Memorandum from the Scottish Executive
Following my officials' appearance before
the Defence Committee on 11 October, I wish to reinforce the importance
the Scottish Government attaches to the provision of quality healthcare
services for serving armed forces personnel, their families and
for veterans.
You will wish to know that at a meeting
of NHS Board Chairs on 5 November, I reminded all Chairs of the
high expectations that the Scottish Government (and, I am sure,
the Committee) have of the role and performance of NHS Scotland
in relation to Service personnel. I asked that they look closely
at what their Boards are doing in this area, and to assure themselves
that there are robust arrangements in place both in relation to
any treatment required by serving personnel and their families,
and meeting the needs of veterans. I also reminded them of the
relevant guidance and asked that they assured themselves that
their Boards are meeting fully the terms of that guidance. A copy
of the guidance is at Annex A. [31]
As my officials made you aware last month,
army medical staff have developed close ties with NHS Lothian
and Edinburgh Royal Infirmary. However, clearly there are particular
concentrations of service personnel in other parts of Scotland
and Defence Medical Services (DMS) have confirmed that their Service
medical personnel have also developed good working relationships
with local NHS Scotland facilities. Navy medical staff have developed
close ties with the Gartnaval Hospital in Glasgow and the Royal
Alexandra in Paisley, reflecting the fact that the main naval
presence in Scotland is at Faslane. RAF medical staff have developed
close ties with Ninewells Hospital in Dundee for the personnel
based at RAF Leuchars in Fife. Those based on the Moray Firth
(RAF Lossiemouth and RAF Kinloss) are treated both at Dr Gray's
Hospital in Elgin and Raigmore Hospital in Inverness. Those stationed
at Fort George in Inverness will also be treated at Raigmore.
Some patients requiring specialist treatment are sent to the Aberdeen
Royal Infirmary.
It is also worth noting that DMS have
indicated that because of our relatively short waiting times,
Service personnel based in Scotland, in the main, have little
need to travel to England for treatment, although I appreciate
that there will be occasions when, due to particular medical conditions,
this will be necessary.
The Committee may wish to note that the
MoD and Scottish Government are currently considering piloting
in Scotland a new community-based model for addressing the particular
mental health needs of veterans. This is part of a wider initiative
with health authorities across the UK. It is designed to meet
the needs of health professionals who are seeking expert advice
and help with the assessment and treatment of such veterans and
to address the concerns of some veterans that the military background
to their mental problems may not have been understood within the
NHS. The pilot model would establish networks of a wide range
of NHS clinical staff and academics and, where appropriate, would
also capitalise on the experience of specialists from the Defence
Medical Services community mental health teams. These projects
would be NHS led, and reflect evidence-based NHS best practice,
with access through a wide range of "gateways" and increasing
input matching increasing case complexity.
On 11 October, the Committee asked specifically
about access to mental health services for veterans. As my officials
explained, the Scottish Government is currently in discussion
with the MoD and Combat Stress to identify service improvements
that can be made to make services more accessible and more appropriate
to the needs of veterans, building on the work that has already
been taken forward by the Rivers Centre in Edinburgh. This is
in addition to the significant additional investment that has
been made in the services provided by Combat Stress in 2007/08.
I should like to take this opportunity
to re-emphasise that we have not had any indication of specific
problems from NHS Scotland or DMS. However, from the transcript
of the session on 11 October I note that the Committee had significant
concerns about whether enough was done to meet the special needs
of service families, who will often be more mobile than the general
population; whether the transition from the services to the NHS
post-discharge was well handled—for example, whether medical
records are transferred effectively; and whether the health needs
of veterans are properly recognised. Further information on these
issues are set out in a Supplementary Memorandum at Annex B. That
memorandum also contains the very detailed information that the
Committee requested from my officials:
— the number of people in prison
with a history of being in the armed forces;
— the number of reservists working
in the NHS in Scotland;
— the number of consultants
and other clinicians in hospitals in Scotland whose salary is
paid by the MoD; and
— GP/Primary Care Dental Services.
I have also appended, at Annex C, a summary
of the contact that the Scottish Government has had, and continues
to have, with the MoD.
There is of course a long-standing arrangement
to provide priority treatment for war pensioners for the condition,
or conditions, which gives rise to their war pension or gratuity.
I have decided to extend the priority treatment scheme to include
those who have served in the armed forces and have a Service related
medical condition, but are not currently in receipt of such payments.
It is right that all veterans who have
health problems as a result of service to their country in the
armed forces should get priority access to treatment. We will,
however, consult on the proposals before providing guidance to
NHS Scotland and to veterans' organisations in Scotland at the
beginning of 2008. We wish to implement the extension to priority
treatment in a measured way that ensures that the benefits are
fully realised for veterans, without compromising the work of
NHS Scotland.
I have also asked NHS Board Chairs to
take steps to ensure that their staff are aware of the guidance
in this area and that it is being fully met, and to review if
there are other steps or measures the NHS should be taking to
ensure that we, as a community, meet Scotland's obligations to
veterans. I believe there is a serious interest from the MoD in
working together with the devolved administrations and the NHS
to address these issues, and that the continuing work and recommendations
of the Defence Select Committee will continue to highlight this
area.
I hope this letter reassures you and
members of the Defence Committee that the Scottish Government
and NHS Scotland takes its responsibility for the health of armed
forces personnel, their families and veterans, most seriously.
I have copied this letter to Christine
Grahame MSP, Convener of the Scottish Parliament Health &
Sport Committee.
Nicola Sturgeon MSP
Deputy First Minister and Cabinet Secretary for Health
and Wellbeing
21 November 2007
31 Not printed. Back
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