The Armed Forces Covenant in Action? Part 1: Military Casualties: Government Response to the Committee's Seventh Report of Session 2010-12 - Defence Committee Contents


Government response


Ministry of Defence (MoD), in consultation with the Department of Health (DH), has prepared this memorandum as the formal response on behalf of the Government to the House of Commons Defence Committee's report on the Armed Forces Covenant in Action? Part 1: Military Casualties, the Seventh Report of Session 2010-12. The Government's formal response to its recommendations and conclusions are set out below. Where appropriate, related recommendations have been grouped together and we have responded with a single narrative. The Committee's findings are highlighted in bold, with the Government's response in plain text. For ease of reference, paragraph numbering follows that in the "Conclusions and Recommendations" section of the Committee's Report.

Introduction

1. We wish to pay tribute to all the British personnel, both military and civilian, who are currently serving or have served on operations in Iraq, Afghanistan, Libya and elsewhere but, in particular, to those who have lost their lives, and the many more who have sustained life-changing injuries as a result of these conflicts. We have witnessed the courage of those severely injured working determinedly to return to active Service. We would also like to express our deep gratitude for the vital contribution made by the families of Armed Forces personnel. We also wish to recognise the dedication and skills of regular and reservist medical personnel, both in theatre and in the UK, in treating and rehabilitating those injured in action, often at some risk to their own lives and mental well-being. (Paragraph 1)

Medical treatment and rehabilitation

2. The evidence of Admiral Raffaelli, supported by that of the Families Federations, sets out the extraordinary quality of care given to our Armed Forces almost from the point of wounding. We commend the Armed Forces medical services for the improvement in all aspects of the medical treatment of injured personnel in theatre from emergency treatment by comrades and then the Medical Emergency Response Team followed by staff in the hospital and then evacuation back to the UK. We note, however, that this greater survival rate of very seriously injured personnel has serious implications for the quality of life of these personnel and for the resources required to maximise this quality. (Paragraph 23)

The Government warmly welcomes the Committee's acknowledgement of the determination and courage to recover shown by wounded, injured and sick Service personnel. Equally, the Government is encouraged by the Committee's recognition of the work of those who provide the medical treatment and rehabilitation at home and in all theatres of operations. Both the previous administration and the current Government introduced a number of important measures in order to support the severely injured on their journey to health and return to normal duty or transition to civilian life. These are now delivering good outcomes and we are moving to a new phase where we learn about, and adapt to the needs of the Service and ex-Service communities in the medium to long term. Good progress is being made, but we are not complacent as there is always more to learn and policies to be refined in this diverse and complex domain.

The establishment of the Transition Protocol and the Armed Forces Covenant have complemented the cross-Government partnership between MoD and the DH alongside the Devolved Administrations to address the health care needs of Service personnel, their families and veterans. The Government will continue to ensure that the health needs of those who have served will be met in the long term. This reflects the Government's commitment to the Armed Forces Covenant, a commitment which has been underlined by writing the principles of the Covenant into law through the Armed Forces Act 2011, and more recently by the creation of a Cabinet Sub-Committee to address Covenant issues.

3. We note the significant advances in treatment resulting in a higher proportion of injured personnel surviving than in previous conflicts. We were impressed with what we saw and heard about the medical treatment in the Queen Elizabeth Hospital and rehabilitation services at the Defence Medical Rehabilitation Centre at Headley Court. We commend the MoD for improvements in the medical treatment and rehabilitation given to injured Service personnel and seek assurance that the new arrangements will be adequately resourced so they may be maintained over the longer term. (Paragraph 28)

MoD will continue to ensure that the Defence Medical Services (DMS) can continue to deliver first class healthcare. The SDSR settlement provided for additional resources to be provided for healthcare. Where it is sensible to do so, MoD enters into long-term partnership arrangements to provide for sustainable and high quality care; for example the partnership that has been established at the Royal Centre for Defence Medicine in Birmingham which is planned to run well into the 2030s.

The Services' Recovery Capabilities will continue to be fully resourced through both public and non-public funding in the long term. The Department is committed to maintaining the very high levels of care and support observed by the Committee, scaled to meet the requirement for as long as necessary. Work continues with other Government Departments and the Devolved Administrations to ensure that the excellent care provided to our personnel while in Service continues for those transitioning to civilian life following discharge.

It is vital that those who served on our behalf, and faced considerable dangers doing so, get the care they need and the support they deserve. MoD is continuing to invest in Headley Court to ensure that sick and injured Service personnel have access to first-class rehabilitation facilities. The most recent project to increase capacity and sustain infrastructure began towards the end of last year. The Government announced the findings of a feasibility study into the establishment of a Defence and National Rehabilitation Centre using private funds in a Written Ministerial Statement on 13 October 2011. The study concluded that, if established, there is convincing evidence that a DNRC would build on the remarkable achievements of Headley Court by offering substantial "betterment" in virtually all areas and providing an assured level of future care that will surpass that which is offered by Headley Court's current and planned capabilities.

4. We would encourage the MoD and the Department of Health to continue collaboration between the UK and USA defence medical services. (Paragraph 29)

Collaboration on defence medical services is an important aspect of the bilateral defence relationship between the UK and the USA. During President Obama's State Visit to the UK in May 2011, an arrangement between the US Department of Defence and the UK MoD on sharing best practice in supporting Service personnel, Service families and veterans was reached. In October 2011, Minister (Defence Personnel, Welfare and Veterans) and the then US Under Secretary of Defence for Personnel and Readiness signed an MOU to direct the activities of the UK/US Task Force. The Surgeon General, Surg VAdm Philip Raffaelli and the Deputy Chief of Defence Staff for Personnel and Training, Lt Gen Sir William Rollo are the joint UK chairs of the Task Force. Four working groups focusing on medical issues and the rehabilitation of wounded personnel have been established:

  •   Working Group 1 - Transition from Military to Civilian Life. 

  •   Working Group 2 - Mental Health. 

  •   Working Group 3 - 'Wounded Warrior' Rehabilitation. 

  •   Working Group 4 - Military Family Support 

Although MoD has the UK lead in this work, all four UK Health Departments (DH and the Health Departments of the Devolved Administrations) are involved in supporting the work of the Task Force. The work of the Task Force has already commenced and is scheduled to continue for four years. It is intended that best practice will be shared and experience in each country can contribute to the development of policy in the other.

5. There are significant opportunities for the NHS to learn from the experiences of the MoD in dealing with traumatic injury. In response to this Report, the Department of Health should tell us what mechanisms, other than medical personnel returning to the NHS after operational service and the recently created Centre for Surgical Reconstruction and Microbiology, it uses or intends to use to ensure the transfer of such valuable experience and advances in medical treatment, both in England and in the Devolved Administrations. (Paragraph 32)

Transfer of knowledge between DMS and the National Health Service (NHS) occurs at all levels of our relationship from the strategic MoD/DHs Health Partnership Board through to the local level sharing of trauma knowledge at key hospitals. In addition to Service medical personnel returning to the NHS and the Research Centre for Surgical Reconstruction and Microbiology, there are several initiatives that will assist in the transfer of Knowledge. For example, Professor Keith Willett, National Clinical Director for Trauma Care is taking forward work to establish regional networks for major trauma and trauma centres across England. He is working closely with MoD colleagues to ensure that the DMS and the NHS are fully briefed on developments and are able to take mutual advantage of experience and knowledge.

