Examination of Witnesses (Questions 264-279)
MR DEREK FEELEY, MR GEOFF HUGGINS, DR NADINE HARRISON
11 OCTOBER 2007
Q264 Chairman: Lady and gentlemen, thank
you very much indeed for coming to help us with our inquiry. I
wonder if I could ask you, please, to introduce yourselves and
say what you do and why you do it? Derek Feeley, would you like
to begin?
Mr Feeley: Derek Feeley. I am
Director of Healthcare Policy & Strategy in the Scottish Government's
Health Department. That means essentially I am responsible for
advising ministers on a range of healthcare policies that stretch
from mental health all the way through to issues around hospital
configuration, etc. One of my areas is around relations with Whitehall
and, therefore, my interests are in defence matters.
Mr Huggins: I am the Deputy Director
for Healthcare Policy & Strategy, Head of the Mental Health
Division, and I have got responsibility for all matters in respect
of mental health within Scotland. I am a member of the senior
Civil Service and do liaison with Combat Stress.
Dr Harrison: I have a GP
background. I work as a medical officer in the Primary Care Division
in the Scottish Government Health Department giving advice to
ministers on all sorts of aspects of policy and strategy.
Chairman: Thank you very much.
Q265 Mr Hamilton: Can you explain,
briefly, the ways in which the National Health Service in Scotland
work with the MoD to look after the healthcare needs of Service
personnel and veterans?
Mr Feeley: I can kick off with
that. I guess the first thing to mention is that there is a concordat,
which the Committee may be aware of, between the Department of
Health and the Ministry of Defence but signed up to by health
ministers from the devolved administrations too. That helps set
a framework, if you like, for the relationships between the departments.
On the back of that concordat we, in the Health Department, issue
guidance to our NHS Boards and I can make the latest form of that
guidance available to the Committee if that is of interest. The
ongoing management of the relationship between the Health Departments
and the MoD is done through what is called a Partnership Board.
The Partnership Board meets about quarterly, certainly three times
per year, to identify areas of common interest and opportunities
for co-operation.
Q266 Mr Hamilton: What special provisions
do you have to make for the needs of the Service communities within
Scotland?
Mr Feeley: It works at a number
of levels, I guess. We are responsible for healthcare for Service
families and their veterans directly and working in partnership
with Defence Medical Services to provide health services for the
Armed Forces. The guidance to which I referred sets some of that
out. Nadine can talk in some detail about primary care services.
On secondary care, members of the Armed Forces based in the UK
are entitled to the full use of NHS facilities on the same basis
as civilians.
Q267 Mr Hamilton: So there are no
special provisions?
Mr Feeley: There are provisions
for access to high quality services through the NHS.
Q268 Robert Key: But no fast-track
facilities, as in England?
Mr Feeley: No fast-track facilities.
There will be a range of factors that a clinician will take into
account in determining how quickly to see a patient, and one of
those will be their occupation. We would not automatically see
every Service person before every civilian, if that is what you
are asking.
Q269 Mr Hamilton: That answer means
there is no provision made other than a normal provision for ex-Service
personnel if they go to see a doctor. If you listened to the first
part of the evidence session, and I am sorry you were not here
at the time, the doctor indicated the possibility of information
passing when a person walks in off the street who is ex-Service
personnel or, indeed, Service personnel on the sick, because many
of the local doctors do not know the issues that affect them.
In England that has been addressed by the fast-track system. What
is the special provision agreed in Scotland?
Mr Feeley: Are you talking about
ex-Service personnel?
Q270 Mr Hamilton: And Service personnel.
Mr Feeley: Geoff will be able
to answer that. Most people are discharged without particular
medical needs. Some have very specific medical needs and every
effort is made to have those needs ready to be addressed in advance
of their discharge. There is a good deal of collaboration and
communication before the Service person is even discharged to
enable them to get access to the NHS services that they need as
quickly as they need them.
Chairman: We will come back to
that in just a second.
Q271 Willie Rennie: Are you aware
of the fast-track system?
Mr Feeley: In England?
Q272 Willie Rennie: Yes.
Mr Huggins: I think he means priority
treatment.
Mr Feeley: Is that what you mean?
Q273 Willie Rennie: We understand
it is called fast-track. Are you aware of that?
Mr Huggins: In Scotland we would
call that priority treatment for war pensioners. It applies in
Scotland and we—
Q274 Willie Rennie: This is for serving
personnel, there is a fast track system. You can go down to the
five MDHUs in England and get fast-tracked treatment.
Dr Harrison: There is not a specific
place in Scotland where that happens but they would go to the
English hospitals.
Q275 Willie Rennie: But you are aware
of that system?
Dr Harrison: Yes.
Mr Feeley: Yes.
Dr Harrison: They would go to
Northallerton probably.
Q276 Mr Jones: The MoD tell us that
certainly in England in terms of war pensioners there is an entitlement
to priority NHS treatment and obviously free prescriptions in
certain circumstances. Is that the same in Scotland?
Mr Huggins: Yes.
Mr Feeley: Chairman, sorry if
I misunderstood Mr Hamilton's question, I thought he was talking
about services in the NHS in Scotland.
Chairman: He was.
Q277 Mr Hamilton: I am specifically
asking about Scotland. Naturally, being a Scottish MP, it is important
from our point of view, and representing Glencorse Barracks we
have an interest in what happens. How often do you meet with MoD
officials and at what level do you meet them?
Mr Feeley: Our representative
on the Partnership Board is one of the Deputy Chief Medical Officers,
Professor Peter Donnelly, so at a very senior level. That Board
meets three to four times per year.
Q278 Mr Hamilton: How many times?
Mr Feeley: Three to four times.
Mr Huggins: Because of the discussions
that we have had in respect of Combat Stress we have been meeting
with the MoD officials more regularly on particular issues around
veterans and mental health. Most recently we met with them on
Monday of this week in the context of the announcement made on,
I think, Tuesday by the MoD in respect of fees for Hollybush House
and the other Combat Stress centres. We have a regular and ongoing
dialogue at the moment around improving care for veterans.
Q279 Chairman: What triggered that
increase in contact with the Ministry of Defence?
Mr Huggins: It was the HASCAS
report. The Health and Social Care Advisory Service produced a
report in 2005 into mental healthcare for veterans, largely at
that time focusing on the services that were being provided by
Combat Stress but also looking more widely at the range of service
needs that veterans had in respect of mental health. That has
generated both the consideration of the current fee base for Hollybush
House but also the consideration of a wider set of policy and
delivery measures around mental health for veterans.
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