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17 July 2008 : Column 147WHcontinued
There have been, and continue to be, serious deficiencies in Defence Medical Services personnel. Recruitment is good, which is not surprising because training is of a very high standard and the personnel are remunerated while training. However, retention remains a serious problem, and there are extremely serious shortfalls in the key specialities of general surgery, orthopaedic surgery, anaesthetics and general medicine. Not all is well. It is probably the most serious shortfall in defence provision. The Laurence committee, in 1997-98, considered all those issues, and on 10 December 1998 made the announcementseared on the hearts of all my constituentsthat the Royal Hospital Haslar should be closed by the Ministry of Defence. I must disagree with the hon. Member for North Durham, who unfortunately is no longer in the Chamber: Conservative party policy was not to close military hospitals, but to focus defence medicine on one hospitalthe Royal Hospital Haslar
which is why it was so devastating when the announcement was made that that single hospital should eventually be closed.
There was a search for a centre of defence medical excellence. The Army would have liked Guys and St. Thomas hospital in London.
Linda Gilroy: I am sure the hon. Gentleman is aware that we used to have a naval hospital in Plymouth, which was combined with Plymouth Derriford hospital trust, and there was great regret about that as wellmany still regret it. However, overall, I think people understand that it was necessary. It has proved of great benefit, not just from the military point of view, but from the civilian point of view in the hospital.
Sir Peter Viggers: There are a number of areas where there were service hospitals and where there has been intense regretnone more keen than in the Gosport-Portsmouth area over the proposed closure of Haslar, which has not yet gone ahead.
After Guys and St. Thomas failed as an option, there was some discussion of John Radcliffe hospital in Oxford, and there was the possibility that a hospital in Newcastle might have been chosen. Eventually, almost by default, the choice fell on Selly Oak hospital, Birmingham, and the Government now seek to make great play of the fact that the west midlands has become a centre for defence medicine. I point out that Selly Oak hospital is in south-west Birmingham, and Lichfield is well to the north-east, some considerable distance away, so 1,100 medical personnel will be located in an area with no particular connection to the services or attraction to them, as far as I can see.
Where do we go from here? We must accept that an effort has been made to provide high-quality treatment to casualty evacuees and that treatment within the NHS is working quite well. Many visitors to the Birmingham facilities pay tribute to the very high quality and skill of the workers there. It is certainly true that there have been improvements to the service environment of military care, and more care is taken now to ensure that military personnel are in military wardswith their matesif possible.
All those who visit Headley Court talk about the quality of the physical environment, the atmosphere and the outstanding rehabilitation work done there. However, there is a need for further facilities for convalescence and aftercare. The charity Help for Heroes, which was founded by Bryn Parry and others, has hit a nerve in that regard and enthused many people to support the concept that service personnel should be enabled and empowered to help each other within a service environment.
Let me focus on the future of Haslar, which has been mentioned twice. There is a civilian dimension to the continuation of the hospital, but that is not relevant to the debate. If the hospital should remain open in some capacity, there would be persuasive arguments for continuing the out-patient and other facilities that are provided for civilian personnel locally. Many of my constituents would like Haslar to be restored as a district general hospital, but that is not likely to happen given the manner of thinking in the NHS. We must identify needs in the armed forces, with which Haslar
has a strong connection, and consider how it could help to meet them. Recommendation 21 of the report says that
providing first-class healthcare for veterans, and making sure that people have confidence that they will be able to access and will receive such treatment, is an integral part of the debt which society owes to those who serve in the Armed Forces.
Some people may not require the specialist facilities at Headley Court but may have other considerable needs such as the need to convalesce in a military environment. The mental health field is important. The excellent charity Combat Stress points out that post-traumatic stress disorder tends to surface about 15 years after an individual has experienced that stress. We have a growing problem with mental health support for those who have served in the armed forces; a significant, pent-up problem is coming our way.