The DMS are also in partnership with The Royal British Legion and Imperial College London, to bring together a critical mass of clinicians, engineers and scientists, collaborating to focus new and emerging technologies to improve the fundamental understanding, mitigation, surgical management and recovery of injuries sustained by Military serving and ex-serving personnel as a result of blast.

6. The number of calls to the recently established helpline demonstrates the high level of need for mental health support for veterans. We welcome the MoD's increased attention to mental health issues. In response to this Report, the MoD should update us on progress on the implementation of the Murrison Report, Fighting Fit. (Paragraph 38)

MoD and the DH have worked closely to implement all the recommendations made in the October 2010 'Fighting Fit' report. MoD has the lead on four of the nine workstreams, with the DH leading on the remainder with our support. Implementation of Dr Murrison's recommendations is almost complete; roll out of the Enhanced Mental Health Assessment in discharge medicals is currently proceeding, and the establishment of the Veterans Information Service is planned for April 2012. All other recommendations have been implemented.

PTSD Screening tool (MoD Lead)

MoD is working closely with King's College London on a three-year study, funded by the US Department of Defence, of a possible screening tool for Mental Health issues using UK Armed Forces personnel. The trial will evaluate computer delivered psychological screening against the standard intervention of a Post Operational Stress Management brief at the 12 week post deployment point. This important study will help us understand the efficacy of screening, examine whether such a tool would benefit the UK Armed Forces and provide evidence on which the US can gauge its current policy on mental health screening. Data gathering and analysis began last autumn using Service personnel who had returned from Afghanistan during the summer of 2011.

Enhanced Mental Health Assessment (MoD Lead)

The pilot of the new Enhanced Mental Health Assessment (EMHA), which incorporates a mental health questionnaire as a routine part of discharge medicals, was successfully conducted on units across the Services during the summer of 2011. Following the evaluation of the pilot, the EMHA is in the process of being rolled out on a regional basis.

Specialist Follow-on Treatment after Discharge (MoD Lead)

New MoD policy has been implemented allowing Service personnel who have mental health issues while serving (or identified at the discharge medical) access to Military Departments of Community Mental Health (DCMH) for up to six months after discharge.

In the event that a person leaving the Service declines to be referred to a DCMH, the medical officer will write to the receiving civilian GP with his findings and information about the transition of Service personnel to civilian life.

Medical Assessment Programme (MAP) & Reserves Mental Health Programme (RMHP) (MoD Lead)

The MAP and RMHP will continue in their roles. Consideration is currently being given to co-locating the programmes to ensure that both programmes are supported as efficiently and effectively as possible. The Department is determined to ensure that the high level of clinical oversight of both programmes is maintained.

NHS Veterans' Mental Health Capability (DH lead)

The NHS Veterans' Mental Health Capability will provide a dedicated MH outreach and assessment team within each current Strategic Health Authority area. These are already in place for the South West and North West. Other areas are in the final stages of putting in place contractual and other arrangements and it is expected that these will go live shortly.

The teams will:

  •   provide a specialist veterans and families outreach and assessment capability, which will aim to complete assessment and care plan development within two weeks of referral;

  •   work with the Combat Stress Community Mental Health teams, other charities, NHS and other statutory services, provide services across each region and link with existing points of veterans care;

  •   manage referrals from a wide range of sources, develop and case manage individual care plans using the most appropriate mix of NHS, charitable and other services to best support the individual's recovery;

  •   work as part of the National Veterans Mental Health Clinical Network and act as a centre of veterans mental health expertise to support and train colleagues in mainstream health and wellbeing provision.

24 Hour Helpline (DH Lead)

The DH worked with Combat Stress to procure a professional 24 hour mental health helpline aimed at the Armed Forces Community. The tender was won by Rethink, and DH provided a grant to Combat Stress to cover the setup and one year's operations. The helpline was opened on 28 Feb 2011 and officially launched on 11 March 2011. It has taken over 3,000 calls from veterans, families and carers. The DH and Combat Stress will be evaluating the effectiveness of the 24-Hour Helpline with a view to continue provision of the helpline beyond the pilot stage.

Big White Wall (DH Lead)

Big White Wall is an online early intervention service for people in psychological distress. It is provided in partnership with the Tavistock and Portman NHS Foundation Trust. Big White Wall combines social networking principles with a choice of clinically informed interventions to improve mental wellbeing. It can be accessed 24/7 and has staff (Wall Guides) who ensure the full engagement, safety and anonymity of all members.

Big White Wall is a community of people who are experiencing common mental health problems who are supported to self-manage their own mental health. Members are able to talk freely, whilst remaining completely anonymous, and have access to a range of materials to enable self-support for common mental health issues.

The DH wanted to ensure that families of those serving and those who are now veterans should also able to access this support. The public site has accordingly been extended to provide free access for both members of the Armed Forces, veterans and their families. This goes beyond the recommendation made by Dr Murrison whose focus was on those serving and veterans.

Approximately 1,500 members of the Armed Forces Community have registered so far, with approximately 40% being Service personnel and the remainder families and veterans.

RCGP on-line training (DH Lead)

The DH, with the Royal College of General Practitioners (RCGP) has developed an e-learning package for the GP community. This was launched in September 2011. The purpose of the package is to raise awareness among GPs of the needs of the Armed Forces Community, and available services and support. It addresses mental health, seriously injured personnel, families, priority treatment and other key issues. The DH is working closely with the RCGP to raise the awareness of the facility more widely.


Veterans' Information Service (DH Lead)

The DH is in discussions with the Service Personnel and Veterans Agency (SPVA), the MoD organisation that delivers pay, pensions and support services to members of the Armed Forces and veterans, to put in place a Veterans' Information Service (VIS). The VIS will satisfy the requirement to contact veterans 12 months after discharge. Its purpose will be to provide the veteran with key information regarding a range of available services, gather evidence to support future commissioning, and provide the opportunity for the veteran to request targeted contact, including mental health and substance misuse services. VIS will entail writing to the veteran a year after discharge, and will include a regionally tailored information sheet and questionnaire with follow-up as appropriate. It is planned to launch the service in April 2012.

