Examination of Witnesses (Questions 340-359)
MR DEREK FEELEY, MR GEOFF HUGGINS, DR NADINE HARRISON
11 OCTOBER 2007
Q340 Chairman: It was.
Dr Harrison: The two sets of records
are separate. There would have to be some communication if there
was an ongoing medical condition.
Q341 Mr Jones: But what is the procedure
for doing it?
Dr Harrison: There is not a procedure,
they are separate records.
Q342 Mr Jones: No.
Dr Harrison: It is the same as
the Scottish Prison Service has their own medical services.
Q343 Mr Jones: No. If I move from
Durham to Edinburgh you have just told me when I register with
a GP in Edinburgh my records will come with me because I am a
civilian.
Dr Harrison: NHS records.
Q344 Mr Jones: Exactly. If I am Army,
Air Force or Navy personnel and I retire or finish up in Edinburgh,
you are saying you are not aware of a system that allows my medical
records then to transfer to my local GP.
Dr Harrison: From the MoD to the
NHS?
Q345 Mr Jones: Yes.
Dr Harrison: That is correct.
Q346 Chairman: Do you think there
should be?
Dr Harrison: I think it is very
helpful to have a lifelong medical record.
Q347 Robert Key: This is very serious
indeed. I wonder if we could clarify this by asking for a note
of exactly what the situation is.
Dr Harrison: This is not a Scottish
thing, this is NHS. This is not exclusive to Scotland. If you
move from Portsmouth to York the same thing would happen.
Q348 Willie Rennie: We were told
this morning about the process that is involved in transferring
records from the MoD to the NHS and it is not automatic that the
records do get transferred. Do you think it would be beneficial
if it was automatic that they do get transferred between the two
organisations so the NHS fully understands the medical problems
that an individual has faced? Would that be of benefit?
Dr Harrison: Yes. Having a continuous
medical record, particularly at a primary care level, is very,
very beneficial, yes.
Chairman: That is something that we can
ask for a note on. Maybe not from you, maybe from the NHS in general,
but health being a devolved responsibility in Scotland it affects
you. If you were able to tell us what your views are of it, it
would be helpful.
Mr Borrow: Just following on that point,
Chairman. My understanding of the situation is that if someone
leaves the Services and goes into civilian life and signs up with
a GP, a good GP would contact the MoD and seek the medical records
held by the MoD, but there is no requirement on the GP to actually
secure those records. The question is, does the absence of a requirement
on a GP to do what seems sensible and proper cause a problem?
Is there any evidence that causes a problem or should we, as a
Committee, be recommending that there is a procedure put in place
to make sure that those records are transferred? I think that
is where the Committee is.
Q349 Chairman: I think that is very
well put, thank you. We are content now to move on. Did you hear
the evidence of Dr Freeman at the beginning? I do not think you
were in for that. Is there anything else you would like to ask
about mental health, Robert? One thing that he said was that psychiatrists
generally on receiving patients who have had a history of being
in, say, two or three combat zones may have no experience of,
or understanding of, the sorts of stresses that those people have
been under. Do you recognise that as a problem or as a fact?
Mr Huggins: I think that is entirely
likely to be true.
Q350 Chairman: Given that these people
are doing this for us, do you think it is a problem which requires
to be dealt with?
Mr Huggins: Generally, where we
are now in 2007 is that we have a model of care which is not about
the single clinician. It is not about the single doctor relating
to the single patient. We work with social workers, nurses, psychologists
and psychiatrists, so generally, if there is a particular need
in respect of the care of a particular patient, what we will look
for is to ensure that need is met somewhere within the team. In
the discussions that we are having in respect of provision of
services for veterans in respect of mental health, that is where
we see the particular value that an organisation such as Combat
Stress, which involves volunteers and others with experience,
can actually bring to the process. The difficulty would be if
we expected everybody in every clinical team to have every experience,
we simply would not be able to deliver that. Increasingly, care
is team based rather than individual based and we think that gives
access to a wider range of skills, talents and experience.
