Welsh Affairs Committee - Minutes of EvidenceHC 131

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Oral Evidence

Taken before the Welsh Affairs Committee

on Tuesday 7 February 2012

Members present:

David T. C. Davies (Chair)

Guto Bebb

Nia Griffith

Mrs Siân C. James

Jessica Morden

Mr Robin Walker

Mr Mark Williams

________________

Examination of Witnesses

Witnesses: Mark Lovatt, Manager, Blind Veterans UK, Llandudno, Alistair Maxwell, Regional Manager (Wales) Royal British Legion, and Clive Wolfendale, Chief Executive, CAIS, gave evidence.

Q1 Chair: A very good morning, Messrs Lovatt, Maxwell and Wolfendale. Thank you for the welcome that we had yesterday at St Dunstan’s. We have one hour before we have to go back to London, so we will try to keep things as concise as possible, if that’s all right.

Before we start the questions, could you quickly introduce yourselves and tell us a little about the organisations that you represent?

Mark Lovatt: My name’s Mark Lovatt and I am the centre manager at St Dunstan’s in Llandudno. We are a charity that supports visually impaired ex-servicemen. I’m an ex-serviceman myself and I did 27 years’ service.

Alistair Maxwell: Good morning. I am very pleased to be here. I work for the Royal British Legion, and I am currently employed as the regional manager for the midlands, Wales, Northern Ireland and the Republic of Ireland. In that regional area, I have 13 county offices delivering benevolence to the ex-service community.

Before I joined the Royal British Legion four years ago, I was a career Royal Air Force officer, and I completed my career by specialising in veterans’ affairs and welfare policy for servicemen and their dependent communities.

Clive Wolfendale: Bore da. Good morning. I’m Clive Wolfendale, chief executive of CAIS. I have been with CAIS for two and a half years, following a 34-year career in policing in Manchester and north Wales. CAIS is a charity, which delivers services for people with substance misuse problems across north Wales and Powys. It has been around for about 30 years, and throughout that time, it has given various types of support-substance misuse and PTSD support-to military veterans. We currently run a clinic, which last did a session on Friday, offering support to some 20 veterans across north Wales with PTSD issues, and funnelling them into substance misuse treatment where appropriate under existing contracts.

On a personal basis, I chair a multi-agency group, operating in north Wales, which seeks to bring together people with an interest in veterans’ issues and improve the situation for individuals in north Wales.

CAIS receives no funding whatsoever for those services; they are done as a pro bono offering on the back of our general charitable remit to support people in need through substance misuse and allied issues.

Q2 Chair: Do any of you know how many veterans there are in Wales? Any approximate figure for that?

All Witnesses: No.

Q3 Mr Walker: Good morning. I am interested in how devolution affects your work and how the Assembly arrangements advantage or disadvantage you. Do any of you feel that the devolution settlement presents any obstacles to your work with veterans?

Alistair Maxwell: I have an office in Cardiff, which is manned by a county manager, who is very closely involved with the Assembly’s work. In fact, I think she’s involved with them next week. I have an overview of Sarah Pearce’s work, and from my perspective, the arrangement is working particularly well and I have been very pleased with the reception that she has had and the opportunity that she has been given to inform the debate in Wales.

Clive Wolfendale: From my perspective, which is not as broad as Alistair’s, a key component is the operation of the health service in Wales, as opposed to the United Kingdom generally, and England in particular. For me, it is critical that health services have a proper role in co-ordinating not only the medical services, but the entirety of provision for veterans. It seems to me, from travelling around England and Wales, that health boards in England-I point to a model in the south-west of England, which offers a very comprehensive structure of provision-may be, in many respects, slightly in advance of the situation here in Wales. I wonder whether that’s worth investigating at some point. I’m very happy to share this with Members.

Q4 Mr Walker: On co-ordination between the different levels of Government, do you feel that there is sufficient co-ordination between the UK Government and the Welsh Government and what they are trying to deliver?

Clive Wolfendale: It seems to me that there is a gap, but I wouldn’t put the tension particularly between the UK and Welsh Governments. There are inhibitors at different levels. Some are due to political oversight, but some, as I’m sure you know, are due to the delineation of responsibilities between the MOD and the health boards and the statutory and voluntary services that administer all that. For me, that co-ordination is critical to moving the agenda forward. With the best will in the world, only the health service really has the infrastructure and the resources to pull that together.

