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Today, we published the first ever cross-Government strategy for supporting our service personnel, their families and veterans. The Command Paper will reinvigorate the cross-Government delivery of services to our service community, as well as providing us with an opportunity to continue to develop our work with the devolved Administrations. The Committee rightly raised a number of issues with regard to that. However, the situation has changed beyond recognition, given the work that is taking place at both official and ministerial level. I have met my ministerial colleagues in the Scottish Government on a number of occasions—I was up there earlier today—and there is a close degree of co-operation. We must keep focusing on that. The Command Paper is about cross-Government working. Supporting our
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servicemen and women, their families and veterans is not just the responsibility of the Ministry of Defence, but is a cross-Government responsibility. I can assure hon. Members that that is taking place and that there is a close degree of co-operation.

We owe our service personnel a debt of gratitude, and it is important that we deliver a comprehensive, fair and relevant package of support, which is set out in the Command Paper. The demands of service life affect not only our armed forces personnel, but their families, who support their careers by accompanying them around the UK and overseas and maintain stability while spouses, parents and/or children are deployed. In addition, we must always remember those who have served and those who paid the ultimate price and the families they left behind. We have a duty to ensure that people receive the support that they need in recognition of their service. While we continue to deliver improvements to the package of support we provide to our service community, we in Government know that more is possible. This work underlines our commitment to work relentlessly to continue to improve health care services to service personnel, their families and veterans.

A lot has been said today about Headley Court and, as I said earlier, I share the Defence Committee’s recognition of the achievements of the staff and patients there. As hon. Members will know, I visit the centre regularly. The dedication and hard work of the staff there, and the courage of the patients, never ceases to amaze me. The Government promised in their response to the Committee’s report to make available the outcomes of their review of rehabilitation services as soon as they were ready. I am pleased that we were able to provide the Committee and Parliament with that information in May.

The review concluded that defence medical rehabilitation is a success story, returning service personnel, whenever possible, to full operational fitness faster than in the past. The review confirmed that Headley Court should continue to be the specialist centre for rehabilitation, and it recommended further improvements to allow it to continue to deliver first-class rehabilitation. Indeed, today’s Command Paper underlines the Government’s commitment to ensuring the high level of care provided by Headley Court through to the NHS.

My right hon. Friend the Secretary of State announced on 6 May that we have decided to invest an additional £24 million in the Headley Court site, as hon. Members have mentioned, over the next four years, to maintain and enhance the facilities and capabilities. It is an old, tired building and it needs work, as we must make a number of improvements. The additional money will enable us to replace the new ward annexe, which was designed to be a temporary structure, by extending the Peter Long unit and incorporating into it an extension and an expanded prosthetics facility, treatment areas and imaging facilities. That money will allow us to replace progressively, over the next few years, all the existing 180 non-ward bed patient and staff accommodation.

I pay tribute to the charitable bodies that have contributed to the work at Headley Court and its predecessor organisations since it first opened its doors to RAF patients shortly after the second world war. The estate is owned by a charitable trust, which has contributed generously to the improvement of facilities on the site. The Soldiers, Sailors, Airmen and Families Association
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has purchased a house in nearby Ashtead, which was opened earlier this year as a home-from-home for families visiting patients at Headley Court, supplementing accommodation that we provided on-site.

Last year, a new charity, Help for Heroes, generously offered to raise funds for a swimming pool and gym, which would together form a new rehabilitation complex, with additional space for rehabilitation and assessment. There are already a number of gyms on the site, and a hydrotherapy pool as well. It is important that we work closely with the service charities and other charities to ensure that we can provide the best possible support for our service personnel and their families. That has always been the case. Nevertheless, I welcome the help given by charities. As I said on 6 May, my right hon. Friend the Secretary of State has decided to invest £24 million, but with current funding for facilities, Headley Court will see investment over the next four years totalling some £28 million, in addition to the funding that Help for Heroes will provide.

Turning to investment and improvement at Birmingham, I was delighted earlier this month to visit the site of the new hospital. It is not yet complete, but I went into a ward that had been provided with some beds showing the form of the cubicles and individual rooms to get an idea of scale, and I was impressed. There will be a military ward at the new Birmingham hospital, and most people accept that Selly Oak hospital is at the leading edge of medical care for the most common sort of injuries sustained by military casualties, such as polytrauma. We have been developing a military-managed ward at Selly Oak hospital, and we want to migrate that concept to the new hospital at Edgbaston.

The new hospital will offer outstanding facilities for military patients. The military ward—the design has now been agreed in outline—will be a designated trauma and orthopaedic ward within the trust’s trauma and orthopaedic division. It will have additional features for the exclusive use of military patients, acknowledging that they have special requirements and are likely to benefit from being together. It will be the ward to which the majority of military patients will, when clinically appropriate, be admitted when their specialist or acute care requirements have been met. The ward will be managed by a senior military nurse—the ward manager—who will be selected and appointed by the MOD in consultation with the trust, and it will be staffed by a combination of military and civilian nurses, the majority of whom will continue to be military.