7. We look forward to hearing the results of the King's Centre current research on the impact of physical injury on mental wellbeing and the effectiveness of post-operational screening. The MoD should review its practices in response to the results of this research. We also recommend that the MoD continue to fund research into the mental health of those deployed on operations, in particular, the impact of multiple deployments and the stress of being in a combat role. (Paragraph 45)

The Department will consider the findings of both the current research on the impact of physical injury on mental well being, as well as the study on the effectiveness of post-operational screening. At present, the evidence for benefit of screening personnel returning from operations is lacking. This important research into the efficacy of screening will give a good evidential basis on which the Department can determine whether such a tool would benefit the UK Armed Forces.

The research being conducted into mental well being of those physically injured will inform the provision of mental health services to these personnel, in particular the requirements of the mental health team at Defence Medical Rehabilitation Centre at Headley Court.

MoD is closely involved with high-quality research which examines the mental health of current and ex-Service personnel. We provide funding for Service personnel working at the King's Centre for Military Health Research, which we have commissioned to conduct a large number of highly acclaimed independent studies over the past years into various aspects of Defence health, including mental health.

8. We recommend that the MoD should commission research into the homecoming experiences of reservists and the support and understanding of families and employers. (Paragraph 46)

MoD continues to strive to improve support to reservists. We recognise that this is a complex area involving a number of factors. When demobilised, Reservists return to their civilian lives and communities; this adds a different dimension to how they are handled in comparison with their regular counterparts. For serving members of the Reserve Forces support is available for the Reservist, their family and the employer through the Chain of Command. For members of the Regular Reserve who return to civilian life, may find that maintaining support can be more challenging following demobilisation. Support is available through the SPVA and the various welfare agencies.

Support to all Reserves is supplemented by MoD's 'Supporting Britain's Reservists and Employers' (SaBRE) campaign staffs. This is delivered at both national and regional level using the website at www.sabre.mod.uk and the helpline that provides guidance and advice specifically tailored to employers. An extant independent Employer Research Programme, in association with SaBRE, is currently conducting research with employers of Reservists following publication of the Future Reserves 2020 Study. The Department will await the results of this study before considering whether further research is necessary.

9. We recommend that the MoD should monitor Armed Forces personnel who have been deployed on operations to determine if PTSD or other mental health problems emerge while personnel are still serving. The MoD should respond to any indication of future problems rapidly and effectively. (Paragraph 47)

The Government's commitment to improving the mental health of our Armed Forces and veterans cannot be overestimated. All involved share a determination to make the mental health services our Armed Forces receive the best in the world. MoD and DH will continue to play their part, working closely with mental health charities such as Combat Stress, who carry out such vital work to improve the mental health support provided to all members of the Armed Forces Community.

The Department is examining ways to further develop mental health support for the Armed Forces including the use of ongoing health surveillance techniques and the aforementioned post-operational screening tool. The Department will respond to any evidential indication of future problems and ensure any new measures are appropriate and beneficial for the individual and the Armed Forces as a whole.

10. We recognise the importance of support for the families of deployed personnel, not only because it is right to look after the families but also because Armed Forces personnel are less likely to develop traumatic stress symptoms if their families are supported. We recommend that the MoD reviews its support for families when personnel are deployed on operations in the light of the results of the King's Centre Research. (Paragraph 50)

We note the observations made by the King's Centre and concur with their findings on the importance of support to families of those deployed for the reasons given. The Department has long recognised the importance of the family for the support they provide Service personnel throughout their career, particularly at times of enhanced stress, such as during deployments. The Committee has already seen evidence of the broad and varied support that is provided for families; however, we continue to explore further ways of improving the support for this important group.

Units already brief families before, during and after deployments in various ways according to the type of deployment and single Services ethos and support structures. Families are also given information in various forms including, information booklets and DVDs, RN Link Letters and 'HIVE' deployment packs. They also have access to wide-ranging information and advice on the Services' community support and welfare websites.

Families of deployed personnel also have access to welfare officers and other support staff to allow them to raise any concerns. Where personnel deploy as Individual Augmentees, the Chain of Command and other support staff are more keenly attuned to the specific needs of the families of deployed personnel.

The Committee is already aware of the Families Welfare Grant that units with deployed personnel can draw upon, as part of the Deployed Welfare Package. This enables them to fund additional welfare support for the families of those deployed. This grant is drawn to the value of £2.20 per week for each of their deployed personnel. Aggregated for an entire formation over the period of a deployment, this represents a significant resource for families' welfare.

In addition, various Service charities, such as the Royal British Legion and Soldiers, Sailors and Airmen's Family Association Forces Help (SSAFA Forces Help), offer both general and specific help to families, either under contract by MoD or in conjunction with MoD. Despite the range of assistance offered, we recognise that there are cases where families require more and we continually review the support provided to identify where this can be further improved. For example, we are sharing best practice with the US in the area of family support as part of the UK/US Task Force on Service Personnel and Veterans initiative and family resilience. Dispersed family support and mental wellbeing feature in this work.

Nevertheless, MoD is keen to avoid an overly paternalistic approach to the support we offer because it can offend some families. The Department strives to seek the right balance between providing information and support networks that families can access on their own terms when needed, and offering more pro-active and direct support to those with specific and more serious needs.

11. It is unclear to us whether the MoD regards the misuse of alcohol and other dangerous risk-taking behaviour as part of a pattern of reprehensible behaviour which requires punishment or discouragement, or a manifestation of stress which requires treatment, or indeed a combination of both. We recognise that the MoD has been trying to tackle the over-consumption of alcohol but there is more that should be done. We recommend that the MoD carry out a study into what is driving the misuse and abuse of alcohol in the Armed Forces and what more could be done to modify behaviour which is significantly at variance with that of the general population. The MoD has yet to recognise the seriousness of the alcohol problem and must review its policy in this area. (Paragraph 55)

The Department's position on alcohol use by Service personnel is underpinned by the independent research that King's published in 2010, which was outlined during the evidence sessions by Dr Nicola Fear. The policies relating to the use of alcohol by those in the Armed Forces are clear and well understood by those serving. MoD and the Services adopt a multi-faceted approach including education, awareness and regulation and, in parallel, medical support for those that require it. This includes a staged system for dealing with alcohol misuse, incorporating administrative, disciplinary and healthcare measures.

A new alcohol (and drugs) testing régime, which seeks to promote an alcohol free environment in safety-critical activities by means of deterrence and detection, is to be introduced. The Armed Forces Act 2011 made changes to the Armed Forces Act 2006 to include new regulations that set restrictions on the amount of alcohol a Service person can have in their body in relation to safety critical duties, in a similar way to the Railways Transport Safety Act 2003. New preventative powers will allow commanding officers to test for the presence of alcohol amongst their personnel and prescribe clear limits for certain predetermined safety-critical duties, such as aviation and handling live firearms. The new policy is scheduled to be introduced in late 2012/early 2013 and will provide a further measure to tackle alcohol misuse and encourage responsible drinking.

