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17 July 2008 : Column 153WH—continued
If the £200 million was pulled in 1998, I must ask the Minister what hope the DMS has of anything really good at Whittington barracks. The stakes are very high
indeed, because if the job is poorly done it is likely to lead to further embarrassment for the Minister or his successors, as trained staff decide to leave the armed forces because they feel dispirited, demoralised and undervalued.
I know that the Minister talks to members of the DMS frequently and members of the Defence Committee have also talked to them. I talk to them too, although sometimes on slightly different terms and I must say that the views that are often expressed by the hierarchy, if I can put it that way, sometimes deviate from those expressed by those lower down the tree. That is only to be expected, but I am particularly concerned by the views expressed by people at the coal face, because those people are the future of Defence Medical Services and they are the people who, on a day-to-day basis, are providing the service, both in the UK and, of course, abroad, which is crucial at the moment.
The Midlands Medical Accommodation project was at initial gate in August 2006. According to the Defence Medical Education and Training Agency, main gate was meant to be achieved at the end of last year. I would be grateful if the Minister could tell us why there has been a hold-up. In the deteriorating climate, we have to be cautious about the project coming to fruition. I have to say, however, that it is a matter beyond even the Minister’s exalted pay grade. Can he reaffirm his predecessor’s commitment to Whittington barracks in the event that DMS does not, in the end, move there?
In 2006, we learned from the right hon. Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram):
“If on the other hand, the transfer does not take place, Army training will continue on the Lichfield site.”
I hope that the Minister is able to repeat that commitment today.
Over the past 25 years, medics have become increasingly integrated in the mainstream of our armed forces. Can the Minister tell us what assessment he has made of the importance to the men and women of the Defence Medical Services of being located as close as possible to front-line units? It would be useful if he could frame his remarks in the light of the inconvenient fact that Keogh barracks and Fort Blockhouse are about as close to the heart of the British Army, Navy and Royal Air Force as we are ever likely to achieve.
One does not need to be Mystic Meg to foresee that, if the Whittington project has its funding pared down through harsh economic circumstances, the DMS would find itself in a very uncomfortable situation. Not only would its quarters be substandard but it would be left isolated from front-line units and, crucially, it would be seen as being out on a limb compared with the mainstream of the armed forces.
Page 8 of the report deals briefly with the operation of DMS. It has been ruled latterly by a curious bipartite organisation that includes two three-star officers who sit side by side, a little like the Popes of Avignon and Rome. The deputy chief of staff (Health) is a line officer and the surgeon-general, of course, is a doctor. If we are honest, the post of DCOS (Health) was created because, in the past, doctors have proved to possess variable—should we say?—management skills. Sometimes they are truly excellent and sometimes that is not quite the case, so I ask the Minister to consider whether we continue to require both those people. Of
course, we should remember in that context that we continue to have the three single service “tribal chiefs”, as medical directors-general at two-star level. For a small medical service, that structure looks increasingly top-heavy.
The Defence Committee heard that we will now have something called the Joint Medical Command, which is currently at Fort Blockhouse, and, eventually, another body called the Strategic Medical HQ. Of course, under current plans both those bodies will be housed at Whittington barracks, once their new offices have been built.
While not wanting in any way to harm the career prospects of my old friends and colleagues in the DMS, I would counsel some caution. Medical personnel have integrated with the command structure as never before, which is exactly as it should be, so I hope that establishing a stand-alone medical command, as it were, and a shift towards the west midlands and away from front-line fighting units will not signal a new era of isolation for the DMS.
Such a situation would be very bad for the credibility of defence medicine and also for the health of the population it serves. Furthermore, it would be a bitter irony if, in their haste to merge with our NHS, our defence medicine personnel found themselves estranged from their patient base, the men and women of our armed forces. Such a development would call into question the whole purpose of the DMS and suggest that perhaps we might even go the whole hog and rely on an extension of sponsored reserves taken up from the NHS. Indeed, that is largely the direction the Americans have taken with their equivalent medical services.
There are a few small points in the Government’s response that need to be picked up briefly. In paragraph 18, the definition of veteran is given as a person
“who has served for at least one day in HM Armed Forces”
or allied services. That may be expedient; I perfectly understand why the definition was chosen. However, I ask the Minister if it is, in fact, wise. We must value our veterans and in doing so we must protect the “brand”. It seems a little odd that a youngster who has turned up at Pirbright or HMS Raleigh, disliked what he saw and taken the next train back home should be given the privileges of a 30-year-old who has deployed half a dozen times and has a chestful of campaign medals. A more realistic definition would be that personnel have at least passed out of basic training, and I ask the Minister to give that suggestion some thought.
I agree with the Government and disagree with the Committee over the flagging of veterans for the purposes of health care. We need to be careful to protect the confidentiality of servicemen and that extends to the Defence Medical Information Capability Programme. Can the Minister confirm that the same opt-outs that apply to civilians and the national programme for IT in the NHS will apply to servicemen and DMICP? DMICP was meant to be available in a deployable form from this year, but I have not seen it. Where is it, and how far behind schedule is the programme? Can we take it that the operational capability envisaged for 2010 will not now be achieved?
