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Westminster Hall

Thursday 17 July 2008

[Mr. Edward O’Hara in the Chair]

Armed Forces Medical Care

[Relevant documents: Seventh Report from the Defence Committee Session 2007-08HC 327and Sixth Special Report (Government Reply).]

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Blizzard.]

2.30 pm

Mr. James Arbuthnot (North-East Hampshire) (Con): It is an enormous pleasure and an honour to open this debate under your chairmanship, Mr. O’Hara. It is about a matter that is crucial to the armed forces, who give so much for our country. The debate is about medical care for the armed forces, and follows on from a report that the Select Committee on Defence began in October 2006.

It may ruin the suspense, but I shall summarise our report by saying that the headline result was that Defence Medical Services gives our armed forces world-class care, which is every bit as good as, and sometimes significantly better than, that provided in the United Kingdom. It is right for me to open the debate by paying tribute to Defence Medical Services and to the men and women who, often in extreme danger, give such high-quality care to the men and women of our armed forces.

The person who acted as my bodyguard in Kabul last week said that he had been injured in the C-130 Hercules that was attacked in Helmand and that if he had not been completely under the influence of morphine at the time, he would have liked very much to go back and thank the medical people who had given him such dedicated, professional and tender care when he was injured. I told him that we were having a debate in the House of Commons this week, and that I could do so on his behalf. He was genuinely grateful to be able to discuss the sort of quality care that he had received; he was just one example among the many thousands of people in our armed forces who receive such quality care.

At the outset of our inquiry, there was a flurry of media reporting about shortcomings at Selly Oak hospital, but that did not prompt our inquiry. The Defence Committee covers all the different strands of what the Ministry of Defence does, and we wanted to examine the full range of health care provision for armed forces personnel and their families. The inquiry was launched against a background of increasing concern for the general welfare of the armed forces. Nowadays, our soldiers—I am referring to all members of our armed forces—must contend not just with the enemy and with privations in the field, but with the media. They must contend with coverage of what they are doing that did not previously exist. That is a thoroughly good thing— the more the people of this country know about what we as a nation ask our armed forces to do, the better.
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Media coverage of operations in Iraq and Afghanistan has been positive and helpful, but I shall come to some aspects of the coverage of our defence medical services.

The Committee held four evidence sessions during 2007, including one in Birmingham and one at the Scottish Parliament, partly because of our drive to try to make the Committee less Westminster-centric. I pay tribute to the Committee for its care and professionalism in conducting our inquiry, and to its staff. The Clerks did a fantastic job in sorting out the large amount of information, not just from oral and written evidence, but from a web forum, which is the new way of communicating with the public, and a thoroughly good thing. The Committee’s final session included the Minister—it is good to see him in the Chamber—and officials from the Ministry of Defence and the Department of Health, and it is good to see them, too. It was a useful and productive exercise in interdepartmental scrutiny.

We visited medical facilities throughout the UK and in Cyprus, Iraq and Afghanistan. Whenever we go to Iraq and Afghanistan, we try to see some of the medical facilities. The web forum that I mentioned brought in many interesting and helpful views of ordinary servicemen and women, and their families. We received responses from people who would not have been able to participate if the intake of evidence had been limited to those who appeared before us. Our report addresses six main areas: the treatment of casualties from operations, rehabilitation and aftercare, co-operation with the national health service, care for veterans and service families, mental health, and the role of reserve medical personnel.

On operational casualties, we visited the Royal Centre for Defence Medicine at Selly Oak in Birmingham because that is the main receiving centre for casualties from operational theatres. We found that the clinical care was excellent, and that the staff, both military and civilian, were first class, and we were hugely impressed by the personnel we met at some of the Ministry of Defence hospital units outside Selly Oak, many of which we also visited.

