Examination of Witnesses (Questions 1-19)
MS SAMMIE
CRANE, COMMODORE
TOBY ELLIOTT
RN, AIR COMMODORE
EDWARD JARRON,
MS SUE
FREETH AND
MRS ELIZABETH
SHELDON
12 JUNE 2007
Q1 Chairman: We welcome our witnesses.
We are about to begin the first evidence session of our inquiry
into medical care for the Armed Forces. We intend to hold several
evidence sessions on this matter and make several visits. We are
also in the course of doing a web forum and have just extended
that forum. One of the ongoing threads in that web forum is criticism
that it is stopping discussion. If you would encourage people
to take part in the web forum it would be very helpful. Even if
they want to have a go at me it would be a very good idea for
people to get involved in the web forum. It is the modern way
to find out things. We hope to publish a report towards the end
of the year because this is an extremely important subject. Perhaps
you would begin by introducing yourselves and saying what your
organisation does and your role in it.
Ms Crane: My name is Sammie Crane,
chief executive of the Army Families Federation. The federation
works to make sure that army families are treated fairly, secure
a fair deal and are represented in the decision-making process
on policy and legislation.
Commodore Elliott: I am Commodore
Toby Elliott, chief executive of Combat Stress, more properly
known as the Ex-Services Mental Welfare Society. My charity looks
after veterans of all three Services and the merchant navy who
suffer psychological injuries as a result of service.
Air Commodore Jarron: I am Air
Commodore Edward Jarron, chief executive of the RAF Association.
That is a membership association which offers comradeship and
welfare. Approximately 10 per cent of its turnover is spent on
comradeship and 90 per cent on welfare support for the Royal Air
Force.
Ms Freeth: My name is Sue Freeth,
director of welfare of The Royal British Legion. I am sure that
many of you know of the work we do. The three pillars of our provision
are: comradeship, remembrance and welfare. We provide a wide range
of welfare activities for both the serving and ex-serving community.
Mrs Sheldon: I am Liz Sheldon,
project director for in-service support at SSAFA. We provide a
broad range of social welfare support for in and ex-service people
and their families. We look after and help 50,000 people a year.
Chairman: I want to run briefly through
the structure of the areas that I hope we will cover this morning
so that if there is a particular subject that you want to deal
with we will get to it at some stage. If there is not a particular
subject that you want to deal with you can pop it into one or
two of your other answers. We will deal with the following: medical
care for operational casualties; rehabilitation for service personnel;
healthcare for service families; care of service personnel after
discharge; mental health; and the general role of the voluntary
sector. It may well be that you believe you have something to
add to what another witness has already said. Because there are
five of you there is no need to come in on every question unless
you want to add a nuance or give a different experience of the
answer to that question. Let us begin with medical care for operational
casualties.
Q2 Mr Crausby: The treatment of service
personnel, especially those injured in operations in Iraq and
Afghanistan, has been a matter of considerable public concern
and debate particularly in the media. Turning first to the Royal
Centre for Defence Medicine in Birmingham, can you tell us whether
you believe that the principle of having a single receiving centre
for casualties in an NHS acute hospital is the best way to deal
with them?
Ms Crane: The feedback I have
had is that the clinical care at Selly Oak is so good it could
not be replicated elsewhere and therefore that is the correct
place to which serious casualties should be taken.
Mrs Sheldon: I have been to Selly
Oak two or three times and involved in projects to set up family
accommodation there. I agree that clinical standards there are
very good, but perhaps it may be useful for the Committee to broaden
the discussion to consider the way in which welfare is delivered
more holistically in terms of looking after the emotional needs
of patients and their families not only at Selly Oak but onwards.
Q3 Chairman: We will come to the
care of service personnel after discharge.
Mrs Sheldon: This is in-service
care.
