Examination of Witnesses (Questions 480-493)
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
Q480 Willie Rennie: And other health
professionals, is there advice given to them? Are their work colleagues
given advice about how to deal with them?
Mr Cash: Yes. People do a round
of promoting this, so in most organisations, and again we need
to re-emphasise this, you get heads of departments together to
(a) say as an employer they encourage it, and (b) what do you
do with people when they come back? Make sure you de-brief them,
make sure that you do not perceive them to have any issues that
have arisen from their service.
Q481 Willie Rennie: It sounds quite
loose. Is there a need for more?
Mr Cash: I think there is room
for more and I think that is why we have picked this up as an
issue in our next phase of work, to really restate that we support
this, so we are planning, as I say, to pull people together, probably
the human resource directors of various organisations on a regional
type basis, to re-emphasise what they need to do.
Q482 Chairman: I would agree with
what Willie Rennie has just said about it sounding quite loose
because when I visited Frimley Park people being de-briefed by
people who had no experience of military service at all, who just
did not understand the sorts of things that people had been through,
was an issue and I hope it is something that you will seriously
address.
Derek Twigg: Okay. Can I just
say it is obviously our responsibility as well and I think it
is in an area where we would look to do more.
Q483 Mr Holloway: I have found the
answers to our questions highly relevant and it is very nice to
see such grown-up people in key jobs in all this.
Derek Twigg: Do you mean all of
us?
Q484 Mr Holloway: Of course, all
of you. However, I cannot help feeling that yet again we have
got the "everything is absolutely marvellous, wonderful,
we have thought of everything" line. We spoke earlier about
pre-emption. Obviously, with members of the press sitting around
you are not going to give us the precise things that you are working
on but there must be areas that you are quite worried about and
you are probably quite relieved we have not touched upon. What
are they?
Derek Twigg: To take your general
point, I will give you an example—Selly Oak. There is no
problem with clinical care or anything like that, but we looked
at it and said, "What more can we do in terms of welfare
support both for the Service personnel coming in and also for
their families?", so we have improved that tremendously.
We have talked again about Headley Court and the review about
what further we need to do. Everyone says it is excellent and,
of course, it is excellent but we are not resting on our laurels
but are looking at what further we can do. In terms of mental
health, we clearly saw there were issues there. That is why we
have introduced the medical assessment programme and why we have
gone down the pilots. On the specific issue about Reservists we
have just been talking about now coming back individually, and
the effect on their mental health compared to the Regular Army,
there is another example.
Q485 Mr Holloway: So we are not going
to see headlines in six months' time of the kind that we have
had in the past that we have been letting these young men and
women down? Is that what you are saying? Is it now broadly sorted?
Is the chapter over?
Derek Twigg: If I could give you
a sort of guarantee that there will never be anything go wrong
or the press will not—
Q486 Mr Holloway: I was not asking
for that.
Derek Twigg: I know, but that
is what the point is. I think if you look at the way some of these
things are reported you would expect there is a systematic breakdown.
I think from your own investigations, and certainly our personal
experience of some of those people who have to deliver services,
that is not the case. Clearly, in terms of veterans, and not least
in terms of mental health, there have been gaps and issues there
in terms of how we can improve that, and there always will be
areas where we can improve, but I do not want to give you a sense
or complacency here. There is not, absolutely not.
Q487 Chairman: Before you move on,
something prompted your statement on Friday. Did that statement
on Friday imply that there is ongoing work, that it is not settled,
that there are still things you will need to be addressing because
you are not entirely satisfied that we are in the right place
here?