The MoD is extremely active in all forms of health promotion amongst its people, including the dangers of alcohol misuse whilst on leave or post-operational deployment. Commanding officers are issued with guidance on alcohol awareness, education and misuse prevention programmes for use at the unit level and we have comprehensive advertising campaigns targeted at individuals and groups. Many of our career courses, at all levels, include education and training on the problems associated with alcohol misuse, including identifying its occurrence. Where individuals have been identified as being at risk, they are given counselling and welfare support. Serious cases are treated through specialist medical and psychological treatment and rehabilitation, including as in-patients when appropriate.

The MoD does not agree with the Committee's conclusion that the Department has failed to recognise the seriousness of the alcohol problem. However, we do agree that the Department must continue to review its policy towards alcohol and measures to promote responsible drinking by those serving within the Armed Forces, just as the Government is committed to promoting responsible drinking by the general population. In support of policy development in this area, we put in place a further three year contract with the King's Centre for Military Health Research (from 2010-2013) to maintain the database of Service personnel and further explore the data obtained in the previous studies. The Department is working with King's to refine research priorities for this next phase and a key area of further research will include alcohol use.

12. Whilst we recognise that it is not possible to do a formal piece of research on the Trauma Risk Management system, we recommend that the MoD evaluate the use and benefits of TRiM and compare it with other similar systems. In response to this Report, the MoD should tell us what it is doing to minimise the number of personnel who are not picked up by the use of TRiM, particularly reservists and those deployed as single augmentees. (Paragraph 58)

TRiM is now a well established and understood process that is proving to be increasingly popular with those that have undergone the process. The Department agrees that evaluation of TRiM is important and this has been undertaken and published.[1] The TRiM process remains under regular evaluation to ensure that it remains relevant and effective. MoD will continue with existing plans to look at better ways to understand the benefits of TRiM through the use of better TRiM intervention recording and outcome audits. The effectiveness of TRiM is being further enhanced through a more robust process of TRiM practitioner selection

TRiM does not aim to be a treatment in itself; rather it aims to facilitate peer and unit support in the short term and, where necessary, to direct personnel towards formal sources of help if they do not appear to be following a normal recovery trajectory.

No matter how worthwhile this process appears to be, individuals cannot be forced to undergo a TRiM intervention. However, new procedures for recording interventions place the onus on the individual who does not wish to undergo this process to declare that fact. This new procedure is working well and is likely to be adopted as tri-Service policy in the near future.

TRiM practitioners are integral to all units deploying to operational theatres regardless of their composition. In this way both Individual Augmentees and Reservists are given the same level of support as their regular or formed unit counterparts.

The TRiM process is only part of overall Post Operational Stress Management. All Service personnel attend decompression, including Individual Augmentees and Reservists who have been in theatre for more than 31 days (this allows short visits to theatre to be conducted without the need to undergo the process repeatedly). Decompression is also proving to be popular and effective, and work is ongoing to ensure that it continues to deliver meaningful, post deployment support and provides a transitional buffer between operations and home life.

13. We commend the MoD for its recognition of the impact on medical staff in working with very severely injured Armed Forces personnel and for the introduction of greater support for such personnel. Such support for medical staff should continue and similar support should be introduced for those staff deployed in theatre and continued when they return home, particularly for reservists who are demobilised on return. (Paragraph 60)

MoD welcomes the Committee's acknowledgement of the measures that have been put in place to support medical staff working with the seriously sick and injured. While deployed to Afghanistan, medical staff have access to the same psychological support offered to all Service personnel, and utilise both TRiM and the standard Decompression process. They have access to the mental health services in theatre, including while at Camp Bastion. This includes access to Field Mental Health Teams which comprise full time community mental health nurses and periodic clinics by consultant psychiatrists, who are available to provide any care and treatment needed. In addition, should the need arise, a UK-based team of a psychiatrists is on high readiness to deploy. On their return to the UK, medical personnel are able to access the support measures offered at a unit level.

For Reservists, support continues during demobilisation when individuals can discuss any health issues with medical specialists who will advise on what steps to take. They can be referred to the Reserve Forces Mental Health Programme (RMHP) for an assessment with treatment delivered through MoD Departments of Community Mental Health or if in-patient treatment is required, via a referral to the NHS by their GP. Support measures are also available at unit level for Reservists while Regular Reserves, who revert to veteran status following demobilisation, can contact the RMHP, the SPVA or the Medical Assessment Programme (MAP) if they need advice or support at a later date. Although the health-care of ex-Service personnel is the responsibility of the NHS, MoD and Service charities work alongside the NHS to deliver the services.

14. In the rest of this Report we have set out the many areas where the MoD is providing outstanding care in relation to military casualties. The MoD rightly recognises, however, that this cannot always be said for the support it gives to families, and in particular children, in the event of the loss or severe injury of a member of their family or someone else the family knows well. The impact of such an event can be widely and deeply felt. While the MoD does in other circumstances acknowledge that it is often the families left behind at home that bear the brunt of the difficulties caused by deployment, it is time the Department turned that acknowledgement into action, and we urge it to look again at the support services it provides for the families and children of Armed Forces personnel. (Paragraph 67)

The MoD understands the importance of supporting families and Service personnel following injury or death and has taken action to enhance care and support as lessons are identified through the experience of recent operations. The immediate support provided by the system of Casualty Notification Officers and Visiting Officers is set out in the Department's previous memorandum. The Visiting Officer maintains the essential and consistent contact between the family and the Service. Visiting Officers are supported by a wide range of experts in the many and varied areas of concern to families. In addition, each of the Services has their own welfare services, officers and personnel specialists who are notified when there is a casualty. These welfare structures play a proactive part in the welfare support of the families and of the bereaved or injured, as appropriate to each individual case. For the families of those injured, the Personal Recovery Officers in the Personnel Recovery Units also maintain contact with the families during the recovery process. We allocate public funds to support families during periods of increased welfare need, such as during deployments, injury or bereavement.

The Committee has previously received evidence regarding the Armed Forces Bereavement Scholarship Scheme that was created in April 2011. The Scheme provides university and further education scholarships for the children of Service personnel who have died on duty since 1990. The Scheme, funded by the Department for Education and the Devolved Administrations, has awarded 92 scholarships to date. Additionally, a number of colleges and schools offer scholarships for the bereaved and dependants of injured personnel, such as the Radley Armed Forces' Fund. MoD's Children's Education Advisory Service (CEAS) routinely provides advice to Service families about educational opportunities and difficulties. CEAS maintains a directory of all schools on the Accredited Schools Database who offer bursaries and other types of benevolence to children of Service personnel killed or injured while on duty.

The Defence Bereaved Families Group provides a forum for discussion of policy relating to the care of the bereaved, involving representatives of those families. It is jointly chaired by MoD and a representative of a bereaved families' organisation. The Group consists of delivery and policy organisations and where improvements are identified appropriate, policy and processes are adapted. The Group has considered issues such as bereavement support, inquest assistance, pensions and support for children; and a sub-group is currently reviewing the information provided to bereaved families to ensure that it is appropriately worded.