Alistair Maxwell: May I build on a point that Clive has made to reinforce what I said initially? It is to do with the formation of health forums. Because I sit across two regions-one being Wales and the other the midlands-I see that the national health forums are much more advanced in my midlands region, especially in the east of the country, where my team and I are very closely involved. I entirely support Clive’s point that that gives us the ability to inform and to position ourselves much closer to the national health service effort, which is so important to veterans as they leave our care and go back to society. In my experience, it is a model that works well in other parts, and I commend it to you.

Q5 Mrs James: Mr Maxwell, my first question is to you. Can you explain the process whereby personnel are discharged, either for medical reasons or because they have come to the end of their service?

Alistair Maxwell: Yes. I will do that very simply, if I may. Individuals who have got a pre-planned exit from the services have, of course, advance notification, so they have an exit date already in their minds. Those people who leave with that period of notice in terms of retirement have sufficient time to prepare themselves, with assistance from the resettlement organisations in the armed services, for life back in the civilian world. That advice is fair, in my view. It is very much a pool from which the individual can take. How they take that very much depends on individuals’ circumstances, but there is a full range of services for employment and, indeed, seeking accommodation, if they require that. In addition, they will transit from the health care of the services to that of the national health service, and there is a process for doing that.

Q6 Mrs James: Do you have any concerns, because we have heard from some veterans who say that the big picture of the resettlement scheme is fantastic, but that some people don’t take that pool of choice or aren’t supported?

Alistair Maxwell: Yes, I have concerns. They surround those who are less able and those who have served for a very short period. In particular-I will not show my true colours-if you have an Army private, who has perhaps come from a less than perfect background before he joined the Army, has then served for four years, during which his every need and want has been looked after, and he has been accommodated, fed and transported around the world, he is perhaps not best able to transit back into civilian life. Also, those individuals whom we classify as early service leavers, who are required to leave the armed services for many reasons-they may have medical problems, or they may have had discipline problems and been asked to leave the service of the Crown-are invariably slightly disadvantaged. That is a difficulty for the services and the MOD. As the charitable sector, we inevitably pick up some of those cases.

Q7 Mrs James: If I could open it out to Mr Lovatt and Mr Wolfendale, what are the problems to with discharge?

Mark Lovatt: That was a really accurate summary. One of the difficulties that Alistair touched on is that the cultural differences in the service are quite stark. The services recruit from a different pool, dependent on what the needs of the service are, but there is a one-stop shop for resettlement. It is the same for everybody, but it does not necessarily catch everybody.

Clive Wolfendale: As I understand it, and I am sure that Alistair will correct me if I am wrong, the resettlement programme does not apply to service folks with less than six years’ service in whichever branch. Of course, that excludes a huge number of individuals, some of whom could have served two significant tours in that time. Some veterans tell me that there is a feeling that some of them are being left behind.

Q8 Mrs James: To fend for themselves, in essence?

Clive Wolfendale: Indeed. The other thing that veterans tell me quite vociferously is that the resettlement programme focuses quite successfully on some of the knowledge and skills that are essential to create a successful life outside the military, but that veterans really struggle with the emotional aspects of combat and its consequences, and the resocialisation agenda that goes with that. A lot of veterans will tell you that that is what they need help with, because often they arrived in the services at a very young age and have not had the life experiences to enable them to make the transition sometimes into, but particularly out of, a very controlled environment. Those are the two areas that veterans particularly talk to me about.

Q9 Mr Williams: Going back to the NHS, and in particular the arrangements for transition, what is the process for the transfer of service personnel medical records to the NHS on discharge? How robust are those arrangements? I am just mindful of the Royal British Legion’s submission, which says of the new protocols, "it is aware of arrangements for England and the devolved administrations in Northern Ireland and Scotland. However, we have not yet seen a version for Wales."