If I may express a few gentle words of surprise at the Select Committee’s report, I would have to say that it focused very much on secondary care, both in this country and on deployment. I am afraid that a constant failing of politicians is that we like to think of health care in terms of hospitals, surgeries and so on. We need to understand that in service medicine, as with practice in civilian life, most encounters take place in a non-secondary care setting. There might have been a little more recognition of the importance of public health and preventive medicine.
It is important that we pay close attention to what one might call service-attributable illness and injury. We should ensure that, as far as possible, people are not harmed by virtue of their service, and that such an approach extends well beyond post-traumatic stress disorder and traumatic amputation. Had there been a little more time, the Committee might have considered the excellent research work done in the DMS, in particular by research institutions such as the Institute of Naval Medicine in Gosport and the Institute of Aviation Medicine. They do extremely important work to enhance clinical care and occupational health. We should not overlook the niche capabilities—some of which are found in those institutions—that are not easily available in the NHS and which the armed forces must continue to provide from their own resources, such as hyperbaric medicine, aviation medicine in general, field and survival medicine, and medicine that deals with the health issues relating to human factors and the extreme physical and environmental circumstances encountered by the armed forces.
The Select Committee report did not dwell on pinch points in the DMS other than to say that there is a problem with retention. Again, had there been time, there might have been some exploration of the impact of the shortage of uniformed psychiatrists. I was surprised that in his statement today, the Secretary of State spoke about deploying psychiatrists. What he neglected to say, of course, was that there are not really any to deploy.
Mental health is an area of service health care that requires, more than most disciplines, an in-depth understanding of the occupational situation in which patients exist and to which we hope that, ultimately, they will return, yet the DMS is short of 14 uniformed psychiatrists—at least it was in January. What impact does the Minister think that that has on the quality of health care provision and what is he doing to improve matters?
The Priory Group’s extended contact expires this November. Can the Minister say when the result of the compulsory competitive tendering exercise to find a replacement will be known? Can he update us on the pilot schemes for veterans’ mental health being run by Combat Stress?
The hon. Member for North Durham (Mr. Jones) spoke correctly about the impact of the press and much of the unsubstantiated adverse reporting that we find in certain elements of it. May I suggest to him a pamphlet published last week about the misunderstandings surrounding the Muslim community in this country? It was written by a journalist—Mr. Peter Oborne, as it happens—and examined the issue well and in some depth. It is a good piece of work and, in the sense that it was written by a journalist, is by a poacher turned gamekeeper. I found it very instructive indeed.
Mr. Kevan Jones: Are we to infer from what the hon. Gentleman says that he will tell the hon. Member for Woodspring (Dr. Fox) not to use some of those spurious arguments when he takes part in defence debates in the House of Commons in the future?
Dr. Murrison: I will defend any of my colleagues and, indeed, any constituency MP who highlights such matters in the Commons and calls Ministers to task on any area of responsibility at all. Anything that my hon. Friend the Member for Woodspring says is well researched and would not be subject to the kind of scrutiny that Mr. Oborne refers to in his report. Mr. Oborne deals very well with some of the more hysterical reports in the press, and the Opposition, who take a serious view of such things, certainly would not pander to them. I can assure the hon. Gentleman of that.
In concluding my remarks, it is important that I say how much I agree with the hon. Member for Portsmouth, South (Mr. Hancock) and my hon. Friend the Member for Gosport (Sir Peter Viggers) in their defence of the work at Haslar. I served at that hospital, which has provided first-rate medical care for many years, and I pay tribute to all those who have worked there. I very much hope that even at this late stage we can review the site to determine whether there is a military health care use for it that may be helpful to DMS or to some of the other organisations that have been mentioned today. After so many years, it would be a pity to lose it, particularly given the nature of the site, which, as my hon. Friend said, is extremely challenging. It is well set up for health care but may present problems for other usages.
Mr. Hancock: To a great extent, I support and have sympathy with the points that the hon. Gentleman is making. However, on Haslar, does he agree that it was more than mischievous for the Leader of the Opposition, the right hon. Member for Witney (Mr. Cameron), to suggest that if he were to come into office, he would keep Haslar open as a hospital, given that it will close in the middle of next year, and that the transfer from its facilities to Queen Alexandra hospital will be completed by the end of June next year? To give that sort of hope to people who have fought a good campaign was maliciously irresponsible and very unfair.
Dr. Murrison: The hon. Gentleman cannot have it both ways, though it is typical of the party that he represents to try to do so. Nevertheless, I am grateful to him for allowing me the opportunity to put on record my party’s position, which is that, if elected, we would hold a review of the Haslar site and its future in defence health care. That is the position outlined by my right hon. Friend the Member for Witney, (Mr. Cameron) and it remains our position. I am grateful to the hon. Gentleman for allowing me to say precisely that, but I do not think that there were any doubts at all in the minds of anybody associated with Haslar.
