Select Committee on Defence Seventh Report


The Defence Medical Services (DMS) provide a range of healthcare, from treating Service personnel injured in combat to providing rehabilitation for sports injuries in the UK.

The clinical care for Servicemen and women seriously injured on operations is second to none. DMS personnel, working with the NHS, provide world-class care and we pay tribute to them. Recent improvements at the Royal Centre for Defence Medicine in Birmingham in areas such as ward management and welfare support are welcome. We acknowledge this progress, and encourage the Ministry of Defence to continue it, and to incorporate these considerations into its plans for developing the facilities in and around Birmingham. There has been considerable inaccurate reporting about the care at Selly Oak. We strongly deprecate this behaviour, and believe editors have a responsibility to ensure that their newspapers report on the basis of facts rather than hearsay.

The DMS's rehabilitation services, especially at Headley Court, are exceptional, and are contributing enormously to the welfare of injured Service personnel. We welcome the review of Headley Court in the light of the continued high operational tempo, and look forward to its results.

Services are delivered to Armed Forces personnel by the MoD, the NHS, and charities and welfare organisations. We believe this is right, and builds on a proud tradition in the UK of linking the community with the Service personnel who have been injured fighting on their behalf. However, the Government and voluntary organisations should engage with a wider public debate about which services are most appropriately provided by each sector.

The MoD's decision to base its secondary care around units embedded in NHS Trusts was, and remains, a sound one. It allows DMS personnel to work side by side with civilian clinicians to develop and maintain their skills, while offering the opportunity for Servicemen and women to be treated in a semi-military environment. However, more needs to be done to address the sharing of best practice between the DMS and the NHS.

Devolution means that the MoD must cooperate with a number of different health departments to provide the full range of appropriate services for Armed Forces personnel, their families and veterans. This cooperation is usually good, but we found that in Scotland it was often inadequate. The MoD must review the structures through which it engages with other departments and administrations. The Scottish Executive must also examine its procedures for engagement and cooperation and look at how improvements could be made.

We welcome the Government's extension of the priority access to healthcare available to veterans but we are not sure that adequate procedures are in place to identify veterans and to ensure that priority access. The MoD's reliance on self-identification is simply not good enough. We are also concerned that medical records are not transferred efficiently enough from military to civilian clinicians. An automatic system of transferring medical records and tracking veterans in the NHS, with an option to opt out, would provide a more robust system which took account of individuals' privacy.

The MoD provides high-quality healthcare for Service families abroad, but spending has lagged behind that in the NHS. There are also doubts about the long-term viability of the stand-alone hospitals in Cyprus and Gibraltar. The MoD must say what plans it has made for the facilities, and how it will continue to provide healthcare for Service communities overseas. It should also set out a timetable for tackling this issue.

Mental health is a vital responsibility for the DMS. We acknowledge the progress they have made and their adoption of a preventative approach where possible. Their community-based system of mental healthcare is in line with NHS best practice. We pay tribute to the work of Combat Stress in assisting veterans with mental health needs, but we are concerned that the identification and treatment of these veterans is not sufficiently thorough or systematic. The NHS needs both a robust method of tracking veterans, and a detailed understanding of their problems.

Reserve personnel play a critical role in the delivery of military healthcare. The Territorial Army has so far met around half of the Armed Forces' medical commitment in Iraq and Afghanistan. The public should recognise the contribution which the Reserve forces make to the military and to society as a whole. The MoD needs to make sure that the Reserve forces are not overstretched and that recruitment and retention remains buoyant.

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Prepared 18 February 2008