Haslar is zoned for medical use; its listed buildings and scheduled gardens mean that there are severe planning restrictions, and there are problems with a large number of graves at the site.
Mr. Kevan Jones: Will the hon. Gentleman give way?
Sir Peter Viggers: May I please finish?
There are considerable restrictions on the sites use, but I am delighted that a number of charities are considering combining forces and putting forward a proposal for Haslars use for military convalescence and care. I very much hope that their meetings, which are planned for next week, will be productive.
Willie Rennie (Dunfermline and West Fife) (LD): I pay tribute to the Committee for its excellent report, and to the Chairman, the right hon. Member for North-East Hampshire (Mr. Arbuthnot), for the way in which he presented the report. He gave quite a lot of detail and presented it in a fair and balanced way. I am sure that many in the military and the Ministry of Defence will recognise that. I also pay tribute to the staff of the Committee, its advisers and the people whom Committee members met when they were out and about on the inquiry.
I say that the report is excellent not just because I was a member of the Committee during the inquiry. I was not a member of the Committee when the report was being finalised and published, but I followed the media concern that was highlighted at the time. As we have heard, much of that concern was unjustified and unfounded. I should like to hear the results of the Telegraph test and whether, given the evidence, the MOD believes that there was any justification. The report recognises good practice and where practice has improved, because good practice was lacking in the past and reform was required. It also identifies weaknesses, and I hope that the Minister will take those observations on board and use them to drive further reforms.
I pay tribute to members of the armed forces, including those who have been injured and who have required the medical service. In general, the support that they receive from Defence Medical Services is first class and the services should be commended for their work. Members of the armed forces should be confident that they have rock-solid medical services that they can rely on in their hour of need.
The first issue that I want to address relates to primary and secondary care and rehabilitation services and care. I was unable to make it to the Selly Oak facility, but I heard many good reports about it. In principle, the idea of bringing together the best from the MOD, military health care and the NHS is first class and commendable. We want the best of both, because our military deserves that. I recognise the concerns that have been raised about Haslar, because we have fought a battle over our local hospital in my constituency, but we recognise that people need the best specialist care at the best location. Although the changes are regrettable, especially for people in the Gosport area, military medical care must come first.
MOD hospital units combine the best of the military and the NHS at a more local level. I experienced that service some years ago when I was a patient at Derriford hospital, where I encountered some formidable military nurses. The care was very good, but I was rather frightened of some of the nursesI am sure it progressed my care somewhat, because I was keen to get out of the place. I thought it was a great facility. Indeed, my son was born there, so I have a lot to commend Derriford hospital forand the MDHU at that facility.
We have heard about Headley Court and the regional rehabilitation units. The Committee visited the unit at Edinburgh and I also visited Headley Court in Leatherhead. Both are, rightly, highly regarded facilities. I was impressed by the work ethic of staff at Headley Court and those who were injured. They recognised that it was their job to get better so that they could go back to work as quickly as possible. Treatment was not just about patients health care, but about getting them back to work as quickly as possible. That excellent facility should be commended. One of my constituents, Sergeant Scott Paterson, who was recently injured in Afghanistan, will, I hope, receive the support of Headley Court. He should be comforted to hear reports of its excellent facilities.
I understand that the Minister visits Selly Oak hospital quite frequently, and that the nurses cancel their leave when he visits. Initially, I thought that that was because he was accident prone, but I now understand that it is because he is so highly regarded there. It is good that he has that connection with the facility, and long may it continue. It is important to have a good connection between Ministers and those who provide the service on the ground, so that they can hear at first hand about any concerns and about good practice that should be spread elsewhere.