In Selly Oak, we were briefed on the Birmingham New hospital and midland medical accommodation projects, which will create a Defence Medical Services centre based on Birmingham and Lichfield. In their response, the Government stated that progress is on course for the Birmingham New hospital to be completed by 2012, and I welcome yesterday’s statement from the Ministry of Defence, which set out the development of Whittington barracks in Lichfield. We hope that the two sites will provide co-ordinated, high-quality medical training and administrative services. The medical staff we met in Selly Oak were very much looking forward to what they clearly regard as an exciting new hospital that will provide even better care than is given at the moment.

I said that I would come to the issue of press coverage. It is necessary, but we must consider whether it is good coverage. The Committee’s report was strongly critical of some of the media coverage of supposed incidents at Selly Oak. We concluded that some stories had been printed without being verified, and in some cases despite the trust flatly denying them. We described that as irresponsible and reprehensible. We know that those stories had a serious effect on the morale of staff at Birmingham—we heard that some of them had been in tears as a result—and that service personnel and their families were worried about whether they or their families would receive decent care if they were wounded.

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Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): Was the right hon. Gentleman as shocked—or perhaps distressed—as me to learn of the time that had to be dedicated to dealing with those press inquiries? If I remember correctly, I think we were told that the time spent on the matter was as much as that of a full member of staff—one of the matrons.

Mr. Arbuthnot: Yes, we did hear that. It is not right for people who ought to be devoting their time to looking after our wounded servicemen and women to be running around putting out bush fires from stories that are incorrect. The words in our report were pretty harsh on that. Since then, the defence correspondent for The Daily Telegraph, Mr. Harding, has written to me to protest at the characterisation of the media coverage, which he said was wrong. He gave us details of the incident about which he had written, and I have asked for and received his permission to forward those details to the Ministry of Defence for its comments. I shall be doing that either later today or early next week. If we were wrong about those reports, of course, we will say so. We have no wish to perpetuate a falsehood. However, we took evidence on those matters and it was not challenged for six months, although it was displayed on our website. I look forward to hearing what the Ministry of Defence has to say about that.

Mr. Kevan Jones (North Durham) (Lab): The right hon. Gentleman will remember that I raised that issue directly with the trust when we took evidence in Birmingham. Is it not the case that the trust has not only refuted what are in some cases wild stories, but that it told us it has received no direct complaints from any member of the armed services or their families that can be linked to any of the more outrageous stories that have appeared in The Daily Telegraph, which were repeated the other day in that paper?

Mr. Arbuthnot: Yes, that is the case. It is also the case that we asked the trust about the general level of complaints at Selly Oak. My impression of the answer we received—this is something that I am remembering from about a year ago—is that the general level of complaints was running at about 10 per cent. of the level for other trusts in the country. That fact backs up our impression that Selly Oak is providing a good service to our injured service personnel.

Mr. Mike Hancock (Portsmouth, South) (LD): In support of what the hon. Member for North Durham (Mr. Jones) has just said, the inquiry was not short. It took place over a long period of time and we received much publicity for the hearings that were held. I was rather surprised that no journalists submitted evidence of their view that the services provided at Selly Oak and elsewhere were not up to standard. No evidence at all was provided to the Committee by anyone who had engaged in smearing the Selly Oak facility. Is the Chairman of the Committee rather surprised that nobody came forward during the evidence stage to back up the stories that had appeared?

Mr. Arbuthnot: I am grateful to the hon. Gentleman for that intervention. Yes, I was surprised. However, the fact that nobody came back to us reinforced in our minds the view that our conclusions—harsh though they were—were pretty correct. Now we have permission to pass the details of the matter to the Minister, we shall
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do so. He will consider them and no doubt we will reach a conclusion on whether we were right or wrong. If we were wrong, we will say so; and if we were right, we will say so as well.

The Committee visited the defence medical rehabilitation centre at Headley Court in June 2007, which is an experience I dearly wish everybody in the country could share—unfortunately the work involved would overwhelm such a wonderful centre. We have much praise for the work that goes on there. The staff are committed and enthusiastic, and patients are being rehabilitated after injuries that only 10 years ago would have been fatal. Headley Court is a good news story, and the Ministry of Defence should certainly not hide its light under a bushel in that regard. In taking evidence from the Minister and from the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), we were reassured that stories about Headley Court being under-resourced were inaccurate and that the Government are looking at the future needs of the DMRC and the resources required.