Sir Peter Viggers: I was present when the leader of our party made a statement on Haslar in my constituency, and he used exactly the same judicious words that my hon. Friend just used.
Dr. Murrison:
I am grateful to my hon. Friend. I look forward very much to visiting Haslar again in the near future, when I will reiterate the same judicious words. I
would have thought that the matter was simple and fairly straightforward. I look forward to an opportunity to hold the review in the next few months, and I believe that people in Gosport generally and those in defence medicine look forward to that day.
Since defence cost study 15—DCS15—in 1994, the DMS has had a torrid time, yet it has stepped up to the plate time and again. To be honest, I see little prospect of better times ahead, certainly in the medium term, but we live in hope if not in expectation.
4.39 pm
The Parliamentary Under-Secretary of State for Defence (Derek Twigg): This debate on Defence Medical Services has been fascinating. I pay tribute to our armed forces, who, as I have said on many occasions, are outstanding in terms of their bravery, sacrifice and professionalism. As we are talking about Defence Medical Services, I should like to give special mention to our medical service personnel, whom I have seen in Iraq and Afghanistan and at various places in the United Kingdom and elsewhere: they are truly outstanding. Considering the amount of trauma that they have to deal with, both in Iraq and Afghanistan, at field hospitals and in places such as Selly Oak, it is amazing how they cope with that and get on with being the professionals that they are. We must not forget that we are asking an awful lot of them in that regard, so I pay tribute to those people, many of whom are very young. They are truly outstanding.
I am pleased that the Defence Committee made so many visits; it is a tribute to the Committee that it put so much time and effort into this subject—rightly so, because it is vital to the health and well-being of our armed forces. The Committee went not just to Selly Oak and Headley Court, but to RFA Argus to see a field hospital training exercise. Those hon. Members who witnessed that could not but be impressed by it. I pay tribute to the Committee for the time and effort that it put into the report. I regularly sign off submissions to the many questions that it asks, which shows how thoroughly its members do their job. I am grateful for the feedback provided by the Committee, which said that it was impressed, having made those visits and received the relevant information.
I shall not spend too much time talking about Selly Oak, because there is not a lot that we need to defend: the work that it has been doing is outstanding. It is unfortunate that things happened in the media and elsewhere that caused a lot of distress to service personnel and their families, because we know that the treatment and care at Selly Oak, both by the NHS and military practitioners, was outstanding. There were issues to do with welfare, support, reception of relatives and accommodation. However, that was not the NHS’s fault. In fact, that is something that we needed to do and improve, and it is being done by the services. Significant improvements have been made, although I will not go into all of those.
On my last visit to Selly Oak, just a few weeks ago, I talked to almost all the patients there at the time. Again, their view, to a person, was that they had superb treatment, care and welfare facilities. That reflects my experience, having visited many times. There were no complaints; I heard only praise. On occasions, things are perceived as going wrong, or do go wrong, as happens in any hospital
or similar institution, but it is inexcusable to use that as an example showing that the whole thing is wrong, and then say that there is a problem. The true test is talking to the service personnel and their families and seeing the results of treatment, in saved lives and limbs, not just in field hospitals, but at Selly Oak and elsewhere.
I should like to deal with the concerns about meeting the needs of veterans, service personnel and families. We published a Command Paper today, demonstrating our commitment to the best possible care for our service personnel, their families, and veterans. I will tell hon. Members more about that in a few minutes. Over the past two years, we have worked hard to ensure that our medical care remains world class. I accept, as the hon. Member for Westbury (Dr. Murrison) said, that our defence medical staff are under great pressure: they are doing an awful lot, given the tempo of operations at the moment, and we need more people. Although we have met all our commitments, whether in respect of reservists or using civilians, we are asking a lot of defence medical staff, and we have to do more to maintain recruitment and retention. No one has ever tried to deny that from the Government’s point of view. A lot of work is taking place, and given the arduous nature of operations, the dedicated care that those staff give patients is outstanding.
We are all struck by the commitment and hard work of our people in our field hospitals in Iraq and Afghanistan, which Committee members have visited. Those people have to deal with horrific injuries, but they get on and do the job. The field hospital at Camp Bastion has moved from tented accommodation to purpose-built infrastructure: the building is temperature controlled and includes a fully equipped operating theatre, an intensive treatment unit for the most critically injured individuals and state-of-the-art medical technology, such as the CT scanner, allowing high-quality imaging of complex injuries, which ensures swift and accurate clinical decision-making. The facility brings together the skills of experts in trauma surgery and recovery, intensive care and nursing with state-of-the-art equipment. However, we are not simply concerned with saving lives in operations—of course, that is a key factor—as we must do our best to ensure that our wounded have continuity of high-quality care, including rehabilitation. The work of Defence Medical Services and NHS staff at Selly Oak, Headley Court and other facilities is vital to the care of our wounded. I have already praised the people at those facilities for what they do. We continue to build on that success.
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