The MoD also offers practical support programmes that can help families following bereavement. The MoD's Directorate Children and Young People (DCYP) are closely involved with supporting children and young people where a parent has been killed in action or medically discharged as a result of operational injury. The £3M Support Fund for Schools with Service Children, which is being coordinated by DCYP, will give schools, academies and Local Authorities the opportunity to receive financial aid to help provide the ongoing support to those children affected by the physical injury and/or mental health issues of their parent as a result of operational deployment. DCYP is also working closely with organisations, including SSAFA Forces Help, and the Child Bereavement Charity, in ensuring that Service children's needs are recognised.

Additionally, the charitable sector provides exceptional support for families in partnership with MoD. SSAFA Forces Help facilitate three self help groups that are considered to be extremely helpful by those involved. The Bereaved Families, the Families of the Seriously Injured and the Bereaved Siblings Group provide advice and mutual support amongst their members in an entirely confidential manner and the groups maintain a strong link with MoD policy staff to capture feedback and allay fears and concerns. The Royal British Legion offers advice and support to families via its specialists and volunteer visitors, who also attend workshops with MoD representatives to examine how families think that services could be improved. The MoD also works with Cruse, the UK's largest bereavement charity, to deliver support counselling to Armed Forces families if wanted.

Notwithstanding all the good work of recent years, MoD is not complacent. The task of examining and improving the support we offer, solely and in partnership with other Government Departments and charities, will never be complete. We will always strive to learn from those experiencing injury and bereavement, to improve further the support we provide so that we meet the contemporary challenges faced by those who endure loss through service.

Return to military service or civilian life

15. The concept that it is a duty of employment to return to health is one which shows clear benefits. This approach combines peer support and a structured military competitive environment which is best designed to aid recovery. (Paragraph 70)

16. We commend the development of the recovery pathways for promoting the recovery of injured and ill personnel. In particular, we are pleased to see that the Army is now managing its injured and sick personnel better although we recognise that the ARC was only recently established and the Army has yet to see its impact. We are concerned that the ARC might not have sufficient capacity to deal appropriately with the number of sick and injured personnel in the Army. In response to this Report, the MoD should tell us the latest position on the numbers covered by the ARC and whether the ARC will reach its target capacity of 1,000 by April 2012. The MoD should also inform us whether this capacity will allow all seriously sick and injured personnel to be supported. (Paragraph 71)

The Government welcomes the Committee's recognition of the significant improvements introduced to the care of wounded, injured and sick personnel as a result of the Army Recovery Capability (ARC). This remains one of the Department's highest priorities after military operations.

The ARC's target capacity of 1,000 personnel represents only one element of its planned Full Operating Capability. Since the ARC was launched in February 2010, considerable thought has been given to the evolving requirement, and introduced several significant enhancements in order to better support the most seriously injured Army personnel. These include an uplift to the overall capacity of the Personnel Recovery Units from 750 to 1,000; an increase in the capacity of the Personnel Recovery Centres at Catterick and Tidworth; the provision of a further Personnel Recovery Facility in Germany; better training for staff within the ARC; a widening of the BattleBack concept of sports adaptive training; and much improved support to those personnel whose future lies outside of the Army to prepare them for future employment.

It will take time to provide these significant additional enhancements, and as a result, Full Operating Capability is expected to be achieved by 1 April 2013. MoD is confident that the original target capacity of 750 will be achieved by 1 April 2012, as initially planned. This will allow the most seriously wounded, injured and sick personnel to benefit from the added support provided through the ARC. The increase in capacity to 1,000 will be achieved by no later than 1 April 2013, although every effort will be made to ensure that this capability is delivered earlier if possible. Once the Army Recovery Capability reaches full capacity, it will provide the facility to care for all of the Army's most seriously wounded, injured and sick personnel. In the interim, the capacity of the Personnel Recovery Units will be carefully managed to ensure that those most seriously injured personnel are properly supported, and further improvements are being introduced to the care of wounded, injured and sick personnel who are cared for outside the Army Recovery Capability, by their current units. MoD is confident that no wounded, injured or sick personnel will be neglected, and they will receive the support they need.

17. We recognise the difficulty faced by the Armed Forces in determining which injured personnel should remain in the Armed Forces and those who should be medically discharged, especially as many personnel wish to remain in the Armed Forces because it is their chosen career and of worries about future access to treatment. We recommend that the needs of the individual should be taken into account when deciding on medical discharge and that those for whom a civilian career would be more rewarding should be encouraged to consider the benefits to themselves of leaving. (Paragraph 73)

The Department welcomes this recommendation. The Defence Recovery Capability helps individuals to explore all of the options available, inside and outside the Armed Forces. One of the key elements associated with the recovery process is the Individual Recovery Plan. Every long-term or seriously wounded, injured or sick Service person should have a tailored Individual Recovery Plan which helps them to focus on the outcome most appropriate to their circumstances: either their return to duty or transition to civilian life. The Plan integrates all aspects of an individual's recovery including medical, welfare, housing, education, re-skilling, work placements and employment opportunities. It will also ensure that individuals have the access to the particular support needed at each stage of recovery, whether that support is provided by MoD, the NHS, the charitable sector or other key delivery partners to drive recovery forward.

It has been the Service policy since the 1940s that personnel who are medically unfit or medically unemployable for service will be discharged. However, the Armed Forces may retain those seriously injured, if they wish to stay, for as long as there is a worthwhile role or it is judged to be in the interest of the individual and the Service to which they belong. Every case is assessed individually, and we can assure the committee that the needs of the soldier concerned are carefully considered as part of this process. No one who is wounded, injured, or sick will leave the Services until they have reached a point in their recovery where it is right for them to leave, however long it takes.

18. We agree with the MoD's policy that those in medical treatment or rehabilitation should be protected from redundancy. (Paragraph 74)

The Government welcomes this recommendation.

19. We are concerned that the arrangements put in place by the MoD for the transition of personnel may be disrupted by the future re-organisation of the health service in England. We wish to be kept informed by the MoD of the results of its work with the providers of health and social care. In particular, the MoD should tell us whether medically discharged personnel are receiving consistent services, no matter where in the UK they live. (Paragraph 77)

The Transition Protocol between MoD, DH and Devolved Administrations supports the seamless transition of care from MoD to the NHS (clinical) and Local Authorities (social). The initial six-month pilot which concluded in March 2011 showed that the protocol was fit for purpose. Lessons identified have been incorporated into current MoD policy. The pilot highlighted areas for improvement and, as the Committee is aware, a subsequent MoD led review of the Transition Protocol is underway. This review includes key stakeholders including the DH, the Association of Directors of Adult Social Services and the Devolved Administrations to ensure the protocol remains fit for purpose, particularly during organisational change. The Department does not envisage that this informal review will result in a formal report. However, should the review lead to some policy changes, these will be reported.