Incidentally, during our visit to Headley Court, we met several soldiers who had recently been extremely severely injured, so I welcome the recent announcement about compensation for those who are seriously wounded. Even though that is not strictly relevant to this inquiry or report, it is a welcome development.

One of the most important aspects of our inquiry was the extent to which the defence medical services co-operate with the national health system. We received many representations, some of which were vociferous, about the closure of stand-alone service hospitals—in particular, about the impending closure of the Royal hospital at Haslar. I am pleased to see my hon. Friend the Member for Gosport (Sir Peter Viggers) in the Chamber because he has fought an extraordinarily dogged and long-running campaign to save Haslar hospital. I pay tribute to him for all that he has done in that respect. He persuaded me that I ought to visit Haslar—it was not difficult for him to do so because he is a persuasive man.

However, the Committee was clear that it finds the arguments in favour of the closure of the service hospitals irresistible. We fully support the Ministry of Defence’s current stance of working through Ministry of Defence hospital units based in national health service trusts and found that there was no evidence that the standards of care offered to service personnel have suffered. In fact, it was clear to us that the current arrangement brings a number of benefits in terms of training, skills and maintenance. I do not want to raise false hopes in Haslar, but I hope that its incredible skills and dedication can be put to good use. Our general impression was that closing service hospitals was the right thing to do.

Sir Peter Viggers (Gosport) (Con): My right hon. Friend specifically mentioned Haslar hospital and I am grateful to him for his courteous remarks. Is he aware that there are active discussions taking place with service charities and others about the possible use of Haslar as a convalescent centre? Those discussions are ongoing, but will he wish them well?

Mr. Arbuthnot: My hon. Friend keeps me closely in touch with those matters. I am not in the least surprised that Haslar, the people around it, and those involved in
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the campaign are producing imaginative suggestions, such as the one to which he has just referred. I certainly wish them well, because it is a valuable suggestion that will preserve the incredible skills of the people in that place.

That was the main issue on our website forum. However, when I visited Frimley Park MDHU, there was only one military patient in that vast hospital. One cannot run a dedicated hospital on that basis, particularly when one recognises that there is a need to make the best use of specialities, such as trauma and burns expertise, and eye treatment. We have to be able to move military patients to places where those specialities exist. We also have to recognise the great healing effect that being in a military environment can provide, but that healing effect, which we saw operating so effectively at Headley Court and which is also operating on the military-managed wards at Selly Oak, does not of itself suggest that we should bring back dedicated military hospitals.

Mr. Kevan Jones: Does the right hon. Gentleman agree with this argument? One advantage that was put to me when I visited the Northallerton MDHU was that such units allow staff who are deployed on operations to gain not only experience of dealing with trauma and so on, but broader experience of areas such as paediatrics, which are increasingly important as our armed forces are deployed in military/civil situations. Last week in Afghanistan, we saw the military hospital dealing with children from the local town.

Mr. Arbuthnot: The hon. Gentleman is right. He raises another argument in favour of integrating the NHS with care for our armed forces, because that creates a wide range of experience that people looking after our armed forces in the field need.

We were told on some visits that service personnel can be fast-tracked through the NHS when that is appropriate. Those arrangements, although theoretically a very good idea, seemed to be unclear. We called on the Government in their response to set out them with a good deal of clarity, and we are grateful that they did so. However, the fact that we had to ask for such clarity shows that there is still a bit of work to do on ensuring that the arrangements are transparent, understandable and understood by those who can take advantage of them.

