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17 July 2008 : Column 141WH—continued

I wish to ensure care for those affected by mental illness by raising the issue of the preparedness of young men and women who are going to places such as Iraq and Afghanistan. They should be given greater preparation for the things that they will experience. I spoke to a psychiatrist who deals with some of the repercussions of what such young men and women have been through. He told me that there was a lack of preparedness for some of the things that young men and women would be confronted with and the sort of scenes with which they would have to live daily. It is easy, from the safety
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of the House of Commons, to say, “Those things are part and parcel of being in the military.” However, 19 or 20-year-olds are bound to be affected by confrontations with ghastly scenes and horrific incidents—a bomb outrage or whatever—and the deaths of friends and colleagues.

I do not know how people can be prepared for that, but some effort ought to be made to ensure that people are given access to proper counselling before and after. One of the problems is the lack of medical counselling on return. Everyone is happy to get back safely, but some people come back terribly scarred by their experiences and what they have seen. Perhaps intervention in those early days back in the United Kingdom would be helpful in softening the burden that they will probably carry for the rest of their lives. It is important that we as a nation recognise the debt that we owe those men and women and do everything that we can to prepare and help them. Let us not wait until they become serious psychiatric cases, desperately trying to hold together a marriage and hold down a civilian job while coping with the burden of what they have experienced in the services.

That will not be easy, and the problem will not be solved overnight, but I would like the Minister to reassure us about a matter mentioned in the report. The hon. Member for North Durham made an effective contribution to our debate in the Committee about the number of servicemen who end up in prison with serious psychiatric problems. Perhaps their journey to prison would not happen if they were given the right care and attention upon leaving the service or returning from combat.

With those thoughts and suggestions, I thank you for calling me to speak, Mr. O’Hara. I wish the Minister well in the work that has to be done in future, and I am grateful for his effort in ensuring that medical services have improved significantly between the last time the Committee examined the matter and our producing this report.

3.31 pm

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): It is a pleasure to be able to join colleagues to debate one of the most interesting and satisfying inquiries in which I have been involved on the Defence Committee. The report rightly pays tribute to DMS personnel and their NHS colleagues, who together provide the world-class care that the Chairman of our Committee, the right hon. Member for North-East Hampshire (Mr. Arbuthnot), mentioned at the beginning of his speech. To quote the report:

In his statement on the Command Paper published today, the Secretary of State rightly said:

Notwithstanding the fact that our inquiry found that that care was world class, we need to continue to push the boundaries of what can be achieved. I am sure that the Minister concurs.

When we visited Selly Oak, we saw men and women—predominantly men—who might never have had the chance to get the care that they were receiving had it not been for the advanced health care that can now be
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offered in the field in the golden hour when it is so important. I learned a great deal about how our armed forces work and support each other when they are deployed, when they are preparing for deployment and during post-deployment decompression. I learned how important it is that their families are there in the background to support them stoically and uncomplainingly, often putting up with situations that they should never have had to put up with.

As I got to know the defence community in Plymouth by visiting the Crownhill community centre and the various associations that such communities are blessed with, I was concerned to learn of the waits that people sometimes experienced for hospital treatments and dentistry. Goodness knows when dentistry was ever as hard-pressed as it has been in recent years, and people find themselves moving just when they might have got an NHS dentist. I would also mention in vitro fertilisation treament. I know that in today’s Command Paper, the MOD undertakes to make improvements on some of those matters, further to those that have taken place since we published the report.

The response to our report stated that the MOD was in the process of reviewing the future requirements of the defence medical rehab centre at Headley Court and the regional rehabilitation units. Things have moved on since that response, and I hope that the Minister will be able to tell us something about the outcome of the review. Like others, I have seen some reports about the level of expenditure that will be provided and the commitment that has rightly been made. I found the dedication of the people at Headley Court to care for injured service personnel, and the terrific commitment of those personnel to get back to fitness for service, one of the most moving and interesting parts of the inquiry.

Mr. Kevan Jones: Would my hon. Friend like to debunk the myth that charities have to raise money for a swimming pool at Headley Court because of a shortage of money? When we went there, the directors and others involved said that that was not one of their top priorities.

Linda Gilroy: Rightly so, and we mentioned in the report the importance of getting the right relationship between the MOD and the third sector, which has always enhanced what the MOD can make available, and will continue to do so. In today’s Command Paper, there is a commitment to get that right through the mechanism that has been set up for continued consultation with the service charities and associations, the Army Families Federation and so on. I hope that that will make for a much better relationship and better understanding between everybody. The British Legion has raised money for additional things. I will return to the work of Combat Stress in a moment, because achieving a balance and getting the relationship with the third sector right is very important. Certainly my hon. Friend is correct that the matter of the swimming pool was another example of getting things completely out of proportion. Perhaps some Members played into that process in an inappropriate way.