Derek Twigg: You will know from
statements I have made in the House in terms of the pilots and
initiatives we are talking about that it is about—well,
we announced it, we did it then. Yes, we are not completely satisfied
because we want to ensure we get the best possible system. It
is not a case of resting on our laurels or resting on the last
initiative or the last announcement. It is about moving forward
and looking all the time. As the Generals will tell you, there
is an absolute commitment ministerially, the same in the Department
of Health, to provide the best possible healthcare and support,
and we are looking to make that change. I will just give you an
example which we have not touched on today but we had it ready
to give you, and I think we should do it at this point. One of
the things I said to the Surgeon-General when he came to the job
was, "How do we know that the health services we are providing
are as good as we all think they are and that generally people
tell us they are, given the gaps and problems, so how do we measure
that?". One of the things we are looking at is having an
independent look at the services, to have the Healthcare Commission
look at them. That is my answer back to you, that we are prepared
to do that. I do not know what that will come out with. I hope
it will come up with a very good report but the fact is that I
want to make sure we have absolutely the best systems in place.
Q488 Chairman: David Hamilton has
just asked if that is for the whole of the UK.
Derek Twigg: Yes, and abroad.
Q489 Mr Hamilton: The reason for
asking is that you have the responsibility because Ben Bradshaw
does not represent the UK; he represents England. He represents
English health authorities; that therefore represents 87 per cent.
Derek on the other hand does represent the UK. I raise that question
quite genuinely because we have seen the discrepancy in education.
Derek Twigg: Our services are
UK-wide as well.
Mr Bradshaw: DMS is UK and abroad
and I think the Healthcare Commission has already indicated that
they would be very happy to undertake a review.
Lieutenant-General Baxter: The
Partnership Board are very keen to get the Chief Medical Officer
of Scotland and appropriate people from Ireland and Wales so that
when something does come up, and I like to think of myself as
a fairly persuasive person, we can say, "Look: what are you
going to do about it?", and then if I get no satisfaction—
Lieutenant-General Lillywhite:
I would just like to answer the question do we have any worries
and perhaps correct a slight mis-impression that I might have
given earlier. Manning still concerns us. We are significantly
improving our manning in many areas but we have a workforce that
is very junior, that in many cases, particularly in the nursing
area, is inexperienced. We still have some way to go to produce
the number of specialist nurses, for example, that we want and,
although consultants as a whole are improving significantly and
have improved significantly over time, there are a couple of areas
like general surgeons and general medical practitioners where
we do not seem to be having the same improvement as we are having
in other areas, so there are still one or two areas that we have
not quite got right which we are looking at.
Q490 Chairman: So if there were any
worry that you would put at the top of your list of worries manning
would be the one, would it?
Lieutenant-General Lillywhite:
No.
Q491 Chairman: Then what would?
Lieutenant-General Lillywhite:
What would be top of my list would be to ensure that the quality
of care we are producing is as good as we think it is and that
is why the Healthcare Commission external audit is an important
part of the work.
Lieutenant-General Baxter: Everything
would flow from that.
Mr Bradshaw: In response to Mr
Holloway's question about this terrible phrase "horizon scanning",
I think the work programme at the board gives a good indication
of where we think the main concerns are, but because of the rapid
development of both medical treatment and technology and the rapid
changes in military techniques and technology these things are
constantly changing and our challenge is to try to stay abreast
of the latest developments and deliver, as we have all said, the
best healthcare possible.
Q492 Willie Rennie: Following on
from Mr Hamilton's point, will this Commission to check on the
quality of the care follow the patient, and if it follows the
patient will it make sure that it goes all the way through the
system so that it goes from the GP and covers the secondary care,
in which case full partnership with the Scottish Government and
the Welsh Assembly will be absolutely essential to make sure that
works, so that it is not just about your services within the military;
it is also about the services across the board. Is that the case?
Lieutenant-General Lillywhite:
I can give you an assurance that we are looking at the care of
our casualties wherever they are treated. I expect the Healthcare
Commission to assist me in being able to identify whether there
is any sub-optimal treatment anywhere that our Servicemen are
treated.
Q493 Mr Hancock: Is it possible as
a veteran to get Mr Holloway some priority to have his Blackberry
surgically removed as quickly as possible? It should be of some
priority.
Derek Twigg: I shall make sure
he gets a veteran's badge.
Chairman: We are reaching the law of
diminishing returns. I think we had better close this evidence
session and say thank you very much indeed to both of you, Ministers,
and to your teams for some very useful evidence on an exceedingly
important subject.
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