Alistair Maxwell: The arrangements for the transfer of records is far from robust, I think. My own recollection from leaving the services was that it was my responsibility to get my records to my local GP. I was very capable of doing that, but others are not so capable. My understanding is, and this involves a great deal of IT wizardry, that the plans are to make the transference of medical records from the services to the NHS as automatic as possible. The indications from dealing with national health forums in my midlands region is that that is an aspiration. I note from a publication on Wales that I read last night that it is also an aspiration here.

Q10 Mr Williams: But it is an aspiration that has been realised in Scotland, Northern Ireland and England. Any explanation as to why we are not at that stage in Wales yet?

Alistair Maxwell: I am unable to comment on that. I just don’t have the detail, unfortunately.

Mark Lovatt: I can support that from personal experience. I have been out of the service since May last year, and my documents have disappeared.

Q11 Mr Williams: What do you put that down to?

Mark Lovatt: A lack of robustness. I think it is something to do with the military, but I also think it is something to do with a particular dental surgery and doctor’s surgery. They are not that interested, either. It is not necessarily the fault of one side.

Q12 Mr Williams: Lastly, where would you expect the lead to come from to remedy that shortfall? Indeed, it is a major shortfall because it goes to the core of the starting point of the services that the NHS should be in a position to assist with.

Alistair Maxwell: I suggest that it is a joint responsibility. From my limited knowledge, it appears that we have two, three or four discrete systems that just will not talk to one another. I think that is a problem across the NHS anyway in terms of IT. A joint requirement on both sides is needed. The services should make the records more available and more easily accessible, and the NHS should have an appetite to receive them in any shape or form. Perhaps there should be an onus on the individual to press harder.

Mr Williams: Assuming that they’re in a position to do so.

Alistair Maxwell: From my experience, I confirm that you are in that position. Once again, if you have the time, intellectual ability and understanding, you can perhaps do it, but many are probably unable to do so because they have very, many other things on their minds. That is the last thing you think of, when you are a fit, young man leaving the service-or lady, obviously.

Q13 Guto Bebb: I was very interested in the submission from the British Legion in relation to the services for those ex-service people with mental health concerns, and whether those services are actually doing what is required. Can you first explain the arrangements when a service person with mental health issues is discharged from the service and transferred to the NHS?

Alistair Maxwell: I don’t have a competence to answer that. Perhaps Clive has, but I have no knowledge myself of how that occurs.

Clive Wolfendale: I’ll try to assist, but I must make the point that it is from our perspective here in north Wales and from being on one side of the equation. It is fair to say that the attempt to create a cogent throughput has only really become a reality in the past 12 months. The report of the National Assembly and the Health, Wellbeing and Local Government Committee on veterans, which was published just a year ago, points to the gaps in that provision. Although there has been work in that time to try to plug the gap, there is, certainly from the perspective of, I suppose, observers and people in the middle-the veterans themselves-insufficient capacity and insufficient organisation in the way that people are transmitted through the system.

With the best will in the world, we have to acknowledge that that gap still exists in Wales. The result is that there are lots of people still not accessing those services, and that the services are probably insufficiently developed to meet the specific needs of veterans with acute symptoms and sometimes comorbidity on those symptoms. Please take that as a personal view based on talking to veterans, and my observation. But that is what it appears to be to me.

Q14 Guto Bebb: To what extent has the establishment of the All Wales Veterans Health and Wellbeing Service dealt with some of the issues highlighted in that report? As a supplementary, to what extent do you think that services in north Wales, for example, are well co-ordinated with services available in other parts of the United Kingdom, for example, the north-west of England?

Clive Wolfendale: In Wales, there is again scope for co-ordination. The links between north Wales and the rest of the UK have principally been through Combat Stress operating in England, where there has been quite a healthy relationship with key individuals.

As some of you may know, the situation in north Wales has been complicated recently by issues associated with Forces for Good, which was without doubt the lead voluntary support agency in north Wales. Much had been vested in that organisation to fight the cause and, in fact, it enjoyed that reputation across Wales. In that vacuum, I have to say that in the past few months the situation has probably deteriorated in terms of the ability to forge a path for veterans, and it is something that CAIS and others have tried to play a part in pulling together.