I have a few questions. There is a military-managed ward at Selly Oak, and there has been some talk of moving towards having a military-only ward. Has there been any progress on that? If it is feasible, when can we expect it to happen? There are MDHUs only in England, but are they being considered for the rest of the UK, so that people on military bases in other parts of the UK do not have to travel to those MDHUs for the accelerated treatment they require? I understand that clinical governance at Selly Oak and at the MDHUs is first class and on a par with that in the NHS, but what confidence does the Minister have that clinical standards and governance in the militarys primary care services are up to the same standard? Has that care been considered to ensure that it is the best possible?
I agree with the hon. Member for North Durham (Mr. Jones) that, in the past, mental health has been the poor relation both in the NHS generally and in the military, so I am pleased that progress has been made on the Territorial Army facility at Chilwell and on extra funding for Combat Stress. The bases local community mental health facilities are excellent, so progress has been made in that area. However, I am concerned about the care provision from the Priory Group, which is neither fish nor fowlneither a local facility nor a military facility. As we heard, when military personnel receive care, it is important that they are surrounded by their comrades, if at all possible. I know that the Priory Groups contract is up for renewal in November, but has there been a tendering process, and will there be other bids from competitors for that work? It is important that we review what the Priory Group provides.
My other concern is whether GPs really know about the mental health facilities, services and support that are available to veterans. One of my constituents was concerned that his GP was not aware of the Combat Stress facility, and he had to wait about two years before he was referred to it. What awareness-raising will there be so that GPs know what is available to servicemen?
I understand that the Rivers centre in Edinburgh, together with NHS Lothian, is one of the pilot projects for Scotland. In the Secretary of States statement earlier, the pilots were referred to as successful. I do not know whether the projects have been reviewed yet, but it is rather early to regard them as successful, so I should like to hear from the Minister about any review that might have taken place.
I reiterate the comments of the hon. Member for North Durham on the identification of veterans. It is a sensitive issue, because not all veterans want to be known as former members of the armed forces, so we must take that into consideration. However, there is a possibility of connecting the Ministry of Defence IT system and the NHS IT system, so that, if required, their details can be accessed and they can receive the best and most appropriate care for their needs. It might be an opt-in system rather than an opt-out. As the programme might be England-only, will the rest of the United Kingdom be considered, so that there is proper connectivity between all the systems?
The Committee Chairman referred to Scotland in terms of a laissez-faire approach. I was pleased to be able to take Committee members to the Scottish Parliament to show off my home country and the excellent facilities and services that it provides, but I was rather embarrassed by the whole experience. People had a very laid-back approach and did not seem to know or understand the needs of the military, military families or veterans. Indeed, I was not quite sure whether the right people were in front of the Committee. They should, perhaps, have put more thought into their presentation, but the visit revealed that, because the MOD and the military are regarded in terms of reserved powers, the Scottish Parliament does not consider them to be its business. That may be an issue for the other Assemblies and Parliaments in the United Kingdom, too. We have problems here at Westminster with the holistic approach, trying to pull different Departments together, but the problem seems to be even greater between Westminster and the devolved Parliaments. We need much greater
focus, so that on health, and on education, with which the Committees previous report highlighted problems, there is greater connectivity and information-flow.
However, there is evidence that the Defence Committee has made an impact, because, having had a quick look at the Scottish Executives website over the past few days, I discovered that there has been a flurry of announcements over the past six months. The Executive have produced a variety of reports, and there is clear evidence that when pressure is applied, sometimes it pays off. Some of the announcements just copy Westminsters, but we should not be too ungrateful, because they are making the same progress as Westminster. Some of the announcements are of derisory sums of money, although as the Secretary of State said that every little helps, we should be grateful for them; but other announcements will make a difference, and that is good, so we should give credit where credit is due.
The report did not investigate British forces in Germany, but I have some quick questions for the Minister. I recently asked some parliamentary questions about the Gilead facility in Germany, which is under the Guys and St. Thomas NHS foundation trust contract. The Ministers answer referred to a validation and review process by the South London and Maudsley NHS foundation trust, and I should like to know the outcome, and whether the Minister is content that the facilitys standards are up to the mark.
