Examination of Witnesses (Questions 420-439)
DEREK TWIGG
MP, LIEUTENANT-GENERAL
ROBERT BAXTER
CBE, LIEUTENANT-GENERAL
LOUIS LILLYWHITE
MBE QHS, MR BEN
BRADSHAW MP, PROFESSOR
LOUIS APPLEBY
AND MR
ANDREW CASH
27 NOVEMBER 2007
Q420 Mr Hancock: Are the Ministry
of Defence prepared to spend what is needed to bring Headley Court
up to a facility where it would have on site the right facilities
for these people?
Derek Twigg: We are absolutely
committed to providing the best possible treatment and service
and care for our people. As I said, the report is going on at
the moment. I do not want to pre-empt what that will say, but
we are absolutely committed to doing that.
Mr Bradshaw: I think there has
been a slight misunderstanding about the role of the hydrotherapy
pool at Headley Court. It is different from the role of a swimming
pool. The temperature is different. The hydrotherapy pool is used
for different sorts of complaints at different stages of complaints.
It is not a question of it not being big enough or of there being
too much demand, as Derek has already said. Ideally you need the
use of both a hydrotherapy pool and a swimming pool. Whether you
could justify having a full-time swimming pool is a matter for
Headley Court.
Lieutenant-General Lillywhite:
When Headley Court told us that they had difficulties with capacity
we immediately provided the additional ward. They have never said
to me that the arrangement they currently have with the local
authority for the use of the swimming pool is inappropriate or
is causing them any difficulties. Were they to do so I would,
of course, consider whether or not we ought to provide one on
site, but to date they have not come forward and said that the
arrangements they have are sub-optimal.
Q421 Chairman: With regard to the
recent news of behaviour at the Leatherhead swimming pool by the
local community, which I am sure we all consider to be simply
disgraceful, has it ever happened before?
Derek Twigg: I am personally not
aware it has happened before. Clearly, we were extremely disappointed
that that happened. Mole Valley Council's reaction has been absolutely
superb and I think they are now up to offering free use for visiting
families as well of the wounded, which I think is excellent.
Q422 Chairman: Can I ask one final
question on funding? Are the increased use of Headley Court, the
increased demands on Headley Court and on Selly Oak and on general
healthcare covered by the contingency reserve?
Derek Twigg: Yes.
Q423 Chairman: They are?
Derek Twigg: Yes.
Q424 Chairman: Thank you. We have
been very impressed by the MDHUs we have visited. Would you accept
that they are primarily places in which medical and nursing staff
from the Defence Medical Services can be trained alongside NHS
staff rather than providing secondary care for military personnel?
Derek Twigg: I think the answer
is both.
Q425 Chairman: Are they single Service?
They seem to have a strong single-Service ethos. That is what
I found when I went to Frimley Park anyway, that some of the MDHUs
--
Derek Twigg: I will ask the Army
to answer that.
Lieutenant-General Baxter: Of
course, the MDHUs have a historic connection. At Derriford, with
the large naval presence, you would be a bit surprised if there
were lots of people in khaki round there. At Peterborough again
there is the legacy of the cold-war air bases, in the past Ely
Hospital, and so an RAF connection. At Frimley Park, around Aldershot
and up around the far reaches of South Tees there will be a natural
centripetal effect to pull the khaki. However, all of them have
a joint flavour to them. I am trying to think: is there one Ministry
of Defence Hospital Unit that does not have a Tri-Service mix?
I do not think so.
Q426 Chairman: I am sure. It was
just that they were positively labelled, "This one is an
RAF one, these three are Army ones, this one is a Naval one".
Lieutenant-General Baxter: Chairman,
you know how proud we are of our tribes and our tribal markings.
Chairman: Indeed so.
Q427 Willie Rennie: Why are there
no MDHUs in Scotland, Northern Ireland or Wales, and does it not
have a detrimental effect on the operational forces in those areas?
Derek Twigg: I asked this question
and it is basically for historic reasons. I think a lot of the
MDHUs have grown up near to the military hospitals. It does not
stop our Service people from getting fast-track treatment at other
trusts or getting the same standard of care as someone in England,
for instance; it does not affect that, but historically it has
been the case. It does not mean, for instance, that Scotland will
not have one. The honest answer is that we are keeping that under
review, but that is the reason for it.
Q428 Willie Rennie: When we visited
Edinburgh some of the people were being shipped out, I think to
Northallerton, to get the treatment they needed, which seemed
an awful distance to travel when Edinburgh has got some excellent
medical facilities.