Headley Court is a world-class facility, and the people there are rightly proud of what they do. When we visited Selly Oak, we saw the provision of cutting-edge
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medical care for the injuries and polytrauma that military casualties sustain. To illustrate the importance of that defence medical centre as the focal point for the whole practice, we were told on our visit that repairing one injury to a serviceman’s hand required 13 specialisms to be brought in from across the teaching hospital.

While we were there, the issue was raised of whether there was an appropriate military ethos in the management of the ward. We saw a great deal being done to improve it, and good practice has been established in the military management of the ward, as it has in military wards elsewhere in the country. I am sure that that practice will be migrated across when Birmingham New hospital, which is being built in Edgbaston, replaces Selly Oak. That will be another major improvement, because we could see that the buildings in which the world-class service was provided were not the best or most flexible. It will be good to see the Selly Oak ward move to its new facilities. I pay tribute to the MDHU at Derriford hospital, as a number of Members have done. It, too, plays an important and under-recognised part in the work of our armed services, ensuring that servicemen and women are fit for service and that those who suffer injury—most commonly musculoskeletal injury—are fast-tracked to be restored to full health and fitness for active service. I greatly appreciate, as I am sure do many of my constituents, the service provided at MDHU Derriford.

On the role of the reserves, my hon. Friend the Member for North Durham (Mr. Jones) mentioned the visit by some of my colleagues recently to Camp Bastion in Afghanistan. The report of that visit tells us that 95 per cent. of hospital staff are reservists, across the provision on deployment. Many of those reservists come from Plymouth Derriford hospital, and they have particular needs and concerns. A review will report later this year on the role of the reserves in general. No doubt it will provide another opportunity to discuss those matters. The all-party group on reserve forces, of which I am a member, as are other colleagues in the Chamber, has been working to introduce proposals, and the report due to be published next Monday will consider the issues.

Reservists face different pressures and challenges from regulars, particularly after the completion of an operational deployment. They do not return to a military environment as regulars do, but to a civilian one, as our report pointed out. Hence they do not have the same atmosphere of camaraderie and shared experience in which to readjust, and the signs of post-traumatic stress disorder can sometimes go unnoticed. For that reason, our report referred in particular to the heavy reliance of DMS on reserve personnel, which has increased as a result of the high tempo of operations.

Combined with smaller numbers of deployable regular DMS personnel, reservists keep our armed forces’ medical service going. Although reservists volunteer to use their skills, there is a danger, as I am sure the Minister is aware, of deploying them so often that the pressure on them becomes excessive. That is why the report says towards the end:


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We also referred to the support that reservists need from both their civilian employers and the armed forces when they return from operational deployments. The public, too, need to recognise the reserve forces’ contribution to the military and society.

I shall pass a few comments on what we said about mental health in the report. I welcome the pilots that have been announced and developed, such as the community veterans mental health pilot. As other Committee members have said, it is a difficult matter. Particularly in mental health, it is hard to keep the level of contact necessary to provide appropriate service for former service personnel and veterans, who might need it many years after concluding their service in the armed forces. The pilot is designed to develop a model of community-based mental health, as recommended by the Health and Social Care Advisory Service, which is an independent body that recognises that in some areas of the country, the NHS can no longer easily access the expertise in military mental health required to meet the needs of some mentally ill veterans. It addresses the issue by establishing a basis for regional networks of expertise. We have such a network in St. Austell, and I think that the Secretary of State said in the Command Paper that others are to be rolled out. However, they were designed to take two years and to be evaluated, and I hope that my hon. Friend the Minister, in responding to this debate, will be able to update us on those pilots, the evaluation and when the roll-out will occur.

I also want to mention Combat Stress. A number of Members visited its facility when we visited nearby Headley Court. I was impressed by the work that it did, and I met somebody who came from as far away as Plymouth, and lived very near my constituency. Combat Stress plays a necessary part. Indeed, it probably provides support to the community mental health pilots that I just mentioned. We need to get our relationship right with the third sector, which is an important player in mental health services. I understand from information that we received recently from Mr. Toby Elliott, the chief executive, that there are continuing delays in resolving some of the funding issues. Despite generous increases, funding is increasingly delayed, and I guess it will continue to be delayed as the community pilots begin to identify people for whom the periodic respite that Combat Stress provides is of particular value. Again, the Minister’s remarks on that would be greatly welcome.