We have a situation now where a group of veterans were in an establishment in Anglesey, on a treatment programme, which collapsed. In fact, at the request of Darren Millar, Assembly Member, at a meeting last week, I shall be going there this afternoon to see what can be done to try to remedy that situation and see what we can do to help individuals who came here with a promise that now appears to be unfulfilled. I cite that as an example of a situation which has existed elsewhere, with establishments coming and going and small charities coming and going. The situation is not comprehensive; it is fragmented. In my view, it is far too often left to the good will of very small organisations and individuals, who find it genuinely impossible to pull together the very complex strands of finance, organisation and clinical resilience that are necessary to provide the treatment that we all seek. Please take that as a very personal view of the landscape.

Q15 Chair: Mr Wolfendale, I asked Mr Lovatt this yesterday, but are there some organisations out there that have attached to themselves the label of veterans charity and which, for one reason or another, are able to raise money but are not necessarily doing a very good job?

Clive Wolfendale: My answer to that, Mr Davies, is that there are too many organisations now-probably around 1,000 in the UK, I would suggest, and certainly quite a lot in Wales-that, often with good intent, are involving themselves, but certainly without proper governance arrangements, so that nobody knows where the money is going, and without proper clinical governance in terms of the therapies. The multiplicity of therapies is astonishing, and there is a lot of dogma attached to that, and resistance to change and acceptance which complicates the situation as well. We have to assume that, among that huge number of charities, some are not fit for purpose, and the evidence suggests that.

Q16 Chair: As somebody who runs one of the most respected charities in this country, Mr Maxwell, what do you think of that?

Alistair Maxwell: I entirely agree with what Clive has said, in that I do not think we have answered the question of how we deal with the transit. Certainly, we are now concentrating on our ability to deal with people once we know who they are. I certainly agree that there is this plethora of charities growing up, which, in my view, seem to think that it is an easy subject to get involved in-it is certainly not. I echo Clive’s concern that there is a capacity issue. There is insufficient capacity across the piece.

To put the Royal British Legion’s perspective on it, we will work with only two bodies when we have individuals who have mental health problems: the national health service and Combat Stress. We will refer no one anywhere else.

Q17 Mr Walker: Coming back to the NHS, since 2008 veterans have been entitled to priority access to NHS services. What does that actually mean in practice?

Alistair Maxwell: As an ex-serviceman with a medical problem, you should be given priority treatment and priority in terms of being seen by your GP. This has been a long-standing commitment. It is one that keeps being reinforced. I have to say that, in my view, progress has been slow. Certainly, when I was serving, I was involved in trying to encourage this along. Now I am with a major charity, I see signs of this being very patchy across my region, where some GPs and some national health service organisations are very pro the ex-military, but the mandate that they have to give them priority treatment is not consistent across the piece.

Q18 Mr Walker: In your written submission, the Royal British Legion said that you had been working very closely with the Department of Health in England on this issue. Has the same kind of co-operation and co-ordination been going on in Wales?

Alistair Maxwell: It has started to, but we are some way from developing that with them. I see that as being very much part of the development of the health forums as an ideal vehicle in which issues such as this can be fleshed out, and in which the education of what we mean by giving priority treatment is explained to those who need to deliver it.

Q19 Mr Walker: Do you think that the Welsh Assembly Government can play a role in pushing that and encouraging it?

Alistair Maxwell: Indeed I do.

Q20 Mr Walker: Coming to CAIS and the drugs and alcohol situation, what sort of proportion of your clients are veterans?

Clive Wolfendale: To answer your question specifically, I would guess-because the information systems are not sufficiently robust to be definite-probably about 20%. It is a question that, of course, we are often asked, because it is CAIS’s principal mission. My usual and preferred answer is to point individuals to research from King’s College, London, which you may be familiar with, and the work of Nicola Fear. It is partly sponsored by the British Legion as well. 10,000 veterans were sampled. It is a hugely impressive and robust study pointing to the prevalence of substance misuse issues. I have copies for Members if you want them afterwards. This is now well rehearsed.

Of the individuals coming out of Afghanistan and Iraq, probably around 45% were diagnosed with some PTSD after a long period of time there-up to 10 years or so, as we know. Three to four times that number are facing significant alcohol misuse problems-most of that starting within their service, but definitely carrying on thereafter. I am not talking about casual social drinking; I am talking about acute, dangerous, life-threatening problems that damage families and relationships and end up in all sorts of situations with criminality and so on.