In 'The Armed Forces Covenant: Today and Tomorrow', published in May, the Government committed itself to ensuring that Service families are duly considered during the NHS reform process. The responsibility for the commissioning of NHS secondary and community care for the Armed Forces will transfer to the NHS Commissioning Board (NHSCB) on 1 April 2013, subject to passage of the Bill. In addition, the NHSCB will take responsibility for the national commissioning of veterans' specific services, fulfil an assurance role in the implementation of the principles of the Armed Forces Covenant and sponsor the regional NHS Armed Forces Network.

As with current practice, the Armed Forces Networks across both England and similar networks in the Devolved Administrations will continue to have a key role in ensuring that the Armed Forces, their families and veterans are not disadvantaged in accessing NHS health care in their region. The Government is confident that the restructuring of NHS England should not affect the Transition Protocol. Within the new agreements, the role of the Armed Forces Champions has been further strengthened. Close liaison will be maintained between MoD, DH, the NHS and the Devolved Administrations to ensure that the standard of care that the Armed Forces Community has a right to expect is delivered and that inconsistencies of service are addressed should they occur. We will report on our ongoing work with providers of health and social care in the annual report on the Armed Forces Covenant.

A regional network of support groups to help all veterans access local services has also been launched. Thirteen groups have been created across the UK, staffed predominantly by former Service personnel, to give advice to veterans about the range of services available to them. This could be anything from helping a veteran get specialist medical care to assistance for a widow to claim a pension. The groups, called Veterans Advisory and Pensions Committees (VAPCs), will help to ensure Service personnel and veterans are not disadvantaged and support the principles of the Armed Forces Covenant. After a successful one-year pilot scheme, the VAPCs will now be permanently established. They will help deliver better services to ex-Service personnel by providing advice to veterans, health authorities, local government and charities on issues affecting veterans at a local level. Each VAPC is made up of a chairman and between 12 and 20 unpaid volunteer members, drawn from the local ex-Service community. The VAPCs have worked closely with the SPVA, The Confederation of Service Charities (COBSEO) and all the principal Service charities have contributed to the review.

Veterans can get contact details for their local VAPC by calling the Veterans-UK helpline on 0800 169 2277 or visiting the Veterans-UK website: http://www.veterans-uk.info

Support for former Service personnel

20. The Government should exclude Armed Forces compensation from consideration when determining means-tested benefits without the need for each person to establish a personal injury trust. We agree with the Veterans Minister that the lump sum payment from the Armed Forces Compensation Scheme is intended to be compensation rather than earmarked to be spent on social care. We therefore conclude that this is not a matter for debate but one which should be dealt with urgently. If it is left to be dealt with following a consultation and debate in the country, there is a risk that in the short term some members of the Armed Forces might be disadvantaged. (Paragraph 81)

The Armed Forces Compensation Scheme (AFCS) lump sum payment paid for pain and suffering is not taken into account in the social care means test if placed in a Personal Injury Trust. Individuals in receipt of a lump sum are advised of this when they receive their AFCS award notification letter. Placing these lump sums into such a trust in order to qualify for the exemption from the social care means test places AFCS lump sum awards on a par with those lump sums paid to individuals through Personal Injury claims. This approach provides important protection for the individual and their future, aside from excluding the money from means testing, and the Department believes this to be the most appropriate way to achieve that protection. This is an established system and we are not aware of it causing any individuals specific difficulties. Injured personnel can receive help and support in these matters from a number of sources, including charitable organisations.

The Government is aware of the social care funding issue in relation to the AFCS Guaranteed Income Payments (GIP). These payments are paid to recognise the effect of the injury on loss of earnings potential. MoD and the DH are working to identify the best way to deliver the Government's Covenant commitment to ensure that these ongoing payments are not taken into account in the means test for social care provided by the public sector.

21. We recognise that payments under the Armed Forces Compensation Scheme are borne by the MoD and there is, therefore, a risk that they are competing for funds against other defence needs such as weapons systems. We shall consider this subject further when we undertake an inquiry into the needs of veterans. (Paragraph 82)

The Government notes the Committee's intention.

22. The policy on the provision of priority treatment to veterans is not clear. We would like to see tangible evidence that the education of GPs is working in regard to the provision for priority treatment for veterans with conditions as a result of service in the Armed Forces especially when it comes to treatment for mental health problems. The MoD should institute an education programme to inform Armed Forces personnel leaving the Services about what they are entitled to with regard to health services. We look forward to seeing coverage of the Armed Forces Covenant in the mandate between the Government and the NHS Commissioning Board and the establishment of similar arrangements being agreed with the Devolved Administrations. (Paragraph 85)

The Government believes that the policy on the provision of priority treatment for veterans is clear. All veterans should receive priority access to NHS secondary care for any conditions which are likely to be related to their service, subject to the clinical needs of all patients. Where secondary care clinicians agree that a veteran's condition is likely to be related to their Service, they are asked to prioritise veterans over other patients with the same level of clinical need. The policy and clear guidance for clinicians has been communicated to the NHS and GPs formally through three gateway letters, as well as more informally through guidance literature and on the military health area of the Department of Health website.

The development of the e-learning package with the RCGP provides further opportunity to raise awareness of priority treatment. The Department of Health will continue to work closely with the RCGP to monitor and assess the impact of the e-learning package on GPs' awareness of veteran and service family issues including awareness of priority treatment for veterans. Separate work in relation to mental health conditions being taken forward in response to Dr Murrison's "Fighting Fit" review of mental health provision will also help ensure that veterans get the appropriate treatment when it is needed.

The requirement to meet the needs of the Armed Forces Covenant is included within the current NHS Operating Framework and will continue to be a key area of delivery for the NHS Commissioning Board. Within MoD, all Service leavers receive information about priority treatment after attending their discharge medical and is also included in the SPVA Service Leaving Pack.

23. In respect of those who have lost limbs, there are likely to be significant medical resource costs, not just costs of prosthetics but also in provision of qualified and experienced staff. We regard it as essential for former Service personnel to receive the same level of support after leaving the Services as they did whilst serving. We are pleased to see that the Government has accepted the recommendations of the Murrison Review on prosthetics, and we would like to see the project plan and timetable for the establishment of the specialist centres and the arrangements for ensuring support health authorities in England and in the Devolved Administrations. (Paragraph 89)

Dr Murrison's report "A better deal for military amputees" was published in October 2011 and the Government has accepted his recommendations. A project has commenced in England to develop an operating model for a National NHS Veterans' Amputee Rehabilitation and Prosthetics Service that meets the recommendations of the Murrison Report and captures those clinical and cultural practices of military provision that are relevant to veterans. This work has engaged key clinical professional groups, the voluntary sector, NHS providers and MoD and is at an early stage.

The Devolved Administrations were consulted during and after publication of the Murrison Review. Each has confirmed its commitment to the provision of veterans' prosthetic services, though it is for them to achieve the intent of the Murrison review.