Military patients will be cared for in single or four-bedded rooms, all of which will have en-suite facilities. The ward will have the capacity, if required, to accommodate about 30 military patients. That number is higher than the number currently accommodated. Civilian patients will occasionally be admitted to the ward, as capacity allows, but unless a major civilian emergency requires all available bed spaces, it will always be possible, because of the configuration of the ward, to care for military patients separately from civilians.

It was interesting to talk to injured service personnel at Selly Oak. When I asked them about being cared for with civilian patients, many of them said that they had no problem with that. Some do, but it is interesting that quite a few do not and find it useful to be with civilian patients. However, because of the nature and format of the new ward, we can care for our military patients
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separately from civilian patients. We shall incorporate new features in the military ward, and space will be provided exclusively for military use, including a quiet room for briefing relatives, a communal space for military patients to gather, facilities for exercising, and a dedicated military rehabilitation area close to the ward.

The new Birmingham hospital will be Europe’s largest and most modern acute care facility. I am absolutely convinced that it is the right place for the teaching and research work of the Royal Centre for Defence Medicine and the care of our operational casualties. That is why today we have reinforced our pledge to ensure the continuity of the facilities provided by Selly Oak, the enhancement of its ethos, and further improvement of the facilities provided to families.

I shall refer briefly to the midlands project. I am pleased that a decision has been made on the redevelopment of Whittington barracks, Lichfield, for use by DMS. The project’s assessment phase is complete, and the Government have concluded that the strategic, operational, economic and personnel benefits will fully justify an investment of about £200 million over the next few years. Co-location on the Whittington site of the DMS headquarters and the DMS training centre will provide a critical mass of military medical expertise and assets in the midlands. The area will be reinforced as the central focus for British military medicine, and Lichfield will provide the future military home for DMS, which will work in close partnership with local universities and the NHS. All the related military medical activities benefit, and can benefit further, from relatively close proximity.

Our project assessment confirmed that the Whittington site offers excellent potential for meeting DMS needs. A combination of new build and the upgrading of existing buildings will provide high quality, fit-for-purpose accommodation, training and sports facilities within easy travelling distance of Birmingham, including the RCDM. The site also offers an adjacent military training area, and full planning approval for the redevelopment of the site has been granted. The project will be delivered in three increments. The first will be the relocation to Lichfield of new strategic medical headquarters and headquarters for the recently established joint medical command by 1 April 2010. Increments two and three will be the relocation of the DMS training centre, and the provision of training facilities and accommodation for staff and trainees between 2010 and 2014. By the end of the project, there will be more than 1,100 DMS personnel at Lichfield, including up to 700 trainees. The project will deliver 811 new single living accommodation bed spaces. The decisions announced yesterday on military medical accommodation in the midlands are further evidence of the Government’s commitment to the health care of service personnel.

I want to bring hon. Members up to date on significant and perhaps under-appreciated developments in DMS clinical care, especially the early stages of the care of battlefield casualties. During the past 18 months, DMS has developed and introduced a number of advances to ensure that it has assessed best practice worldwide, including US experience, and it has carefully audited the outcomes using internationally accepted methods.

The recently published Journal of the Royal Army Medical Corps provides the most comprehensive collection of papers yet of UK medical experience on current
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operations. It shows that the priority that we have placed on maximising survival on the battlefield has proved successful. The underlying message is that more personnel are surviving than would be expected, given the severity of their injuries; that the quality of care for the injured is at least the equal of that usually found in the UK; and that our success coincides with the introduction of a significant number of initiatives.

Dr. Murrison: The Minister cited the Journal of the Royal Army Medical Corps. Does he recall, as I certainly do, a paper that it printed about two years ago by a distinguished orthopaedic surgeon and member of the RAMC, which pointed out that there is a severe airlift shortage for combat evacuation in theatre? If he does, will he assure us that that has now been rectified?

Derek Twigg: The hon. Gentleman will be aware that we have increased the number of helicopter hours. I make regular checks, and the medical evacuation teams in Afghanistan are doing an amazing job and saving lives today that might not have been saved a few years ago. We are always trying to put more resources in. We have increased the number of helicopter hours, and we are trying to increase them further, but our medical services in Afghanistan are of such a standard that they are saving lives that might not have been saved a few years ago. That is due partly to improvements in civilian medical care and the introduction of CT scanning on deployment, and to our ability rapidly to exploit new technologies and equipment such as the introduction of a bandage that reacts with blood; a bandage that enables local pressure to be better applied to a wound; and a tourniquet that can be applied one-handed, and is issued to every soldier. That has given our soldiers the means to save their own lives. We are sharing those lessons with the NHS and civilian health authorities, not least because reservists are going back into the NHS, so they are benefiting the country as whole.

It is important to make the point that others provide support, including the National Blood Service, through the provision of blood and platelets to deployed theatres. Such services, together with the Medicines and Healthcare products Regulatory Agency, provide support and governance advice in procuring equipment and setting up a process that enables us to take blood from soldiers in theatre, remove the platelets and return the red blood cells to the donor so their performance is not compromised. That represents a technological solution to the medical and logistical challenges posed by the need for platelets to be delivered daily to theatre. The Defence Medical Services are determined to learn constantly, to engage in scientific debate, to stimulate further research and development that will assist us to maximise the survival rates of personnel injured on the battlefield, and to improve the quality of life for the survivors.