So, my answer is that this is mainly an alcohol problem. The problem with drugs is much less pronounced in our experience with veterans. The problem of alcohol addiction among veterans outweighs the PTSD issue by three to four times. That is something that is currently often overlooked. They go hand in hand. My other answer to your question is that from the recognition by clinical experts, the veterans I speak to and my own observation, everybody with a PTSD problem, just about, is likely to have a drink problem. They seem to go absolutely hand in hand. That is the experience that just about everybody involved seems to recognise. That is the landscape as I see it-nationally and certainly in north Wales.

Q21 Mrs James: Just a quick addition to that-you mentioned the link with alcohol. Is it the case that they are self-medicating, because they have problems, and they are using alcohol?

Clive Wolfendale: That is precisely the situation that they are in. In the absence of treatment or other medication or therapies, alcohol is a recourse.

Q22 Mr Walker: You mentioned that some of these problems start while people are still in service. Do you feel that you have sufficient links, and are you able to get into the services to try to deal with that problem at source?

Clive Wolfendale: No, we don’t. It isn’t CAIS’s particular focus, and never has been, to work with the military. Of course, I am sure that we would be very pleased to do so, but I am sure that my colleagues here recognise that the culture of drink within the armed services has been very prevalent, and remains so in some cases. I say that as a long-serving officer in the police, where a similar culture was and is prevalent. It is something that I think we need to think about very carefully, because that is often where the problem starts. Because there is that tradition and prevalence, the consequences when people leave with problems are pretty obvious.

Q23 Nia Griffith: If we could turn to the disabled facilities grant, we have seen league tables of how well councils across Wales do in providing across the piece for the whole population. What has your experience been in terms of veterans and, picking up on the British Legion submission here, the shortfall in that grant?

Alistair Maxwell: About 18 months ago we started to take a stance on disabled facilities grants. Quite frankly, the charity’s provision for such facilities was being abused, in our view, across the piece. Councils and local authorities, in our view, were certainly not meeting their statutory obligations. I think they saw the major charities, ourselves included, as an easy route to save funding. We are taking steps to ensure that individuals who do apply for disabled facilities grants now, regardless of need, seek statutory provision as a first course rather than turning to charities. Only once that avenue it exhausted will we, as a charity, fund the requirement that was set in place or identified through the disabled facilities grant. I have to say that since we started that, across both my regions, I have seen a marked improvement in councils and local authorities facing up to their responsibilities.

Q24 Nia Griffith: In other words, when you said, "No, look, you’ve got to do this," they have responded.

Alistair Maxwell: Yes, they have.

Q25 Nia Griffith: Have you taken it up with the veterans Minister in the Assembly?

Alistair Maxwell: We have taken it up with the ombudsman. I think we have had one, if not two, successful cases, which have found in our favour.

Q26 Chair: Do you find that too, Mr Lovatt, with people with blindness and sight problems?

Mark Lovatt: I am at a very early stage in my role in the charity, so I am not fully aware of that. I am aware that we have individuals who know the system and who know how to move around either different charities or the social services to try to get what they want. We tend to be very much needs-led, so if the need is not there but there is a want, that is not necessarily something that we would support. I certainly do not have the background to be able to answer that robustly.

Q27 Chair: If veterans are on a war pension or have been recipients of compensation, I believe the local authority is allowed to disregard that when allocating other forms of benefit such as housing. I believe most do, but not necessarily all. Are there any in Wales that could be doing a little more than they are doing at the moment?

Alistair Maxwell: I have no knowledge about it.

Q28 Mr Williams: I want to turn specifically to rehabilitation services in Wales. As a starting point, could you tell me what rehabilitation centres are located in Wales, both for physical injuries and for those with mental health concerns?

Chair: We might start with yours, Mr Lovatt.

Mark Lovatt: I know my own, but I am not aware of any others.

Q29 Mr Williams: Can you help me in terms of the rehabilitation centre in St Athan? Does that treat veterans or only injured serving officers?

Mark Lovatt: Is that the one on the military unit?

Mr Williams: Yes.

Mark Lovatt: Headley Court used to deal with all rehabilitation issues. About six or eight years ago, it regionalised a lot of its work. I have a feeling that that will be a regional rehab unit for serving members.