Commodore Elliott: One cannot
refute the priority that casualties must be given the best that
is available in this country. If the surgeon general says that
he cannot do it with his Defence Medical Services then we have
no argument about from where it should come. If Selly Oak can
provide it that is fantastic.
Ms Freeth: We have made two trips
there in the past three months. I reiterate other comments here.
We are very satisfied with the medical care being provided there.
I believe that the therapeutic value of being in a military-managed
environment is absolutely critical to the improvement and rehabilitation
process and the care when casualties are evacuated. The interface
with health and personal care for individuals whilst there is
perhaps the point where further improvement needs to be made.
At the moment healthcare is extremely good, but support for people
who visit and for the individuals whilst there in terms of providing
basic essentials is currently provided by charity which some of
suggest is perhaps not appropriate. These are essential things
like toiletries and clothing for people who have been separated
from their possessions and travel assistance for visiting families.
It is particularly difficult for single personnel. I think that
those are areas where we encourage further consideration.
Q4 Mr Holloway: Do families not get
rail warrants to visit injured soldiers?
Mrs Sheldon: They do. There are
regulations which give help with transport and accommodation for
seven days when the patient is either seriously ill or very seriously
ill. Once the patient moves off that list public funding stops.
One can imagine that it is very difficult for families travelling
from one end of the country to the other, or from overseas, to
visit patients. One has foreign and commonwealth families. Fijian
and South African families come over and suddenly find themselves
stranded in the UK because funding has stopped. That is where
the charities are stepping in because public funding has stopped.
Air Commodore Jarron: I agree
with the broad point that in order to provide the level of medical
expertise that is required for battle casualties being part of
a teaching hospital is the way to go. I do not think any of us
would disagree with that. In terms of support for families, the
Royal Air Forces Association is at the beginning of that process.
We have been largely a veterans organisations and we are now focusing
far more on current Royal Air Force support. Like The Royal British
Legion, we are looking at ways to support people who often have
been hauled off the battlefield, treated in theatre and then sent
straight back. Little items like toiletry packs are things that
we are starting to put in place.
Ms Crane: As to travel, the travel
allowance that is given to families is supposedly for seven days
initially. It can be and frequently is extended. It applies when
someone is seriously or very seriously ill and once the individual
is no longer on that list the amount of travel assistance available
reduces.
Q5 Mr Crausby: Therefore, it relates
to serious illness, not the seven days?
Ms Crane: The amount of travel
assistance for families applies whilst service personnel are seriously
ill or very seriously ill.
Q6 Mr Holloway: If someone who has
not seen his family for ages gets hurt in Afghanistan and may
die assistance is available for seven days, but if he gets better
and is there for a month or two and is not in danger the family
end up paying for it?
Ms Crane: Yes.
Q7 Mr Holloway: That is incredible,
and it should be all over the press.
Ms Crane: I should like more clarification
about when it does and does not, because when I have talked to
them they have said they have extended the allowance whenever
it has been requested.
Ms Freeth: Clearly, there are
lots of people involved in advising individuals. For some people
what is available in principle and what they hear about and are
able to access therefore is too variable.
Q8 Chairman: Did you say that the
allowance had been extended whenever the request had been made?
Ms Crane: Yes.
Q9 Chairman: So, people are not aware
that they should be making the request to extend the allowance?
Ms Crane: That is my point. I
have asked that there is more information about how families request
that additional grant. The feedback we have had is that quite
often people are very proud; they feel that they are asking for
charity and it is not at the top of their mind. There ought to
be a pamphlet or something giving that information.
Mrs Sheldon: There is quite a
lot of confusion and a number of people are involved in trying
to address the issue. But people at Selly Oak are pretty hard
pressed in trying to see if they can extend people's stay there.
They could be looking at all sorts of different channels to get
funding and assistance from the charitable sector, or perhaps
welfare funding within the MoD. For the people who are trying
to deliver the service, let alone families, it is very confusing.