Q351 Chairman: Okay. The suggestion
that Dr Freeman made was that since many of these veterans will
never consider going anywhere near psychiatric nurses or psychiatrists
of any sort, but they are quite likely to approach GPs for physical
ills, it would be helpful if GPs had some training in recognising
the need for mental health treatment. Is that something that you
would feel able to respond to?
Mr Huggins: It is, again, a more
general issue in that I would say there are many people who are
reluctant to present themselves to psychiatrists or mental health
services. What we have seen both in work environments and in public
health environments is that people manifest with lower back pain,
"I feel a bit low", they respond through taking more
excess alcohol and substance abuse, they do other things. GPs
are increasingly aware of the range of reasons why people might
be showing particular symptoms which might be linked back to traumatic
stress of different kinds. Certainly we are doing work in Scotland
about the range of factors that might cause people to present
in GPs' surgeries with different forms of problems: issues around
child sex abuse; issues around trauma in early life. These are
similar issues that require GPs to have that understanding of
the wider reasons why people might turn up in their surgeries.
I think my answer is therefore yes and it is certainly something
that we are working on.
Q352 Mr Jones: Can I try and understand
the system in Scotland. You have clearly got this now on your
radar screen and the reaction you had to some of our questions
was you devolved this to the local boards. What powers have you
got to ensure that these things you are going to try and do are
carried out? In terms of at a political level in Scotland, how
high do you think health for veterans and Armed Forces' families
is? Has it ever been discussed in terms of a report in this place
or anything else?
Mr Huggins: It certainly has been
discussed in the Chamber on occasions.
Q353 Mr Jones: By who though?
Mr Huggins: I recall the First
Minister discussing it.
Q354 Mr Jones: This one or the last
one?
Mr Huggins: It would be the last
one, this one has not had much time yet, and he certainly identified
it as an area of funding. The Scottish Executive, as was, committed
a certain amount of funding towards the redesign and redevelopment
of Hollybush House because of the priority veterans had for the
organisation. It is an issue which has political and service delivery
profile.
Q355 Mr Jenkins: What was the money
spent on?
Mr Huggins: What was the money
that was allocated to Hollybush House spent on?
Q356 Mr Jones: Yes.
Mr Huggins: The Hollybush House
unit has been significantly redeveloped in the last two to three
years and is about to be reopened on Monday.
Q357 Chairman: On Monday.
Mr Huggins: Yes.
Q358 Mr Jones: The other side of
the question is what powers have you got to ensure that the health
boards do get this on their radar screen or carry out what they
are doing?
Mr Feeley: Health boards are subject
to regular performance review. There is a monthly meeting between
the minister and the chairs of all the health boards. There are
regular meetings between the chief executive of the NHS in Scotland
and the chief executives of the health boards. We are in regular
contact with our counterparts on boards to make sure that policies
are turned into action on the ground. There was a recent report
carried out about scrutiny of public services which reported that
the Health Service was over-scrutinised, but we believe it is
appropriately scrutinised to make sure that policies are turned
into good services for patients, including veterans.
Q359 Willie Rennie: My understanding
is that the difference between Scotland and England in the NHS
is that it is more advisory and health boards have got slightly
more independence and can take clinical guidance and other guidance
and can implement it in their own ways with their own priorities.
Is that your understanding of it?
Mr Feeley: One of the key differences
between the NHS in Scotland and the NHS in England is that we
do not have the kind of purchaser/provider split that you have
in England. The boards have responsibility for both planning and
commissioning the services and providing, and the boards have
responsibility for secondary care, primary care, mental health
services, public health services, so they can provide the whole
range of services to Servicemen, their families and veterans,
ordinary members of the public. It is perhaps easier to get a
handle on who is doing what when you are only holding 14 organisations
to account.
Chairman: We will move on to personnel
issues.
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