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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