Q10 Mr Jenkin: I am somewhat astonished
by this. I always imagined that when a serviceman was injured
and shipped back home there would be a single point of contact
for the family. Whether or not it be home representation of the
unit, there would be somebody who was the point of reference for
that family and the red carpet would be rolled out. What is missing
from that?
Ms Freeth: The CO is responsible.
Q11 Mr Jenkin: COs are usually pretty
busy in theatre so that is not viable.
Ms Freeth: When a casualty occurs
the provision for the family is exceptional. People are found
everywhere and brought to wherever that soldier goes, whether
it is to Germany—Ramstein—or Selly Oak. That is very
successful, and heaven and earth are moved to make sure that the
family gets to the soldier. What we are talking about here are
days, weeks and months later when the soldier is not in such a
critical condition and then the travel allowances reduce and confusion
arises, but the initial stage is very good.
Q12 Linda Gilroy: Ms Crane, have
you dealt with individual cases of that kind? Are you able to
give us more precise examples of what you have said?
Ms Crane: I can access them and
have been told about them. Very few families have contacted us
to complain about their treatment at Selly Oak.
Q13 Linda Gilroy: One of the difficulties
facing the Committee is that it hears about cases and it fully
understand why people may be reluctant to come forward. But it
would help us enormously if through your organisations people
can contact us with examples of these things rather than just
hearsay.
Ms Crane: What I am saying is
that it is positive.
Q14 Chairman: You may be able to
give us a case study, perhaps with the names removed if people
wanted to remain anonymous.
Ms Freeth: Most of the cases we
have seen are those involving single soldiers. They do not have
those family arrangements. Those are the individuals in respect
or whom we have been approached to help finance travel allowances.
We have done that in a number or cases and I am sure we can provide
details on those individuals.
Q15 Chairman: I want to come back
to the issue referred to by Sammie Crane. She said that if there
was a request the allowance would be extended. Have you been aware
of that? If so, presumably you would say to the individual soldier
that he should ask for an extension of the allowance.
Ms Freeth: That is not always
understood in terms of the individuals. The unit welfare officer
is dealing with the individual concerned. Inevitably, we send
people back to challenge whether there is already something available
for them, but they come back and are told it is not there. Maybe
there is not enough information. The people who are assisting
people in the whole process are not always the best informed,
perhaps not for want of trying, and so it is still very variable.
Q16 Chairman: Therefore, the unit
welfare officers are not aware that they should be extending the
allowances?
Ms Freeth: In some cases I believe
so.
Mrs Sheldon: One of the issues
here is that from Selly Oak to Headley Court is not just a straight
patient pathway; people dip into and out of specialist units and
go backwards and forwards maybe from Selly Oak. It could take
some time for them to reach Headley Court, if at all. It is very
confusing for all the people who are trying to manage the process
and communications and get clarity about entitlements and allowances.
We have helped in instances where people, both single soldiers
and families, have been sent to other specialist units and have
needed help with transport, so we can supply information.
Q17 Mr Holloway: To go back to the
point about people receiving this benefit if they are told about
it, are we really saying that the main mechanism for looking after
people when they are no longer critically ill is the dead wood
in the rear party?
Ms Freeth: The unit welfare officer
under the new SAM system is responsible for ensuring that local
contact is maintained with the individual on his or her return,
deployment or discharge. That will depend very much on the experience
they have had. I do not know how much training they have received.
Q18 Mr Holloway: There is no quality
control whatever.
Ms Freeth: I believe that the
new SAM system for local control and involvement has been in place
for less than 12 months, so perhaps it is a little early to challenge
it, but it certainly needs scrutiny.
Q19 Mr Holloway: But not for families.
Ms Crane: I think it is slightly
unfair to call them "dead wood".
Mr Holloway: I was in the Army and I
know that sometimes among the people who do those jobs there is
dead wood.
Chairman: I entirely agree with Ms Crane
that to talk about dead wood in the rear party is pejorative.
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