Select Committee on Defence Seventh Report

Conclusions and recommendations

1.  We find the arguments in favour of the closure of the stand-alone Service hospitals irresistible. We accept that the reduction in numbers of personnel which took place in the Armed Forces after the end of the Cold War meant that there was insufficient patient volume to make the military hospitals viable in the long term (Paragraph 14)

2.  The principle behind the decision to move from stand-alone military hospitals to facilities which co-operate with the NHS was the right one, from a clinical, administrative and financial point of view, and we see no evidence that the care offered to military personnel has suffered as a result. Indeed, we believe that Armed Forces clinicians now have experience of a much broader range of cases, which benefits their training. We also support the decision by the MoD to disengage from the Haslar site. (Paragraph 14)

3.  It seems clear that there has been much inaccurate and irresponsible reporting surrounding care for injured Service personnel at Birmingham, and that some stories were printed without being verified or, in some cases, after the Trust had said that they were untrue. We condemn this completely. Editors have a responsibility to ensure that their newspapers report on the basis of verified fact, not assumption or hearsay. The effect of such misrepresentation on the morale of clinical staff and Service personnel and families was considerable. We consider the publication of such misleading stories as reprehensible. (Paragraph 29)

4.  We acknowledge the progress which has been made at Selly Oak in terms of creating a military environment, to take advantage of the healing process of being surrounded by those who have been through similar experiences, to make patients feel comfortable and give them familiar surroundings. The MoD has made substantial efforts in this regard, and we look forward to hearing of further progress in the response to this report. The MoD must make sure that the issues of welfare for patients and families are central to its planning in developing its medical facilities in and around Birmingham. (Paragraph 34)

5.  We also welcome the improvements in welfare provision and pay tribute to the work of welfare and charitable organisations. We consider that there is nothing intrinsically wrong in welfare and charitable organisations contributing to the support of our injured Service personnel. Indeed, quite the reverse is the case, since it builds on a proud tradition in the United Kingdom of linking the community with the Service personnel who have been injured fighting on their behalf. The MoD and the voluntary sector should engage openly with the debate about which services are more appropriately provided by the Government and which by charities and voluntary groups. (Paragraph 35)

6.  However, we also underline the fact that many of the improvements set out above are relatively recent, and there has been a great deal of change over the past 18 months. The MoD should not be complacent: they have had to learn important lessons and it is clear that the picture at Selly Oak was not always so positive. Nor should progress now stop, but the MoD should continue to learn lessons from its experiences in treating injured Service personnel at Selly Oak. (Paragraph 36)

7.  We acknowledge the case for concentrating the main clinical and training assets of the DMS and DMETA on one cluster of sites. While Birmingham may not be close to a major Service community, we accept that it is suitable in terms of transport links and proximity to a university, both of which are important factors. However, the MoD needs to make its case for the Birmingham-Lichfield 'dumb-bell' more explicitly, and we expect the Government response to our report to set out in detail the plans and progress on this. The MoD and, where appropriate, the voluntary sector should also make sure that there are adequate travel and accommodation arrangements for families visiting patients in Birmingham, and, as important, that these are easily understood and accessible. (Paragraph 43)

8.  The UHBFT/RCDM services are delivered at Selly Oak in buildings which are in many cases ageing. Delivery of the PFI development is scheduled to bring new, state-of-the-art buildings and facilities by 2012. We expect the MoD, as part of its annual reporting process, to state whether delivery on the Birmingham New Hospitals project is on target. (Paragraph 44)

9.  We were very impressed by the services at the Regional Rehabilitation Unit we visited in Edinburgh and commend the staff for their excellent work. The MoD's approach to musculo-skeletal injuries is forward-looking and sensible, and we are persuaded that it has been of significant benefit to Service personnel as patients, and to the efficiency and effectiveness of their units. (Paragraph 47)

10.  We readily acknowledge the extraordinary work which is carried out at Headley Court and have nothing but praise for the staff, who have had to cope with an increased tempo of operations and treat patients with injuries which, only a few years ago, would have been fatal. We regard this as a good example of the Government and charities cooperating to provide those services which they can most appropriately deliver. We were astonished by the ability of some gravely-injured Service personnel to be successfully treated, and to return to active military duty. However, we are concerned by reports of problems with the local community in terms both of developing the facilities at Headley Court and of using local authority amenities. If it is true that some local residents objected to the presence of Service personnel, we find that attitude disgraceful. The Government should make the outcome of the current review into the facilities at Headley Court fully available, and should explain what planning it has done to account for the increased operational tempo and its implications for Headley Court. (Paragraph 54)

11.  We are satisfied that the MoD and the Department of Health are aware of the management problems which the deployment of personnel from MDHUs poses for the Trusts in which they are based and that they are working in a coordinated way to minimise these problems. (Paragraph 57)