On the priority treatment of veterans and associated issues, we all accept that over decades entitlement to priority treatment has not been made well known to veterans and has not always been used as we would have liked or expected. We made an announcement towards the end of last year about extending the priority so that GPs can make referrals if they believe that an injury was caused in service. The reinforcement of that is now taking place for GPs, primary care trusts, hospital trusts and so on, which is a good step forward.

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The Committee rightly raised concerns about how we make that process stick and work. It is right to deal with that, which is why the cross co-operation between ourselves, the NHS and the devolved Administrations is important. It is important to get the information out through the ex-charitable organisations, journals, websites, the Veterans Agency and GP surgeries. I accept that if I asked some GPs if they know about the announcement, they might well say, “I’m sorry, I don’t know about that. I get lots of information passed through to me about various issues.” The key is to keep ensuring that we reinforce the message. The way to do that is to keep checking that the message is getting through. However, something that has not happened in decades is not going to happen within a few months. We must maintain the pressure in relation to that and I assure hon. Members that making sure health care workers are aware of that process is one of my priorities.

In terms of veterans health and tracking, hon. Members will appreciate that although we accept that more can and should be done, the millions of veterans we currently have—three still from the first world war, many from world war two and many from the period of conflict in Northern Ireland—means that it is impossible to track veterans. The records do not exist and people move or there are changes in many other sorts of circumstances. The defence medical records system and the link to the NHS mean there is an opportunity to do more, which we will consider.

It is a fact that once some people leave the services, they do not want anything more to do with the military and that is the end of it—although they might change their mind in 20 or 30 years’ time. It is also a fact that the vast majority of service personnel do not have any issues or problems whatsoever; they get into employment pretty quickly and get on with life. They use their immense skills, training and various professional attitudes to become good citizens who contribute in a variety of ways. We must do more for those who do get into difficulty because it is a great tragedy when that happens. We will, of course, continue to explore how we can do more in that area, as the Committee has requested.

I shall emphasise a number of the initiatives we have launched in relation to mental health. There were also a number of issues that we set out today in the Command Paper. In terms of the mental health pilots, we started first with Camden and Stafford and we are still rolling out the rest. It is early days yet to take a concrete view on the success of the pilots, but they seem to be working well. We are working with Combat Stress and, of course, the NHS to provide veterans with a mental health service. Over the next few years, initiatives are also taking place in the NHS to increase therapists. That is a key part of the process and will take account of the issues around veterans’ health.

The extension to the medical assessment project that I announced across the river at St. Thomas’ hospital means that any veteran from 1982 onwards can go for a mental health assessment. They should primarily be referred to an assessment by a GP, but they could self-refer.

Linda Gilroy: May I remind the Minister of a point made about the funding and Combat Stress? I appreciate that extra funding has gone in, but I believe that the
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specific problem is about the new NHS model of funding that is being developed, rather than the MOD model. Is the Minister aware of that?

Derek Twigg: I am not aware that that is a problem. The point is that we are working together with Combat Stress and the NHS to develop the veterans’ mental health service. We have put significant funding into Combat Stress and I see Toby Elliott, its chief executive, on a regular basis. I am not aware of the specific problem that my hon. Friend mentioned, but I am happy to come back to her on that.

Willie Rennie: My understanding is that the concern is that the future funding of Combat Stress will come through the Ministry of Defence, rather than the NHS.

Derek Twigg: It is important to ensure that those who need help go to the right place and therefore commissioning to provide that is the right way to go. That help might be at a Combat Stress facility or it might be part of the NHS. Obviously, by that stage, we hope there will be a service for veterans’ mental health. The key thing is to make sure that the veteran is directed to where they can best get help, and commissioning that process by working together is the correct way forward.

Mr. Hancock: May I return to the issue of giving proper support for veterans and raise the point again about veterans in prison who suffer from psychiatric illness? They will not have organisations such as Combat Stress available to them and will not have some of the dedicated medical care that is available to civilian veterans. Those in prison are particularly vulnerable and need to be given some consideration. The link between the MOD and the prison service needs to be considerably strengthened.

Derek Twigg: The hon. Gentleman makes an important point and research has taken place on the issue. Dr. Ian Palmer, the psychiatrist who runs the medical assessment programme at St. Thomas’, has offered his services, about which I have written to the Under-Secretary of State for Justice, my hon. Friend the Member for Liverpool, Garston (Maria Eagle). He is willing to go into prison to do assessments. That offer has been made, but the hon. Gentleman is right: we need to consider what more we can do in that area, as it is of concern.

Willie Rennie: I should have made it clear to the Minister earlier that Combat Stress is concerned that it would have to bid to a variety of NHS trusts throughout the country, rather than just to the Ministry of Defence. That would create a huge bureaucratic burden on Combat Stress and might make its operation quite difficult.

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