to achieve this morning. Thirdly, I will sketch out the background to the issue. Fourthly, I will run through the key points that need addressing. Fifthly, I shall wrap up with some concluding remarks.
I have two interests in this case—a constituency interest and a regimental interest. The constituency interest is that Lance Corporal Compton lives just—but only just—outside my Faversham and Mid-Kent constituency, in Staplehurst. His Member of Parliament, my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) is, incidentally, fully briefed on this case and is fully supportive. Therefore Lance Corporal Compton and I have the county of Kent in common.
The second connection, which is probably more obvious, is regimental, because we both served in the Life Guards. I served in that regiment from 1982 to 1995, and although three of those years were spent at university, I saw active service in Northern Ireland, with the UN in Bosnia and as adjutant of the regiment during the Gulf war. None of that, it is fair to say, bears comparison with the Army of today, particularly given the intensity of the low-level, hand-to-hand fighting seen in Afghanistan. In a week in which the death toll has reached 100, it is hardly surprising that there have been a considerable number of horrific injuries, such as the one that we are debating today.
I should like, in passing, to pay tribute to the Household Cavalry, which has supported Lance Corporal Compton right through his recovery and will, no doubt, continue to support him in the years ahead. I also pay tribute to Alistair Galloway, a young officer who served with the regiment and who, despite leaving the Army, has continued to help and advise Lance Corporal Compton.
What do I hope to achieve with this morning’s debate? The answer is simple. For reasons that I will outline, an offer of only 57 per cent. of the maximum compensation payable is inadequate recompense for injuries including third degree burns to 70 per cent. of his body, the loss of his ears and nose and complex injuries to his left arm and right leg that will never fully recover. It is inexcusable—I suspect the Minister agrees with me—that Lance Corporal Compton has received no indication whatsoever of the guaranteed income payment, which is effectively his pension, that he will receive for the rest of his life on leaving the Army.
I absolutely do not want to turn this into a party political issue or open up a wider debate about the operation of the armed forces compensation scheme, although that would be a worthwhile outcome. I simply seek to persuade the Minister that he should look again at this case, personally and as quickly as possible, to right what I believe, as a former soldier and current
parliamentarian, is a horrible injustice. If the Minister agrees to re-examine this case personally and as quickly as possible, as far as I am concerned that will be a good outcome from this morning’s debate.
What is the background to the case? Lance Corporal Compton was injured in southern Afghanistan on 1 August 2006 while serving with D Squadron of the Household Cavalry Regiment in Helmand province. As the driver of a Spartan armoured reconnaissance vehicle, he suffered third degree burns to 70 per cent. of his body and a gunshot wound to his leg during a Taliban ambush on the vehicle. He was the only survivor of the incident, which resulted in the deaths of three of his colleagues from an improvised explosive device, or IED—I suspect, Dr. McCrea, that you will be familiar with such devices from your own constituency—and a direct rocket-propelled grenade attack. He fell from the vehicle while he was on fire and removed his burning body armour and helmet while coming under fire from the Taliban. He then crawled more than 80 m into cover, where he sustained a gunshot wound to his leg. It is a remarkable story. Lance Corporal Compton was rescued by other colleagues and evacuated to Camp Bastion, where he fell into a coma that lasted for three months, during which time he was revived after “dying” on three occasions. He was then flown to the specialist burns unit at Broomfield hospital in Chelmsford, Essex.
As a result of the attack, Lance Corporal Compton has lost both of his ears and his nose, which have been rebuilt. He has undergone multiple operations to repair his face and body, and he is still having rehabilitation treatment at the defence services medical rehabilitation centre at Headley Court in Surrey. That has enabled him to walk again and to regain the use of his arms and legs, but he will require further surgery and care in the future. It is an extraordinary tale that has clearly resulted in horrific and lifelong injuries.
The case presents two key issues. First and most importantly, the lump sum award made to Lance Corporal Compton under the armed forces compensation scheme does not reflect the severity of the 10 injuries that he sustained or account for the continued requirement for medical care that he will have for the rest of his life, his loss of future earnings—he can never be promoted again within the Army—and the momentous impact that his injuries will necessarily have on his quality of life. In my view, he fully deserves the maximum award, which is capped at £285,000.
Secondly, Lance Corporal Compton has still not received an indication of the guaranteed income payment to be paid annually for the rest of his life, which he is likely to receive on medical discharge from the armed forces—I referred to that point earlier. For fairly obvious reasons, it would be of immense benefit to him to calculate his income for the rest of this life, so that he can plan appropriately for the future.
Those are the two key issues, but the case raises a number of other matters, and I would be interested to hear the Minister’s comments on them. First, the Veterans Agency appears to have paid out the lowest amount available for each of the specific injuries sustained by Lance Corporal Compton. For example, burns to the face and neck are compensated as a tariff level 7 injury at £34,500. However, if Lance Corporal Compton were
compensated for the loss of his nose and ears—he has clearly lost them—a considerably higher tariff, which runs up to £86,250, would be used. If the Veterans Agency is going to pick and choose between very different tariffs, surely—particularly in cases such as this—it should choose the higher tariff.