Lieutenant-General Lillywhite:
Quite a lot of our military people in Scotland get treated in
Scotland and all the practices have relationships with their local
NHS and they use them. Clearly, if there is an advantage in going
down to Northallerton they will take advantage of that advantage,
so that, if I may say so, deals with Scotland. Just to clarify
Northern Ireland, we still have our Musgrave Park military wing
in Northern Ireland. That works in conjunction with a local hospital—it
is not a trust there—and clearly, as the reorganisation
in Ireland goes forward, we will keep under review how we deploy
our secondary care personnel there.
Q429 Mr Hamilton: Just to follow
up that point, if a person goes down south for a long time are
arrangements for their family to be able to come down? The second
thing I want to say is that in the literature you indicate that
they do receive medical attention in Scotland, it is true, but
that is fragmented at present because of the working relationship
they have with each of the health boards, so how do you deal with
the fragmented relationship they have in Scotland?
Derek Twigg: They should not in
any way be unfairly treated compared to people in England. If
there are any cases I would be happy to look into them, Mr Hamilton.
Mr Hamilton: I read in the paper,
Chairman, that the minister responsible for health in Scotland
indicates quite clearly that there is a good relationship with
the Lothian health board but there is a need to improve the relationships
in other places, so I will bring it to the attention of the minister.
Q430 Mr Jenkins: How many of our
Service personnel who are admitted for medical treatment go into
a military hospital and how many go into the NHS when it is elective
treatment? What is the breakdown exactly?
Mr Bradshaw: We are not satisfied
that these are completely accurate, but it is about 65% military
to 35% not.
Q431 Chairman: Given that you had
no notice of that we are impressed.
Mr Bradshaw: I have done my homework,
Chairman.
Q432 Mr Holloway: It strikes me from
the stuff this morning that if we are going to continue with this
level of operational tempo perhaps the Committee should do an
inquiry into the wider issue of veterans and perhaps look to the
United States which might have some lessons for us. Whilst Selly
Oak is much more focused now it took time to react to the criticism
and it strikes me that the MoD, whenever there are problems, tends
to justify and defend. I know of at least one general who thinks
that you guys could be a little bit more proactive and should
we not look at ourselves a bit more in order to pre-empt the criticisms
that you are bound to get in the future in terms of treatment
of veterans? It is a cultural thing almost.
Derek Twigg: First of all, I spend
a great deal of my time defending the Government's position in
various parts of the press because I think there is a very good
story to tell, quite frankly, and Selly Oak was one example of
that, or whether it is Headley Court or our regional rehabilitation
centres or the type of treatment that we have out in operations.
I think we have been proactive but I think the fact that the Secretary
of State has announced his Command Paper, which will look at the
whole issue about what we now currently provide in terms of our
Service personnel and veterans, the whole range of healthcare,
welfare, accommodation, will be a really good way of setting out
the arguments for what is happening on the ground, what more needs
to be done and what we can do to improve that further. I think
that is going to be a very good way of doing that, but I can give
you an assurance, Mr Holloway, that we do everything we possibly
can to get out the positive messages.
Q433 Mr Holloway: It is not about
messages; it is about delivery.
Derek Twigg: When I was talking
about positive messages it is about the delivery that we provide.
As I say, if you go round and talk to the individual wounded Service
personnel at Selly Oak, like I do, the overwhelming view there
is of a very positive message about how they and their families
are being treated.
Q434 Mr Holloway: Forgive me, but
I am saying that I think you should be far more proactive in seeking
out things that are wrong and will be picked up. It is terrible
that we do it if it comes down to negative publicity in the press.
Derek Twigg: I am sorry; I misunderstood
the question. No; we do. That is why, for instance, I visit Headley
Court and Selly Oak and other parts of the healthcare system,
and obviously Iraq and Afghanistan, to talk to those delivering
it and look at where the issues might be and where we can improve
things, and that applies to other parts of my role in terms of
veterans and healthcare.
Q435 Mr Holloway: I wonder how Lieutenant-General
Lillywhite feels about this idea of being more pre-emptive.
Lieutenant-General Lillywhite:
We are.
Q436 Mr Holloway: You were not.
Lieutenant-General Lillywhite:
We are. In terms of all the improvements that I described, that
is the result of us being extremely proactive. The work that I
am doing with the Medical Research Council I referred to before
is us being proactive and seeking where we can improve quality
of care.
Derek Twigg: Can I just give you
an example? This does not seem to get much publicity, but, of
course, we have a major contract with King's College in which
we are monitoring and assessing those people who served in Iraq
and Afghanistan on a variety of issues. Mental health is one that
comes straight to mind but there are lots of different issues
we are having them working with us on and looking at issues and
how they are affecting them in their service during their time
in Iraq and Afghanistan. It is very proactive. We are not sitting
waiting for problems to happen. We are going out there and trying
to find out what is happening on the ground and how we can improve
it.