12.  The principle which underlies MDHUs is a sound one. We believe that embedding DMS personnel in NHS trusts to work side by side with civilian clinicians is the best way to develop and maintain their skills, as well as providing an opportunity for Servicemen and women to be treated in a semi-military environment. We were impressed by the MDHUs which we visited and are satisfied that they deliver high-quality care to military and civilian patients. (Paragraph 61)

13.  The MoD and the Department of Health should address the sharing of best practice as a matter of urgency. More structured exchange of skills and techniques is in the interests of the NHS and Service personnel. We also consider it probable that the MoD, when working alongside forces from other countries, will learn lessons from differing approaches adopted by those other countries which could usefully be shared with the NHS. We expect the response to this report to explain in detail what steps will be taken to encourage this. (Paragraph 62)

14.  We appreciate the strength of Service loyalties and the power of traditional connections, but we suggest that more needs to be done to ensure that MDHUs are representative of a genuinely tri-Service DMS. (Paragraph 63)

15.  The priority in the treatment of injured Service personnel must be to return them as quickly as possible to operational effectiveness, so it is sensible for the DMS to use whatever mechanism delivers this objective most efficiently. The MoD should express more clearly the arrangements for 'fast track programming', and we are concerned that they are not fully or properly understood by all parties involved. (Paragraph 64)

16.  Our visit to Scotland left us deeply concerned. It is unreasonable to expect any administration, whether in Whitehall or one of the devolved assemblies, to micromanage the agencies which execute its policies. But depending on guidance and taking a laissez faire approach to making sure that such guidance is implemented is totally inadequate, and reinforces our view that the issues confronting Service personnel and their families are not sufficiently high up the list of priorities for the Scottish Executive. (Paragraph 69)

17.  We accept that plurality is an inevitable outcome of the devolution settlement. However, we are concerned that the provision of some aspects of healthcare in Scotland, for Service personnel and their families, is not always given the priority it deserves because of poor cooperation and communication. The MoD must review the structures through which it engages with other departments and administrations, and explain how it intends to improve the situation. We also expect the Scottish Executive to review its arrangements in response to our report. (Paragraph 70)

18.  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. (Paragraph 75)

19.  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. (Paragraph 76)

20.  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. (Paragraph 79)

21.  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. (Paragraph 80)

22.  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. (Paragraph 83)

23.  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. (Paragraph 85)

24.  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. (Paragraph 89)

25.  We consider that the MoD provides adequate mental healthcare for serving members of the Armed Forces. We have been told on visits that there is a culture of individuals 'bottling things up' inherent in the Services, but we note with approval the steps which have been taken to attempt to prevent problems through 'decompression'. This should be an integral part of the procedures for all personnel returning from operational tours. It is also important that the problems which can arise are recognised throughout the Services, so that early warning signs can be spotted and dealt with before problems get worse. We believe it is sensible to approach mental healthcare from community-based provision, delivered in conjunction with local military units, in-patient treatment being a last resort. The MoD should also review its contract with the Priory Group to assess its effectiveness. (Paragraph 97)

26.  We welcome this additional funding, and pay tribute to the work which Combat Stress is doing. The MoD is right to engage with private organisations such as Combat Stress where that is appropriate, but it must continue to ensure that the organisation is adequately funded and has the clinical capability to deal with the patients who are referred to it. The MoD should also think more strategically about, and explain in their response to this report, their relationship with private and charitable organisations, and the extent to which they should provide services on behalf of the Government. (Paragraph 104)

27.  We are concerned that the identification and treatment of veterans with mental health needs relies as much on good intentions and good luck as on robust tracking and detailed understanding of their problems. If the NHS does not have a reliable way of identifying those who have been in the Armed Forces, then it already has one hand behind its back when it comes to providing appropriate clinical care. We repeat our belief that there must be a robust system for tracking veterans in the NHS, and this should feed into enhanced facilities for addressing their specific needs. (Paragraph 110)

28.  We understand and appreciate the vital role which Reservists play in delivering the Armed Forces' healthcare capabilities, and believe that they are an integral component of the DMS. We have seen ample evidence of excellent cooperation between Regular and Reserve forces, and believe that Reservists bring important skills to the Armed Forces. We also think that operational deployment gives members of the Reserve forces the opportunity to make use of their training when back in the UK. (Paragraph 118)

29.  The MoD must not take the integral involvement of Reservists for granted. It must make sure that recruitment remains buoyant and that retention is sufficient to guard against any degradation of capability. It must also ensure that members of the Reserve forces receive proper support, both from their civilian employers, and from the Armed Forces when they return from operational deployments. The public should recognise the contribution which the Reserve forces make to the military and to society as a whole. (Paragraph 119)

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