Further memorandum from the Ministry of
Defence
Welfare Support for Service Personnel
and their Families
CASUALITIES' IMMEDIATE
NEEDS
1. Defence Medical Welfare
Service (DMWS) staff supply casualties with "comfort kits"
comprising toiletries, plus any clothing they require on arrival.
Items such as rucksacks, TV cards, the loan of portable computers
with Internet access, or TVs in their ward are also available
on request.
2. The Defence Medical Welfare
Service provides 24/7 on-call response to urgent needs.
3. The Ministry of Defence
(MoD) has recently increased the allowances paid to all its hospital
in-patients to assist with their short-term needs. Whilst hospitalised,
all patients receive £5 per day for incidental expenses,
without the need for receipts. If hospitalisation is overseas,
Service patients receive £10 per day for incidental expenses.
In addition, if a Service patient was in receipt of the Operational
Allowance and/or Longer Separation Allowance at the time they
were hospitalised, then these allowances would continue until
they were discharged.
4. We are of course also grateful
for the support that Service charities supply in meeting casualties'
needs whilst in hospital.
TRAVEL/SUBSISTENCE
SUPPORT FOR
FAMILIES
5. The family of an injured
Service person who has the required medical recommendations is
entitled to travel, accommodation and subsistence at public expense.
6. The MoD covers the cost
of travel, accommodation and subsistence for two close family
members to be at the bedside of an injured Service person. This
can be extended to allow other additional family members to travel
to be at the bedside. This is done if it is deemed by the medical
authority to be in the best interest of the patient's recovery.
Examples of exceptional circumstances include: split families;
partners who are not next of kin and other close relatives such
as siblings. Each circumstance is considered on a case by case
basis.
7. Initially, these costs
are covered for 7 days, but can be extended for as long as required,
subject to medical advice. The regulations equally apply to the
families of Foreign & Commonwealth Service personnel.
VISITING OFFICERS
8. Families of an injured
Service person are assigned a visiting officer whose main responsibility
is to act as the link between them and the Service. The visiting
officer is trained in this role and will be fully aware of the
families' entitlements. The visiting officer will advise families
accordingly and will liaise with the appropriate authorities to
make the necessary arrangements as required.
9. Welfare officers at Selly
Oak also supply information to family members.
10. The appropriate publications,
including JSP 751 (Casualty and Compassionate Policy Procedures)
and JSP 752 (Tri-Service Regulations for Allowances), are widely
available and clearly set out the entitlements for families.
ACCOMMODATION
11. The Royal Centre for Defence
Medicine (RCDM), Birmingham, has allocated 5 rooms providing overnight
accommodation, plus a "quiet room" in one wing of the
hospital for use by relatives visiting Service personnel. These
rooms are provided free and on a priority basis to the families
of those most seriously injured.
12. Further accommodation
is available on the Selly Oak site including flats which can be
used as family rooms.[24]
Some of the flats have benefited from recent refurbishment funded
by the Soldiers, Sailors, Airmen and Families Association (SSAFA),
which is helping to provide a more suitable environment for the
families of the patients concerned. RCDM can also provide a list
of local B&B accommodation which has been inspected by Defence
Medical Welfare Services (DMWS).
13. The MoD places enormous
priority on the needs of its injured personnel and their families.
To that end, procedures are under continual review to ensure that
the best possible support is provided. In addition the MoD acknowledges
the excellent support provided by charitable organisations in
achieving this aim.
WAITING LISTS
NHS Treatment
14. Serious injuries Service
personnel sustaining serious injuries are treated immediately.
15. Elective hospital treatment
Where military patients need elective hospital treatment, they
are entitled to receive local NHS treatment in any District General
Hospital, or they are referred to one of the NHS Trusts (referred
to as host trusts) which host the five Ministry of Defence Hospital
Units (MDHUs) or to University Hospitals of Birmingham Foundation
Trust (UHBFT) where the Royal Centre for Defence Medicine is based.
16. In recent months, at any
one moment in time, approximately 4,200 personnel across all three
Services are in the process of being seen in the MDHUs or UHBFT.[25]
Many of these are being seen for relatively minor conditions (eg
dermatitis or a vasectomy) that will not affect their deployability.
