Select Committee on Defence Seventh Report

5  Care for veterans and Service families

Priority access for veterans

71. Medical care for ex-Service personnel is the responsibility of the NHS. However, since 1948, there has been an entitlement to priority access for war pensioners to treatment for conditions relating to their service.[51] On 23 November 2007, the Government announced that this priority access would be extended to all veterans for conditions which were believed to derive from service. This followed a pilot project run by Hull Primary Care Trust, and the Health Minister estimated that it would extend priority access from around 170,000 veterans across the UK to a figure in the region of 5,000,000.[52]

72. Just as important as priority access to treatment for veterans is ensuring that those who are eligible are aware of their entitlement and how to benefit from it. Andrew Cash, Co-Chair of the DH/MoD Partnership Board, said that this was a two-part process: personnel would be informed of their entitlement while in the Armed Forces, while the arrangements would also be explained in the operating framework issued to PCTs and to general practitioners.[53]

73. The new system will, therefore, rely on self-identification by veterans, some of whom may be reluctant to make their status known. This seems to present a fundamental problem. Even assuming the seamless transfer of medical records (which we consider in paragraphs 77-79 below), a clinician will not automatically have any way of knowing that a patient has served in the Armed Forces, let alone that his or her condition may be related to the period of service. This is all the more problematic given that some conditions can show symptoms months or years after the patient has left the Armed Forces (particularly in relation to mental health, which we consider in Chapter 6 below).

74. In response to these criticisms, the Surgeon-General counselled caution. He told us that:

Not all veterans want it to be known that they are veterans, so we just need to be careful about being too proactive in some cases. An individual who has left the Armed Forces, in some cases, not many but in some cases, may wish that severance to be complete, and we need to be very careful about being too proactive and overriding an individual's wish.[54]

75. We welcome the Government's extension of the priority access available to veterans in England. However, the MoD must explain clearly what it is doing in conjunction with the devolved administrations to ensure that this entitlement extends across the UK. It should also give a clear definition of who qualifies as a veteran and is therefore entitled to this treatment.

76. We also acknowledge that the implementation of the policy will present some challenges in terms of privacy. However, the MoD and the Department of Health need to do much more to make sure that the entitlement to priority access is widely understood and taken up by those who need it. We do not believe that there is currently a sufficiently robust system for tracking veterans in the NHS, and we expect the MoD's response to this report will set out the Government's thinking on how this could be improved. Simply to rely on the individual to bring his or her status as a veteran to the attention of a clinician, given some of the conditions which are common among ex-Service personnel, is inadequate and an abdication of responsibility. We believe that an automatic tracking system with an 'opt-out' provision would balance the need for robustness with the protection of individuals' privacy.

Transfer of records

77. An issue which goes hand in hand with priority treatment for veterans is the transfer of medical records from the military to the civilian clinician. The system as it was explained to us is that those leaving the Armed Forces, after having a medical examination, are given a summary of their medical history to present to a civilian general practitioner upon registering. The GP can then, if necessary, request the full medical records of his or her patient from the MoD, relating to the period of service in the Armed Forces.[55] The Health Minister also claimed that the transfer of the summary would become automatic under the NHS National Programme for IT when the NHS and MoD computer systems were integrated.[56] The Surgeon-General added that he did not think the system was ineffective, as there was currently no backlog of requests from GPs for military medical records.[57]

78. The system remains essentially reactive. It is the responsibility of the individual veteran to present the GP with a summary medical report, and the responsibility of the GP to request the full records if necessary. We heard anecdotal evidence from Service personnel that the procedures do not always operate as they should, that records are not transferred, are not fully disclosed, and are not always accepted by clinicians, for example when needed for insurance policies. Commodore Elliott, Chief Executive of Combat Stress, put the problem plainly:

The procedures for medical discharge involve handing the patient across to the National Health Service, and the medical records go with the patient into the NHS. All too frequently the problem is that the Services do not know where that patient will end up. He has nowhere to go. A lot of servicemen who are being discharged will not contact their local GPs and all the services that they should connect up to until they are in trouble, and therein lies a huge problem.[58]

79. We remain concerned that medical records do not transfer as seamlessly from the Armed Forces to civilian life as they could. Too much is left to the initiative of the patient, and on our visits we heard that the existing system often works imperfectly. We recommend that the MoD re-examine its procedures with regard to medical records and examine ways in which there could be an automatic transfer of records and a more effective safety net for those who, for whatever reason, do not take the initiative in transferring or requesting records. We also ask the MoD to give us an update on the progress of its IT system, the compatibility with the NHS National Programme for IT, and its anticipated schedule for implementation of the new system.

Wider implications

80. The care of veterans is important not just in terms of making sure that first-class healthcare is available swiftly and easily to those who have served the country. It has a wider impact on the perception of Service life, both in terms of Service personnel and their families, and in terms of the community at large. We have already expressed concern over the issue of recruitment and retention of personnel by the Armed Forces.[59] We believe 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, and, as such, has an impact on recruitment and retention.