A new telephone advisory service has been set up in Germany, and there has been a pilot. Did it involve health care support workers, who are part of the system, or higher-grade nurses? There is some concern about the use of such support workers at the facility, and we want to ensure that it is as good as, if not better than, NHS Direct, or NHS 24 as it is known in Scotland. I understand that the facility has been quite under-used. Perhaps it is at an early stage and, in time, usage will increase, but is there any concern in the MOD about the lack of calls having an effect on the deskilling of the work force at the telephone advisory service?
Several references have been made to military families, and I was pleased that todays statement recognised that families who have a nomadic existence should neither suffer nor fall to the bottom of the list for housing, health care or education. It is a welcome step, but its implementation will be an awful lot more difficult. We need to ensure that people understand that they are not being de-prioritised, and that they get the place they deserve. Getting a dentist is difficult enough as it is, so it is important that we do not penalise military families. When they are overseas, perhaps in Germany, they receive appropriate care because they are cared for by Defence Medical Services, but it does not seem to be the case in the UK, so I should welcome some progress.
The report did not make an awful lot of the shortage of key personnel, but there are a number of shortages, and the MOD must recognise that a huge amount of work will be required both to keep people in the forces and to recruit new people. The training facility is excellent and will be very helpful to their careers, so to counter those shortages, we should get the message out that those people are welcome in Defence Medical Services. The fundamental problem, however, is overstretch. We ask people to do too much in difficult conditions, and it is no surprise that they leave early. We need to address the issues of overstretch and what we ask people to do.
Overall, the report is excellent. It is balanced and considered, and the MOD must be congratulated on its improvements. I thank all the people who make the armed forces health services the success that they are, and I hope that as many people as possible outside the Chamberin the armed forces and beyondread the report and recognise the progress that has been made.
Dr. Andrew Murrison (Westbury) (Con): I start by declaring my interest as a medical officer in the reserve forces.
I pay tribute to the House of Commons Defence Committee for delivering its report on an issue of vital importance to our armed forces, and to the Chairman of the Committee, my right hon. Friend the Member for North-East Hampshire (Mr. Arbuthnot), for the manner in which he delivered the report this afternoon. I also pay tribute to the men and women of our armed forces and, of course, to those who look after them, both within the Defence Medical Services, the NHS and increasingly the charitable or third sector.
Today has been quite a big day for the armed forces. We had the launch of the Command Paper. There are lots of very good points in it, a few of which, I must say to the Ministerif I may pull his legare eerily familiar. However, I commend in particular the Governments attitude towards service families and NHS waiting lists. Furthermore, after my brief reading of the report this afternoon, I also commend the statement that people who are being cared for at Headley Court will be cared for to the same standard in the NHS when they become veterans. The Minister and I have corresponded about that issue over the course of several months, so the statement on it is very welcome.
The Defence Committee rightly asked the Government to be more explicit about the so-called Lichfield-Selly Oak dumb-bell, but the response from the Government at the time seemed to duck the issue. Since then, we have been told that Ministers have assessed the project and are now able to give it the green light. Underpinning the whole project, of course, is the need to allow an Army training regiment to relocate from Lichfield to Pirbright, and I will talk a little more about that issue in a moment.
Before I do so, I think that it would be instructive to refresh our memories about the move to Selly Oak and to consider what lessons it might have for the future of the DMS at Whittington barracks. The closure of Haslar dates from Admiral Timothy Laurences committee of 1998, which considered that the MOD should not be in the business of running hospitals. Ministers readily agreed to that and a centre for defence medicine was proposed, to be based ultimately in Birmingham, which would cost £200 million.
At the time, the money did not materialise and the Royal Centre for Defence Medicine landed up in a somewhat undistinguished redbrick Victorian building, where it remains to this day. We really should take our hats off to the DMS for putting such a brave face on conditions that are far less inspiring than the service warrants, particularly in current operations.
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