Our greatest concern arose from our evidence session in Edinburgh, at which we took evidence from officials from the Scottish Executive. We were extremely disappointed by the laissez-faire attitude that characterised the Scottish Executive’s approach to injured armed services personnel and their families, and the issue of whether those people had proper access to appropriate facilities. The Ministry of Defence has to work with a number of agencies to deliver the full range of services for the armed forces. It must be a very high priority for the Ministry of Defence to ensure greater co-operation between it and the devolved organisations. Given that our armed forces are spread all over the country and given their needs, which can be very great, unless there is better co-operation, our armed forces will suffer, which would be wrong.

On care for service veterans and families, we have no doubt that the clinical care provided to service personnel is first class, but the Government have a responsibility to veterans and services families, too. During our inquiry,
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the Government announced that veterans would receive priority access to NHS treatment. We welcome that, but we must see action, not only on how the access is available but on how those who are eligible for priority access are identified. We are concerned that the Government have no real plan to identify and to track people once they leave the armed forces.

The treatment of service families is also vital. How the relations of armed forces personnel are provided for is a very important factor in retaining those personnel. That responsibility is shared between the Department of Health and the Ministry of Defence. Both Departments must ensure that service families are afforded the highest possible quality of care. People should not be penalised because members of their family have joined the armed forces.

Mental health was one of the most important aspects of our inquiry. It is a heavy responsibility, and takes a heavy toll on those who have served their country. The Committee was satisfied that the provision of mental health care for service personnel is adequate, and DMS is right to pursue a community-based approach to those services. I have heard in recent weeks that there can be a worrying delay in discharging patients from the Priory. Will the Minister consider that in his reply? Veterans are extremely important in this context, because mental health problems can take a long time to develop. We were told that it took on average 13 years after discharge before someone presented for care as a result of mental health problems. The Government therefore have a continuing responsibility to those who have served in the armed forces and may have been traumatised by their experiences.

The Committee pays tribute to the excellent work that Combat Stress does in providing respite care for veterans. We greatly welcomed the additional funding that the Government announced last November, but problems will remain as long as there is no robust and systematic way of tracking veterans in the NHS. We concluded that the lack of such a process meant that the NHS had one hand tied behind its back when trying to deal with veterans’ mental health needs.

Reservists play a vital role in the provision of armed forces medical care. The Territorial Army has so far provided about half the medical personnel for the deployments to Iraq and Afghanistan. We visited a TA field hospital that was about to deploy to Afghanistan and we were enormously impressed by the enthusiasm and professionalism of the soldiers whom we met. Regular and reserve personnel seemed to work seamlessly alongside one another, and there were benefits for both sides.

When we visited Camp Bastion in Helmand last week, we heard that there were some glitches. Will the Minister consider that in his reply? We heard that the field hospital reservists who trained in the UK had not been trained on precisely the same equipment as they went on to use in Afghanistan. We heard that the paperwork was slightly different in Afghanistan. We heard that the intensity of casualties was not something for which they had been prepared, but that was perhaps because we visited the hospital on a day when there was a sudden jump from nine casualties to 30 casualties. Either way, we were enormously impressed by the quality of what we saw in Camp Bastion, but it would be helpful if the Minister ensured that the equipment that
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people train on is the same as that which they operate when they get into the field, that the paperwork is easy to manage and the same as that which they use in the field, and that people know that there can be a sudden influx of serious casualties. The Government must not take the contribution of reservists for granted. They must ensure that reserve personnel have the support that they need and are not disadvantaged in the labour market.

The Government response to our report is helpful and reasonable. I pay tribute to the co-operative and consensual way in which the Ministry of Defence has treated this inquiry. From the outset, we emphasised that it was meant to be a constructive process, and the Ministry of Defence has responded in kind. Where we asked for further information, the Government have in the main provided it. The emphasis must be on transparency and progress. The Ministry of Defence should continue to inform us and the House of developments in medical care for the armed forces and must continue to make improvements in the way in which such services are delivered. We hope that our report has contributed to improvements. First-rate care is already given by Selly Oak hospital. We have nothing but praise for the armed forces and defence medical care. We are grateful to the Government for the way in which they have responded to what we hope has been a constructive report.

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