The MoD has agreements with these Trusts to provide accelerated
access for elective referrals of Service personnel to meet operational
requirements. The MDHUs are situated in areas with dense military
populations so the trusts are ideally located to provide the required
accelerated access. The accelerated access at the MDHU Host Trusts
currently provides for approximately 50% of cases being seen in
4 weeks to outpatient appointment, and 6 weeks to surgery, if
this is clinically appropriate. We are working with the MDHU Host
Trusts to deliver 100% within these targets by April 2009. These
are much shorter timelines than current NHS targets, which are
13 weeks to outpatient appointment and 6 months to inpatient treatment.
They will still be shorter than the future NHS target for the
patient pathway from referral to treatment which must be within
18 weeks by the end of 2008.
17. We hold the following
figures for purely elective referrals to MDHU Host Trusts for
the year 06/07 (ie they do not include treatment of operational
casualties; other emergencies that are treated on a clinical need
basis; and the estimated 30-40% of elective referrals from single
Service primary health care that are treated by local District
General Hospitals that do not host MDHUs).
| New Outpatients | 23,520
|
| Elective Daycase | 6,150 |
| Elective Inpatient | 2,933 |
| |
18. The vast majority of these patients
remain at work during the referral process.
19. Additionally, the MoD has developed
a specific musculo-skeletal fast track programme to meet the relatively
high incidence of these disorders within the military environment.
Full details of this programme are provided within para 43 of
the MoD's Memorandum of Evidence.
Treatment outside the NHS
20. Many military patients receive treatment
outside the NHS and do not, therefore, appear on NHS waiting lists.
For patients requiring physical rehabilitation care, the Defence
Medical Services (DMS) have their own facilities.[26]
We also have our own out-patient mental health facilities; inpatient
mental health care is provided in psychiatric units belonging
to the Priory Group of Hospitals. Last year's figures for those
treated and assessed in our Regional Rehabilitation Units (RRUs)
and referred on for Fast Track treatment are set out within Annex
C of the MoD's original Memorandum of Evidence.
Numbers fit for duty
21. The latest available data for the year
ending 31 March 2007 show that there are less than 800 Service
personnel (around 0.5%) unfit to undertake any military duties.
22. Some 23,700 (13.7%)[27]
are not fully fit for unrestricted employment,[28]
but, for example, of around 16,000 in the Army in this category,
some 11,000 are still "operationally deployable with medical
limitations". For example, an infantry soldier could still
work in an operational HQ if he was unable to withstand high levels
of physical activity. Similarly, many of those not fully fit for
unrestricted employment in the Navy and Air Force are still able
to play some part in maintaining operational capability (eg filling
home base billets thereby releasing fully fit personnel for deployment.)
Reception Arrangements for Military Patients (RAMP)
23. Since April 2001, RCDM at Selly Oak
has been the main centre for the return of UK Armed Forces casualties
aeromedically evacuated from all over the world, including Iraq
and Afghanistan. The NHS Hospitals in Birmingham have the capability
to manage the full range of clinical needs that Service patients
might present, and a significant proportion of these patients
will be treated on trauma/orthopaedic wards, including the new
Military Managed Ward.
24. UHBFT has the capacity to cope locally
with the scale of surges seen to date in the number of military
casualties.
25. In the event of a significant casualty
surge, the MoD and UHBFT would jointly manage the receipt of casualties,
and would be able to use the existing national Reception Arrangements
for Military Patients (RAMP) plan. This plan is designed to handle
increasing numbers of Armed Forces casualties returning to the
UK from an overseas theatre of operations in time of conflict.
Elements of RAMP have been invoked successfully in the past (eg
in the early phase of OP TELIC) and we have established an effective
partnership with the Department of Health (DH) at government level
and locally between NHS Trusts and military units. Under RAMP,
when casualties are aeromedically evacuated to the UK, the selection
of the hospital to which they will be admitted is made in conjunction
with the DH on the basis of clinical need and bed availability.
Derek Twigg
10 July 2007
24
Due to child protection policy at the University Hospital Birmingham
Foundation Trust, children under 16 are not allowed to stay in
the 5 RCDM rooms, since the accommodation contains communal facilities
which are used by other adults staying in the accommodation. Back
25
ie they have been referred for an outpatient or inpatient appointment,
or are already receiving a course of treatment. Back
26
Paras 22-4 MoD Memorandum of Evidence. Back
27
16,081 Army, 3171 Navy, 4450 RAF. Back
28
This covers those in medical categories P3 (fit for service including
operations within specified individual limitations), P4 (pregnant)
and P7R (temporarily unfit for full duties). Back
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