Lieutenant-General Baxter: One
of my jobs is to play the "daft laddie" and a customer
and go and ask all the stupid questions about why do we do things.
On the very question about MDHUs I asked, "Why have we got
one here?". That is part of my role as a non-professional
medical person.
Q437 Mr Holloway: In the interests
of maintaining morale then perhaps you should put a tabloid newspaper
head on sometimes when you do it.
Mr Bradshaw: The Concordat has
existed since 2002, long before the negative publicity around
Selly Oak, and the work programme has been dealing with a lot
of stuff, like the role of Reservists in the NHS, what we can
do to encourage more Reservists in the NHS, what happens to Service
personnel's families when it comes to moving and dropping off
waiting lists. These are issues that have been work in progress;
they have not just been done because of negative tabloid headlines
around Selly Oak.
Lieutenant-General Lillywhite:
Just talking about being proactive, a significant number of my
staff spend a lot of time visiting places like the United States.
Our pain consultant is about to go over to look at how they manage
pain and see whether we can learn any lessons from the way they
do it. I have mentioned mild traumatic brain injury. I have had
staff going over there to consult and see again whether there
are any lessons for us. We go and visit the Institute of Surgical
Research down in San Antonio to discuss where we are doing better
than they are and where they might be doing better than we are
to try and ascertain what are the factors that lead to better
outcomes. There is an awful lot of intense proactive work occurring.
It is not just at my level; it is at levels right down to the
working level.
Q438 Robert Key: Can I just touch
on one very brief point? A number of consultants and clinicians
in my hospital in Salisbury are in the Reserves and serve regularly
in, for example, Afghanistan and Iraq. They come back and are
reviewed by their chief executive and told they are not doing
enough trauma surgery in the hospital, when in fact they are the
experts. I just wonder if the National Health realises how lucky
it is to have Reservists who are clinicians getting real experience
of trauma surgery and so on coming back.
Mr Bradshaw: I certainly do, Chairman,
and I think good practice in the National Health Service does,
but I fully acknowledge that that good practice is not as widespread
as it should be. One of the things we are considering doing is
putting more explicit advice in the annual operating framework
about the need to encourage Reservists, not just for the reasons
that Mr Key has outlined in terms of the expertise that it delivers
to the National Health Service but also for the cross-fertilisation
of cultures which I think is very important.
Chairman: I want to move on to
mental health now, which is a major area that has come up a lot
this morning already.
Q439 Willie Rennie: The MoD has said
that the incidence of medical discharge from the Armed Forces
due to psychological illness was extremely low, running at about
0.1% in January 2007, but Combat Stress in their evidence to us
said that they have seen a massive increase in the number of people
presenting to them with a 30% increase over the last year to round
about 885 new referrals. There seems to be a bit of a contradication
between the two. Can the Minister explain that?
Derek Twigg: The figures—and
we can probably provide them to you—are that roughly in
terms of the number of Service leavers a year, round about 150
are discharged with mental health problems and I think around
25-30 with PTSD. That is not in any way belittling the fact that
for those people that is a tremendous difficulty and is affecting
their lives, so I just want to put that on record. One of the
problems, of course, is that many people will not present with
the symptoms for some years after they have left, often ten or
15 years, and I think that is maybe where the disparity is in
terms of the figures. We are doing regular assessments, as I mentioned
previously, with King's College in terms of mental health and
lots of other issues for those currently serving in Iraq and Afghanistan
and that will obviously inform our future policies. If I could
explain the approach that I have put in place in the last 12 months
or so, we have done a number of things which are to do with the
fact that when people leave it might be some years after before
they present with symptoms. For instance, we have increased Combat
Stress's funding by up to 45% from January next year. As I announced
on Friday and spoke briefly about at the start of this meeting,
pilot schemes have been put in place so that we can improve how
we treat and care for our veterans who may have left the Service
some time ago. I have also extended the medical assessment programme
across the way at St Thomas's Hospital, so those veterans who
since 1982 feel the need to have an assessment for mental health
can go there free of charge and have an assessment by a former
military psychiatrist, Dr Ian Palmer, and, of course, the Reservist
mental health scheme came out of the study that King's were doing,
so that where there was an albeit small but statistically significant
difference between those we deployed and did not deploy in terms
of their mental health we put them in the Reservist mental health
scheme. I think we have recognised that there is more we have
to do and we have to deal with that, but in terms of the figures,
because many people are saying it is later on, the question comes
back to, "Therefore, what do you do for those people?",
and I think the initiatives I have just described are part of
that road to doing more.
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