Examination of Witnesses (Questions 240-259)
DR J GORDON
PATERSON OBE
11 OCTOBER 2007
Q240 Mr Jones: That is very helpful,
but where does it fit in? For example, when we went to Selly Oak
earlier this year and we saw accommodation being provided by SSAFA
and other organisations, where do you fit in? Are there demarcation
lines that one organisation does not do what you do, or what?
Dr Paterson: The building on the
Selly Oak site is actually an NHS building. Our contract does
not allow us to do anything to that building other than visit
the people in it. The main focus of work at Selly Oak is actually
daily or more frequent visits to the patients on the ward. Since
that written submission was produced, we have increased our staff
from three to six. As I am sure you will realise, the numbers
of casualties coming into RCDM are now at an all time high and
we feel it is essential to maintain a 24-hour service.
Q241 Chairman: The impression that
comes through your memorandum is that you feel essentially that
you could be doing more, in a sense that you are under-used and
under communicated with, is that correct?
Dr Paterson: Yes, it is. As you
probably realise, the statement of requirement for our service
is essentially written by the Surgeon-General and the contract
is managed by the contracts branch of the MoD, and those are two
completely separate individuals and organisations. Sadly, there
is an assumption that when you ask to do more you are asking for
more money, and we are not. I believe there is the potential to
provide better welfare service, more intensive welfare service
with the resources we have, and I have given some examples in
the paper. Our contract requires us to provide an inpatient hospital
welfare service. If a Serviceman comes back to the same hospital
for an outpatient visit six weeks later our contract does not
allow us, in fact, to see them and yet that Serviceman or Servicewoman
may well have established quite a strong relationship with a welfare
officer, as may the members of his or her family, yet it does
seem a lost opportunity not to continue that contact. The resource
implications, I suspect, would be minimal.
Q242 Chairman: What do you think
then should happen when the contract comes up for potential renewal
in 2009 to resolve some of these issues?
Dr Paterson: I think two things.
There should be a root and branch review of what it is that is
meant by a hospital welfare service and is it really just an inpatient
service. Many of the criticisms, some of them probably exaggerated,
are that people get lost in the system. There is one specific
issue. I am assured that the Joint Casualty Compassionate Cell,
which is a Tri-Service organisation, does know the whereabouts
of all personnel who are hospitalised, not just in the Ministry
of Defence Hospital Units. Our submission would be that these
are very often people with whom we have established a relationship
when they have been in Selly Oak and I do not believe it would
be breaching confidentiality rules if that organisation was to
say to us, "This serving member of the forces, who you already
know, has actually been hospitalised six miles down the road and
maybe you would like to make contact with them". We would
not impose our service but the feedback we have had from Service
personnel is that they would appreciate it.
Q243 Chairman: What would you say
that you do as an organisation that is different from what, for
example, SSAFA does?
Dr Paterson: We are very much
part of the clinical team. Some of our staff have healthcare backgrounds
but we are not clinicians; we are definitely not clinicians. If
you ask the military commanders, and certainly if you ask Defence
Medical Services staff, they would say that our personnel are
integral members of the clinical team, they are there on day one
when the casualty is hospitalised, and that is quite different
from the other organisations.
Q244 Mr Jones: That last point is
very useful. Do you really think what is needed here is that the
MoD/NHS needs to clearly define—it is possibly because there
have been some bad news stories, some true and some not about
the way in which people are dealt with—the contract when
it comes up for renewal and it needs to be a bit wider than what
you do or a series of organisations coming together to put together
a welfare package around the individual which would be not just
your side in terms of the clinical element but also, for example,
how you deal with families, next of kin and things like that,
so we do not possibly get duplication or a mismatch as you are
describing where demarcation lines are drawn between you and another
organisation?
Dr Paterson: There was a very
unfortunate set of circumstances at the end of last year when,
in fact, there were numerous individuals and organisations giving
very mixed messages and I think a lot of Service personnel and
families were very confused as to what was the right story. Can
I stress that we are not in competition with these organisations.
Q245 Mr Jones: No, I am not suggesting
you are.
Dr Paterson: We work very well.
I do take your point that clarity of what it is that is required
and who can contribute what to that requirement would be very
valued.
Q246 Willie Rennie: Is it confidentiality
reasons that are stopping you contacting people in other circumstances?
Dr Paterson: It is very interesting
because most of our staff in normal circumstances are deployed
in Germany and it is not a problem. My experience, having worked
with data protection for 40 years, is the Germans are much keener
on data protection than we are, yet if any serving member of the
British Armed Forces is hospitalised in Germany there is a free
passage of information, so I do not understand it.