The DH has put in place a project board and project manager to take forward the recommendations made by Dr Murrison. A series of consultations with key stakeholders, the NHS and others is currently taking place. These discussions will help shape the specification for the specialist centres. There will then be a tendering process with a view to having the centres in place by the end of 2012 or early 2013. Interim arrangements will be put in place with effect from 1st April to ensure that the needs of those discharged from service before establishment of the specialist centres are met. The DH will provide a copy of the project plan and timetable to the Committee in the next two months, having completed the consultation process.

24. We note that other costs relating to long term mobility issues, for example cars, housing and other aids and adaptations, need to be considered and resourced by other Government Departments. In response to this Report, we ask the Government to set out its proposals to ensure that these matters will be properly resourced. (Paragraph 90)

The Transition Protocol, piloted last year and being further developed throughout 2012, is designed to smooth the transition from Service life to living as a civilian, for our wounded, injured and sick. It develops a bespoke plan involving expertise from within Defence, including the chain of command, and from medical and social services, local government, housing experts, charities and others as required, all working with the patient group. The aim is to ensure the individual leaves the Armed Forces in a measured manner, and is only released to the care of wider society when it is the right decision and society is ready to step up to the mark. MoD continues to work closely with other Government Departments and Local Authorities to ensure that the State can fulfil its commitment to the individuals as their needs develop and alter through life. This is the type of issue which the new Cabinet Sub-Committee on the Armed Forces Covenant will be well placed to tackle.

25. We are not convinced that the Department of Health and the health authorities in England and the Devolved Administrations fully understand the costs and implications of long term medical care and social care for ex-Service personnel with brain injuries. Our visit to the US defense center for excellence for traumatic brain injury highlighted their assessment of the links between traumatic brain injury and PTSD and mental health problems. It is very important that former Service personnel whose health has been seriously mentally or physically undermined in the service of the country be given the best possible treatment. In response to this Report, we expect the Department of Health, the Devolved Administrations and the MoD to set out how they intend to provide such services and ensure the appropriate quality of the treatment and the necessary support. The Government should commission a review into the needs of ex-Service personnel with brain injuries and examine research which considers the long term effects of traumatic brain injuries and the mental health needs of veterans. (Paragraph 93)

As the Committee is aware, MoD, DH and Devolved Administrations have been collaborating on the protocol for the transition of care for the seriously injured. This important initiative is in place and ensures that the long-term needs and services required by the seriously injured are met. The pilot cases included a number with acquired brain injury from both operational, and non-operational, injuries. This work is currently being taken forward in collaboration with the development of the Defence Recovery Capability and receiving NHS services. The pilots did highlight the particular challenges associated with care for those with a serious brain injury and the issue of long-term care needs to be addressed.

The needs of the long-term medical and social care for those with brain injuries are significant and MoD exercises considerable effort to ensure that the proper provisions are in place before the Service person is discharged. Within the NHS, the needs of those with brain injuries is also well known and fully understood. It is already provided for all those who have received serious brain injuries as a result of traffic accidents, sporting and occupational accidents.

MoD continuously commissions and monitors research into health and mental health. Previous research has established a link between head injuries and depression and suicide. We also recognise an association between Mild Traumatic Brain Injury (MBTI), also known as Post Concussion Syndrome, and mental health issues. Interestingly, the rate of concussion is significantly less common in UK Armed Forces personnel than in US personnel; this is not yet fully understood.

The symptoms associated with MTBI can be similar to those arising from mental health disorders or those caused by complications of medication used to treat pain. The identification of the cause of these symptoms can be difficult and may not necessarily be beneficial to the individual. As a consequence, DMRC Headley Court has produced a treatment approach that treats the individual's symptoms, thus offering coping strategies and techniques to alleviate their problems. This is the subject of a research evaluation at present.

The Government is aware that the very small numbers of UK Service personnel who have serious Traumatic Brain Injury are a high-risk group for mental health issues. Current research is being conducted in order to understand the effects of brain injury and brain hormones (Neuro-endocrine); this will help treatment to minimise damage to brain following trauma and help us further understand the long-term effects of traumatic brain injury.

26. We regard it as essential that the support of ex-Service personnel suffering from mental health problems should be treated as being as important as that for those with physical injuries. The MoD told us that it did not expect PTSD to develop in an overwhelming number of troops after they left the Service but we remain to be convinced. We recommend that the MoD works with the Department of Health, the NHS and the Devolved Administrations to ensure that GPs and other service providers are aware of the support available to former Service personnel with mental health problems. The MoD should work with the charities to communicate with former personnel and their families about the availability of support. (Paragraph 97)

The Department considers that the current academic research or attendance figures at the MoD's Departments of Community Mental Health do not indicate that levels of PTSD will increase above current rates. However, MoD is not complacent and will and must remain vigilant and continue to monitor those who served in Iraq and Afghanistan.

With regard to communicating the support available, the Department is clear that communication with former personnel about the availability of support is an integral part of delivering Dr Murrison's recommendations in his Fighting Fit report and contributes to an ongoing programme of raising awareness and communication within the NHS, GP, service charities and others. The Government will continue to work with the charitable sector through initiatives such as the DH Third Sector Strategic Partnership with the Royal British Legion and Combat Stress and the Armed Forces Networks in order to promote the support available for former personnel and their families.

Relationship with the charitable sector

27. The MoD told us, and we accept that it was slow to take advantage of offers of additional funding from the charities and has been reviewing the way it responds to offers of additional funding. In response to this Report, the MoD should tell us the outcome of this work. The MoD now appears to be better at engaging with those charities providing funding for capital projects. (Paragraph 101)

28. We recognise that there is a long and honourable tradition of the charitable sector providing support for our Armed Forces, for their families and for veterans. This is not only valuable in material terms but also helps to keep the people of our country connected to the Armed Forces. Nevertheless, we are concerned the charities may be paying for projects that the MoD should more properly fund. We are also concerned that the MoD may not have planned for the future replacement and maintenance of some of the additional facilities provided by such charities. We recommend that, in response to this Report, the MoD sets out its policy with regard to what it should properly fund and how it will work with the charitable sector and what its current plans are. (Paragraph 103)

29. We believe that there is a possibility that charitable donations will begin to reduce when the Armed Forces no longer have personnel in combat roles in Afghanistan and recommend that the MoD's future plans for projects should not depend on such funding. We would suggest to the Armed Forces charities that now is the time to be raising money to be held in reserve for when future funding for Armed Forces projects declines. (Paragraph 104)

Providing the necessary support to sustain the health, welfare and wellbeing of Service personnel and their families is an accepted Defence responsibility. MoD receives public funds voted by Parliament to meet this obligation. However, there will always be some instances when the Department is not able to fund the provision of facilities and services, within the optimal time frame or to a higher standard. In these circumstances there is a long tradition of the Armed Forces receiving charitable assistance and it is entirely appropriate for the continuing generous support of charities to complement existing provision from public funds as is the practice in many walks of life.