Secondly, the revised award to Lance Corporal Compton does not appear to take account of all his various injuries. As a result, injuries to his arms are included in the award, but there is no compensation for the smoke inhalation injuries that he suffered. If the compensation were calculated for all the different injuries that he received—a lawyer has actually done that calculation—Lance Corporal Compton would have come out above the maximum compensation figure.
Thirdly and far more generally, the armed forces compensation scheme is, as the Minister knows, currently undergoing a review. How long will that review take, and will Lance Corporal Compton’s compensation be reconsidered as a result? If the scheme is upgraded, I hope that Lance Corporal Compton will be in a position to benefit. Finally, there is the question whether the capped level of £285,000 is appropriate in cases such as this where the injuries are so horrific.
In conclusion, in Lance Corporal Compton we have a wholly extraordinary young man who saw three of his comrades killed and who then crawled 80 yd under fire while still alight. As a result, he sustained horrific injuries, including third degree burns to 70 per cent. of his body, the loss of his ears and nose, and the loss of full use of his arms and legs.
In fairness to the Minister and the Ministry of Defence, I accept that it is difficult to reconcile injuries on that horrific scale with a standard formula. However, there is a clear case for the Minister personally to call for this file and to reconsider the case as quickly as possible, with a view to awarding Lance Corporal Compton maximum compensation. I also hope that the Minister will undertake not only to carry out an independent review of the case but to arrange for Lance Corporal Compton to receive an indication of his likely pension—the guaranteed income payment—as a matter of urgency.
In a week in which the death toll in Afghanistan has reached 100, it is appropriate this morning to pay tribute to all those who have lost their lives or been injured on operations. It is vital that all our servicemen deployed on active service know that they will be properly, and I hope generously, looked after if they suffer injury, particularly injury of this severity. As I am sure the Minister will agree, they deserve no less.
11.6 am
The Parliamentary Under-Secretary of State for Defence (Derek Twigg): I congratulate the hon. Member for Faversham and Mid-Kent (Hugh Robertson) on securing this debate on this very important subject. He rightly raises a number of issues relating to this case that I hope to address today. First, however, I want to express my deep sympathy to the family, comrades and friends of the three soldiers—Privates Nathan Cuthbertson, Daniel Gamble and Charles Murray—who were killed in Afghanistan at the weekend. Of course, my thoughts are also with the loved ones of the other members of the armed forces who have lost their lives, both in Iraq and Afghanistan.
The amount of compensation awarded to sailors, soldiers and airmen who are injured in the service of this country, and to the families of those who sadly have lost their lives, is a very important issue that matters greatly to individual service personnel and their families.
I know that, as the hon. Gentleman said, he served in the same regiment as Lance Corporal Martyn Compton and I congratulate him on his distinguished service. I am sure that he will join me and the whole House in recognising and paying tribute to the courage, professionalism and commitment shown by Lance Corporal Compton and all members of the armed forces, and by the families who support them. Of course, I congratulate the Household Cavalry on the support that it has shown for its injured service personnel, particularly Lance Corporal Compton.
I want to say at the outset that the Government are fully committed to meeting our duty of care to serving personnel, veterans and their families. As has been recognised by many organisations, including the Royal British Legion, we are making improvements, including to service pay, accommodation, health and welfare provisions, force protection and personal equipment. Of course, however, we recognise that there is still scope for further improvements. That is why we are working on a cross-Government Command Paper on personnel, which will examine a range of issues to see what we are doing well, what we could improve on and what it is possible to achieve.
The hon. Gentleman raised the issue of the review of the armed forces compensation scheme, which I announced recently and for which we had asked. I cannot give him a date at this stage as to when we can say something further, but the fact that we are reviewing the scheme is important in itself.
I of course want to join the hon. Gentleman—I am sure that all hon. Members do—in wishing Lance Corporal Compton the speediest possible recovery from his condition and the injuries that he has received. I met him last week to discuss both his experiences of welfare support and the compensation issues. I regularly meet injured personnel; I make a point of meeting them at Selly Oak hospital, Headley Court or elsewhere.
A number of questions have been raised today about the particulars of Lance Corporal Compton’s case. I am sure that the hon. Gentleman will understand that, while I am happy to discuss such issues with Lance Corporal Compton directly, it is only appropriate that I confine my remarks this morning to the support, compensation and welfare available to the armed forces in general, rather than discussing the particulars of one case, as important as that case is.
There are a couple of issues that I will respond to. Lance Corporal Compton raised the issue of the notification of the guaranteed income payment with me last week, and I assured him that we will get him an assessment of what that payment will be, based of course on his current salary, because the amount will depend on what his final salary is. We will carry out that assessment and such assessments will be made for other injured service personnel in the future, too.
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