Q247 Willie Rennie: Is that the reason
given in this country as to why you cannot go to the outpatients?
Dr Paterson: Yes.
Q248 Mr Jones: But you are under
contract, are you not, from the MoD?
Dr Paterson: Yes.
Q249 Mr Jones: It is not as though
it is like me, Joe Bloggs, or my organisations coming off the
street and saying I want to have access to these people. Surely
they are referring people to you, are they not? I cannot get my
head round that one.
Dr Paterson: This is in stark
contrast to the behaviours of the clinical staff because our staff
sit in on multidisciplinary case meetings with the chaplain, the
psychiatrist, the surgeon and the nurses.
Q250 Mr Jones: But the taxpayers
are paying for your services, are they not?
Dr Paterson: Indeed.
Q251 Mr Jones: So why should that
be any different from a taxpayer paying for the services anywhere
else?
Dr Paterson: Lest I sound paranoid,
you probably realise that this argument of confidentiality has
been raised on a number of occasions when a number of Service
families have said, "My son got lost in the system".
I was very encouraged by Dr Freeman's comments about the fact
that clinical information now passes quite quickly from the MoD
to the NHS, but I do believe, and I think our staff feel slighted
that we cannot be trusted with clinical information, we are bound
by a code of confidence.
Q252 Willie Rennie: The fact that
you have had to come before us to tell us this, does that indicate
a breakdown of the relationship between you and your contractor?
Dr Paterson: Not at all. Can I
say that we enjoy very good relationships with the MoD. They are
aware we are here and were offered sight of our submission. They
are very relaxed that we are here.
Mr Jenkins: If I can just say,
Chairman, I sympathise with you on the Data Protection Act. In
the past I have had to go to the Information Commissioner several
times to get things clarified and to get him to send signals out,
but jobsworths abide in this world and for some reason they just
do not read legislation or understand. If it is for its primary
purpose, and the primary purpose in this case is to trace, track
and look after the welfare of an individual patient, they can
release that information but, unfortunately, they do not read
the small print, they just act as a jobsworth and stop people
doing their job.
Q253 Chairman: In your submission
you gave an example of someone who did not appear on bed state
lists issued to DWMS and you heard about his visits to hospital
only because his mother 160 miles away told you he was going to
be in hospital.
Dr Paterson: Yes.
Q254 Chairman: When something like
this happens presumably you make representations to the Ministry
of Defence to say that there ought to be better communication
with you under your contract.
Dr Paterson: Yes. We had a very
productive meeting with the current Surgeon-General a few months
ago and we made a strong plea that the regional model of working
that we have in Cyprus and in Germany, which is basically anywhere
there is a Serviceman or Servicewoman in hospital we visit, was
extended to the UK. The Surgeon-General was very receptive but,
sadly, nothing has happened.
Q255 Chairman: Looking at it for
a moment from the Ministry of Defence's point of view, what do
you think their difficulty in relation to doing this has been?
Dr Paterson: I think there may
be two explanations. One is the MoD themselves may not have known
about Patient A, that he had moved from a military Ministry of
Defence Hospital Unit, had gone home and had then been readmitted
to an NHS hospital. They may not have known. I think my second
point is had they known, at the moment the system would not have
prompted them to tell us that the patient had been admitted to
a nearby hospital, either because they did not want to tell us
or they felt they should not tell us.
Q256 Mr Jones: The example you have
just given, is that someone who has left the Armed Forces that
you are talking about or somebody who is in it?
Dr Paterson: No, he was still
serving.
Q257 Mr Jones: Surely the MoD would
know about that individual.
Dr Paterson: They may not have
done. If he had gone back to a private home as opposed to living
in barracks it may have been a civilian GP who referred him into
the local hospital.
Q258 Chairman: Surely his unit would
be well aware that he was not turning up for work.
Dr Paterson: He was on sick leave.
Q259 Chairman: Ah, yes. Good point.
You do not get involved in Headley Court, do you?
Dr Paterson: No, and that surprised
the Surgeon-General because Headley Court has had a lot of publicity
in the recent past around its hostel accommodation. The Surgeon-General
was very surprised. In fact, I think he had assumed that we were
because clearly the welfare needs of patients who are being rehabilitated
and their families are quite substantial. Again, the Surgeon-General
suggested that we ought to be involved; we are still waiting for
an invitation.
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