The Department now has an established process for ensuring that any potential projects proposed by the voluntary and community likely to exceed £1 million are considered for coherency with wider Defence priorities, and that long-term affordability issues are addressed. Key stakeholders including the Chain of Command, Surgeon General, Finance Officers and the Defence Infrastructure Organisation are consulted. Consideration is given to all aspects of the projects including, affordability, sustainability, downstream costs, estate optimisation issues and applicability across the whole Armed Forces Community. MoD will prioritise the projects that are under consideration to enable charitable funding to be directed to support the greatest need. Projects below £1 million are to be dealt with under local arrangements.

The Department is careful to ensure that any acceptance is appropriate and adheres to HM Treasury rules. Exceptionally, HM Treasury has agreed that where a donation is offered towards the costs of a welfare facility, which would normally be publically funded, it may be accepted and retained by the Department. HM Treasury approval is required before the acceptance of charitable funding for core activity which is regarded by the Treasury as novel or contentious.

MoD recognises that there has been a change in the charitable funding being offered. Traditionally Service charities have assisted in the welfare and veterans arenas through the provision of advice and counselling services and through welcome, but relatively low-value, gifts. Donations are now being specifically targeted, for example the Defence Recovery Capability is underpinned by substantial financial investment by both MoD and its principal financial partners Help for Heroes and The Royal British Legion; this represents the single largest charitable contribution to the Armed Forces in British history. Sometimes the Department's response to accepting funding is necessarily slower than some would like, but this is to ensure that sustainability issues are considered and due diligence is undertaken.

30. Whilst we recognise the work done by COBSEO and the MoD to improve the coordination of the charities supporting Service and ex-Service personnel, more needs to be done. We also exhort the charities to co-ordinate their efforts and in some cases to consider the merger of appropriate charities serving similar groups of people. The MoD should consider building on the COBSEO cluster system for charities whereby a suitable organisation is given responsibility to co-ordinate efforts in a particular area, for example, housing. COBSEO should encourage charities to use some of their reserves as it is now "a rainy day". (Paragraph 108)

The need for improved coherence within the Service charity sector is well recognised. However, change takes time among a collection of independent organisations, all of whom are intent on supporting the Armed Forces Community. COBSEO has made significant efforts to encourage greater coherence and reduce duplication of effort and MoD has been, and remains, fully supportive of that effort. Many of the charities are undergoing reviews of their work and we remain hopeful that duplication will reduce. Careful analysis and planning is required if change is to be coherent.

MoD fully supports the COBSEO 'Cluster' system, as well as the similar 'Pillar' system used by Veterans Scotland. Minister (Defence Personnel, Welfare and Veterans) has publicly stated the Department's support for COBSEO's work, including the Cluster system, in his speech to the organisation's Annual General Meeting on 27 October 2011. We do not agree that the Department is in a position to exert pressure on the Service charities to work in a particular way. This is the business of the Service charities that form the membership of the Confederation, all of whom are independent of Government. We continue to work closely with COBSEO and its members who deliver considerable benefit to the Armed Forces Community.

31. The MoD should help to address the possible confusion as to where those affected can find support from the charitable sector. In particular, the MoD should publish on its relevant websites a clear description of where help can be found for different groups of personnel (for example, those in the individual Services or even Units). It should also as a matter of course provide such information to personnel when they leave the Services. (Paragraph 109)

The SPVA is currently reviewing the charity links section of the www.veterans-uk.info website to create a 'charity hub' with better information in an easier to navigate format. All the main Service and ex-Service charities are being offered a page of information each and over 20 have replied so far. A call to others has been published on the website and in the publication 'Veterans World'. The new portal is expected go live shortly.

As part of its ongoing efforts to increase awareness of the support that it provides to veterans SPVA has recently published a video on YouTube to make veterans aware of the one-to-one help provided by the SPVA Veterans Welfare Service to anyone who has served in the UK Armed Forces. The video shows how welfare support is provided automatically to those medically discharged or those bereaved by service with an 'on request' service for all other members of the veterans' community, including dependents and families.

In addition, all Service leavers are already, as a matter of course, provided with a comprehensive 'Leavers' Pack', which contains information on charities providing support for the Armed Forces Community. The pack contains information sheets on the SPVA, including the Veterans Welfare Service, SSAFA Forces Help, the RBL, RBL Scotland, the three Service Benevolent Funds, BLESMA, Combat Stress, the Regular Forces Employment Association, the War Widows Association, RBLI, Age Concern, Citizens' Advice Bureaux, the Salvation Army, the Royal Hospital Chelsea and a specific sheet on how to seek help and advice if having problems. Whilst this is only a selection of the many support organisations and systems for the Service community, most of these organisations are also able to provide advice and onward referral if they are unable to help with a particular problem.

MoD will continue to work with the DH, Combat Stress and other military charities to improve the mental health support to all in the Armed Forces Community. A recent example is the development of web pages, accessible both internally and externally to the Department, which set out the services available should individuals require assistance.

Conclusion

32. We have been impressed by the courage, hard work and determination of those injured on operations to get well and, if at all possible, to return to active duty. The same may be said of the brave and skilful personnel, both military and civilian, who are providing the medical care that our Armed Forces need. The MoD is now providing first class medical treatment and rehabilitation both in theatre and back in the UK. It also provides other support for severely injured personnel in their journey to health and return to duty or to civilian life. It is too soon to say whether the individual Service recovery pathways and the transition protocol with health authorities are working well but they represent steps in the right direction. (Paragraph 110)

33. Our major concern is whether the support for personnel when they leave the Services will be sustainable over the long term when operations in Afghanistan have passed into history. In particular, we are concerned about the number of people who may go on to develop severe and life-limiting mental health, alcohol or neurological problems. We remain to be convinced that the Government as a whole fully understands the likely future demands and related costs. (Paragraph 111)

34. We note that the charities and Families Federations are making a significant contribution to the support of injured Armed Forces personnel and veterans and their families but fear that their contribution may be constrained if the level of charitable donations reduces substantially. We urge the charities and the MoD to work even more closely together and explore ways of ensuring that new capital projects provided by charities can be sustained into an era when current levels of donations may no longer be relied upon. (Paragraph 112)

The Government, as noted in the introduction to this memorandum, welcomes the Committee's acknowledgment of the determination and courage to recover shown by wounded, injured and sick Service personnel and of the work undertaken by those who care for them medically or support their welfare. Our commitment to the Armed Forces Community cannot be overestimated and has been enshrined in the Armed Forces Covenant. The Government will maintain its efforts to ensure that the health needs of those who have served will be met in the long term, including those that have suffered serious physical or mental injuries. In order to do so, we will continue to work closely with charities to support Serving personnel, their families and veterans.


1   Academic Centre for Defence Mental Health (ACDMH) - The acceptability of 'Trauma Risk Management' within the UK Armed Forces 05 April 2011 Back


 
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