This is one of the most interesting and satisfying inquiries with which I have been involved through the Defence Committee. As colleagues have said, we will have a role in ensuring that the issues that we have debated this afternoon are seen through to their conclusion, if a conclusion is possible with such things, or certainly to an even higher level of service. I look forward to gaining some insight into how that will be achieved. The Government gave us some idea in their response of how matters would be taken forward. Things have developed since then, and we saw some glimpses of that development in today’s very welcome Command Paper.

Perhaps the most important part of the Command Paper is the implementation mechanism. There was a reference earlier to our session with the Minister and his colleague from the Department of Health. We had a similar session when we considered education. Only such joined-up thinking across government will ensure the
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full implementation and delivery of the recommendations that we laid out for the sort of continuously improving world-class service that we should be able to offer our servicemen and women and their families.

3.49 pm

Sir Peter Viggers (Gosport) (Con): The work of the Defence Medical Services involves courage and skill, and some of it is inspirational. The Committee’s mood has been to support the work of DMS and pay tribute to it, and the report has been well received both in the House and among the wider public. So much courage, skill and good will has gone into the report and goes into DMS generally that one might think that all is well. However, all is not well in DMS, which is probably the area of the greatest difficulty and need in the armed forces spectrum.

Defence medical services are highly specialised, and the individuals involved in the armed forces tend to be youngish and fit, so those working in DMS need to be specialists in fitness and injury. Traditionally—I am going back more than 10 years, before the 1998 decision—armed forces service personnel did not necessarily receive the highest quality of medical care from the most experienced medics, because it was provided by service personnel who might not have been leading specialists in the field. In 1998, therefore, the Government in effect cut the umbilical between Defence Medical Services personnel and armed forces personnel, making it clear that services personnel would receive the best possible medical treatment within the NHS. It was decided that DMS personnel would train and work within the NHS and so broaden their experience.

It must be correct that services personnel receive the best possible medical care.

Mr. Kevan Jones: Will the hon. Gentleman give way?

Sir Peter Viggers: I will give way to my—I almost called him my hon. Friend—colleague from the Defence Committee.

Mr. Jones: I am not sure that what the hon. Gentleman is saying is correct. When I visited Selly Oak and MDHU Northallerton, the services personnel—the nurses and doctors—wore different uniforms from the NHS staff. The few military personnel at Northallerton when I visited were treated by, and could identify, services personnel, so I do not think that the relationship has been broken at all.

Sir Peter Viggers: I must disagree with the hon. Gentleman. When armed forces personnel come back with specialist problems, they can be treated in any of seven—I think—hospitals in the Birmingham area, if they are “casevaced” into Brize Norton. The speciality will be appropriate for the wound—whether an ear, nose and throat problem, an eye problem, a cranial problem and so on. The best specialists in the NHS will be employed to treat them. They would not necessarily be treated in a military ward.

Mr. Jones: I am sorry, but I disagree. From my visits to Selly Oak, it seems to me—the hon. Gentleman might know better—that if specialist treatment is required in another part of the NHS trust, it happens, but the
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teams who work on the patients do so in a military-managed ward. I do not think that there is a trade-off between the two.

Sir Peter Viggers: Perhaps in due course the Minister will adjudicate this round of fisticuffs. My understanding, from my visits to Selly Oak and elsewhere, is that services personnel will be treated using the best available facilities in the NHS. If those providing the care happen to be armed forces personnel, so be it, but if the military defence services do not have the necessary speciality, someone in the NHS will provide it.

There is another dimension. Of course, wherever possible armed forces personnel should be treated in a military environment. If someone has lost a limb, every possible care should be taken for that individual to be with his mates in an environment where his wounds will be understood, and where he can talk in the language he is used to using in a military environment with military personnel. It would be wrong for someone who has lost a limb—the hon. Gentleman pointed out that they can be “casevaced” back within 12 hours—to be in a bed in an NHS ward between two elderly civilians who have suffered strokes. It is thus important to have a military environment, as far as possible, but it is also important that military personnel have the best possible medical care, wherever that might come from.

Mr. Jones: I am disappointed in the hon. Gentleman, because actually I quite like him, but he is perpetuating myths that do this debate no good at all. Many civilian patients in Northallerton, for example, have military backgrounds, because Catterick camp is on the doorstep. It is not true that many military-managed hospitals have no connection with civilian care. I urge him not to go down that route.

Sir Peter Viggers: I think that the disagreement, if there is one, is more apparent than real. If someone is “casevaced” out of an area of conflict with very serious wounds, they will get the best possible treatment within the NHS—full stop. If someone in the armed forces is injured more routinely, where possible he will be treated in a military environment. I do not think that there is a chasm of difference between the hon. Gentleman and me—but perhaps we can discuss it elsewhere.


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