Memorandum from the Royal British Legion
Thank you very much for the invitation
to take part in the Defence Committee's inquiry into medical care
for the Armed Forces.
We very much look forward to the results
of the forum that you launched in April, and hope that the exercise
will provide you will some valuable first-hand information. We
would like to submit the following written evidence:
1. Transferring to the NHS—with
regard personnel and families returning from overseas postings,
and those being discharged from the military, more needs to be
done to manage the transfer of medical care and the expectations
of individuals. Many of the issues in this area seem to stem from
the change between private/public or "medicare" health
systems that operate overseas, and in-Service health care arrangements,
to the NHS. There is little that the Ministry of Defence (MoD)
can do to improve services in the NHS, or the administrative requirements
to register with GPs. However, there is room for progress toward
a seamless transfer of health care, particularly at medical discharge,
and more that can be done to manage the expectations of individuals.
2. Healthcare for those on
operations—the current survival rates for those who have
injured in the course of active operations are very impressive.
The evidence suggests that more people than ever before are surviving
very serious and complex injuries on the battlefield. The efforts
of field hospitals should be applauded.
3. Healthcare for those evacuated
to the UK—the media criticism on this issue has been relentless.
We believe that was cause for serious concern during the first
few years of the conflicts in Afghanistan and Iraq. The main areas
of concern related the lack of a military environment, security
for patients and welfare support of both patients and their families
at the Royal Centre of Defence Medicine (RCDM).
And, the Ministry of Defence (MoD) have
responded to concerns raised by charities and the general public,
including the newly introduced Military Managed Ward, improvements
to security arrangements and additional welfare staff. These developments
are welcomed.
Areas that we believe still need to be
addressed include travel costs and further accommodation for families
at both RCDM and Defence Medical Rehabilitation Centre (DMRC).
We have been told that a charity supplied both furniture and leases
for families' accommodation at DMRC over the Christmas period—because
funding could not be found within the MoD. We have also been informed
that funding is not currently available for personal items (such
as clothes, shoes and toiletries) for military patients at RCDM.
These items are currently being supplied by a benevolent organisation.
The NHS Foundation Trust in Birmingham
is currently taking forward plans to build new hospital facilities.
We believe that the MoD should be planning for the best possible
treatment solutions for military personnel. Priority should of
course be given to clinical excellence, but the importance of
a military environment should not be overlooked.
4. Mental Health services
with the Armed Forces—we believe that there is a current
shortage in number of psychiatric clinicians within the Armed
Forces. Health surveillance being carried out by King's College
London has not yet shown an increase in mental health problems
for Regular serving personnel. However, anecdotal evidence from
the mental health charity Combat Stress suggests mental health
problems, such as Post Traumatic Stress Disorder (PTSD), are often
presented late. The number of vacant posts for psychiatric clinicians
within the Armed Forces should be considered within the inquiry.
The need for further efforts to reduce the stigma attached to
mental health problems within the Services should be highlighted.
One issue that the health surveillance
being carried out by King's has brought to light, is the heavy
drinking culture that exists within the Armed Forces; particularly
among younger members. Alcohol is often used to cope with, and
can mask, mental health issues. We do not believe that the MoD
is currently doing enough to address this issue, or that they
are giving due consideration to the effects on mental health problems.
The King's study also recorded an increase
in mental health problems among Reservists returning from conflicts.
In a response to this issue, the MoD has introduced the Reservist
Mental Health Programme (RMHP). However, while this programme
is open to Reservist it is not open to veterans who have been
recently discharged. This has created a two-tier treatment offer—as
situation that needs to be addressed. The MoD are about to commission
several mental health treatment pilots, in partnership with the
Department of Health (DOH), that are aimed at veterans. However,
results and roll-out will be several years coming. The RMHP could
be considered as an interim solution.
5. Delivery of health services
through NHS contracts—the figures being supplied by the
MoD regarding NHS healthcare and rehabilitation contracts are
encouraging. The figures indicate that all NHS contracts are delivering
to the targets agreed by the MoD. The emphasis on providing care
close to an individual's place of residence is important, and
contracting with the NHS does seem to be only cost effective way
of achieving this. However, more than six contracts will be required
if the MoD are to achieve this aim.
Additionally, while targets are being
achieved we have yet to see any information regarding patient
satisfaction. Information on the types of contracts, the NHS Trusts
involved, the agreed targets and patient satisfaction rates all
need to be made more transparent by the MoD.
14 May 2007
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