Service families overseas

81. The MoD is responsible for the delivery of healthcare to Service families posted abroad. It is provided in a number of different ways. In Germany, British Forces Germany Healthcare Services (BFGHS) is a partnership between the MoD, Guy's and St Thomas' NHS Foundation Trust, the Defence Medical Welfare Service, SSAFA Forces Help and the Defence Dental Service which provides "seamless primary, community, secondary and tertiary care". Hospital facilities are the responsibility of Guy's and St Thomas', which subcontracts with five German provider hospitals. In the Permanent Joint Operating Bases (PJOBs) at Cyprus and Gibraltar, primary healthcare is provided by PJHQ, using primarily Service personnel, while secondary care is provided by The Princess Mary Hospital (Cyprus) and the Royal Naval Hospital (Gibraltar). There are also contracts with some local healthcare providers and UK-based NHS hospitals to provide access to services which MoD resources cannot supply.[60]

82. SSAFA Forces Help, which is involved in providing some healthcare services for families abroad, observed that the standard of care offered was "generally very satisfactory and indeed in most cases excellent". However, it warned that the substantial increases in funding for the NHS had not been matched by the MoD in terms of funding healthcare abroad: the NHS budget had risen by 5% a year since 2002, while the MoD's expenditure had risen by only 2%. Given that it was necessary to pay military clinicians comparable salaries to those of civilian staff, the funding gap was exacerbated.[61] The Minister accepted that the MoD had not been able to match the rate of increase in expenditure enjoyed by the NHS. He told us in November that it was a subject of ongoing discussions with the Treasury.[62]

83. We acknowledge that Service families posted overseas generally receive very good healthcare through sensible partnership arrangements. We are glad that the MoD accepts that its spending has lagged behind that of the NHS. It is essential that medical care for our Service personnel posted overseas should keep pace in every way with the NHS, so that they are not penalised for joining the Armed Forces.

84. Another issue which is under review is the continuing existence of stand-alone hospitals for Service communities overseas in Cyprus and Gibraltar. When we visited The Princess Mary Hospital at RAF Akrotiri in November 2006, we saw a facility which was clinically of a very high standard, but which was serving a population of a size so small that the facility was underused and overstaffed. However, it was not possible to outsource the provision of all services to local providers. Equally, it was reliant on visiting clinicians or locums from the UK for some services. This made clinical continuity and the maintenance of skills difficult.

85. We doubt if the establishments in Cyprus and Gibraltar are clinically or financially viable in the long term. The MoD should make clear how it intends to address this problem and what options are being explored for maintaining healthcare provision for Service communities in a more effective and efficient manner. It should also set out a timetable for tackling this issue.

Service families in the UK

86. One of the major issues for Service personnel and families returning from overseas postings is making the transition from a situation in which the MoD provides healthcare, to a situation in the UK in which families (though not Servicemen and women) are entirely reliant on local NHS services. Particular concerns have included the process of registration with NHS general practitioners and dentists (pressure on the latter is particularly acute, as has been reported widely in the media), and the management of expectations when transferring from one regime to the other.

87. The problem of dentistry in particular was put to us by Sammie Crane of the Army Families Federation. She identified two aspects of this problem. The first was that Service families move so regularly that it could be very difficult to get to the top of a waiting list for an NHS dentist, while such lists are non-transferable. The second, anecdotal, issue was that families in which both parents are Service personnel, and whose dentistry needs are taken care of by the MoD, often found that dental practices would not register children unless one parent was also registered with that practice.[63]

88. There appeared to be an acute lack of support for families in Scotland making the transition from postings abroad to those in the UK. The Scottish Executive told us that "these are really matters for the MoD", and demonstrated no substantial awareness of the problems which Service families faced.[64] Asked whether more could be done to ease the transition, one official responded, "I suppose they [the MoD] could give them an information pack".[65] The impression was created that Service families would have no more information and support in getting access to healthcare after prolonged absence overseas than any other sector of the population.

89. We acknowledge that the healthcare of Service families in the UK is the responsibility of the NHS. However, the MoD has a part to play, and should be doing more to support Service families during the transition from overseas postings to reliance on NHS healthcare. There should be better cooperation between the MoD and health departments across the UK. The Scottish Executive also has a responsibility to improve its procedures in this regard. Providing this sort of support is a vital part of maintaining morale among Service personnel themselves and their families, which has such a profound effect on the retention of experienced Servicemen and women.

51   Ev 95 Back

52   Q 373 Back

53   Q 385 Back

54   Q 390 Back

55   Q 389 Back

56   Q 387 Back

57   Q 390 Back

58   Q 85 Back

59   Defence Committee, Fifth Report of Session 2007-08, Ministry of Defence Annual Report and Accounts 2006-07, HC 61 Back

60   Ev 95 Back

61   Ev 112 Back

62   Qq 467-69 Back

63   Q 57 Back

64   Q 312 Back

65   Q 311 Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2008
Prepared 18 February 2008