Q30 Mr Williams: In view of your answer, should there be a military rehabilitation centre dedicated to Wales? Is there a critical mass to use that facility, were it to exist? What would you say to people who might say that it would detract from resources that could be dedicated to bigger centres elsewhere in the United Kingdom?

Mark Lovatt: It depends what you mean by rehabilitation.

Q31 Chair: We have had a submission from one veteran, who is trying to set up a centre in Wales for Welsh soldiers. His view is that Welsh veterans should not have to leave Wales in order to be treated, but we looked at your excellent facilities yesterday, and you are treating veterans from all over the United Kingdom. Do you see an argument for having a centre specifically for veterans living in Wales, or do you think that it is perfectly reasonable to operate on a UK-wide basis?

Mark Lovatt: When you join the military, you join the UK military. Welsh veterans will live in Wales, Scotland, Ireland and England. The same applies to all other nationalities. I am an example of that. We would need good UK cover, which would probably include some rehabilitation in Wales, but centres would be open for any servicemen. We need to come back to whether you are talking about physical rehabilitation.

Q32 Mr Williams: We are talking about both: physical and mental health facilities.

Mark Lovatt: Okay.

Clive Wolfendale: My first answer is that there are certainly sufficient numbers of individuals located in Wales, or born in Wales, who want to stay in Wales to fill a rehab centre of some description. With physical disability, mental health issues, social issues, whatever, there is no question but that the numbers are there. My position is similar to Mark’s in that this is a UK perspective. Having specialisms is good as well. We have a centre of excellence here in Llandudno. That’s the first response.

The second response is that there are more units in Wales. They come and go. We had one in Llandudno, Tŷ Gwyn, for some years. It disappeared eight to 10 years ago. We had Pathways in Bangor. That was quite a well regarded institution for some time. It disappeared about 18 months ago. We have the establishment on Anglesey that I referred to earlier. That is still going and would regard itself as some sort of treatment centre, but without governance and support at the moment. Until recently, we had a hotel in Llandudno that was established as a centre for assisting veterans. These establishments come and go. Sometimes there are costs associated with that, both financial and personal, because there are legacy issues when people are let down in that way.

There is scope for much more co-ordination in that sense. If this is worth doing, it’s worth doing well, and there is no doubt that there is significant demand for residential centres that offer longer-term therapies and a holistic approach to rehabilitation, focusing on emotional socialisation and particularly getting people back into work, because the unemployment rate among veterans, as you’re probably aware, is extremely high-probably double or triple the national average. Those are the things that are needed. Of course, as you would expect me to say, a facility with the ability to treat individuals with substance misuse problems, particularly alcoholism, is, for my money, almost a necessity, because it is so prevalent and destructive. Unless that is addressed, any other treatments will just be superfluous.

Q33 Mr Williams: I do not ask the question about the location of facilities in Wales from a nationalistic point of view. I am mindful of the people we have met. Some of the people at St Dunstan’s yesterday had travelled from areas all over the UK because it is a centre of excellence. It is more a case of responding to the need on the ground throughout the country. Obviously, Wales has needs as strong as those anywhere else.

Mark Lovatt: Absolutely. I wonder, when you ask the question, what you are seeing in your mind as a veteran. Hopefully we showed you that yesterday. It could be a 22-year-old or a 92-year-old. It’s really important that we don’t differentiate. The youngsters have real needs now, but they will get older. If we don’t take account of that, what will happen to them in 10, 20 or 30 years’ time?

Alistair Maxwell: I agree with everything my colleagues have said, but to answer specifically on dealing with those individuals who are in dire need of rehabilitation, who are seriously injured, there is no doubt in my mind that a more central approach, the approach of having the best facility, whether that be at Headley Court or wherever else we put it, is the way to do it. I would not water that down by setting up specialist units and organisations in other parts of the country, but where I really do see the effort required is at local level, where you have long-term rehabilitation and individuals who want to be closer to their families, closer to those they want to settle with. The charitable sector can give more to that, and perhaps local and national Governments will look at that to give much more service.

Interestingly-forgive me-across my midlands in terms of the forums, even when we look at the national health service, the difference between Lincolnshire and Essex is hugely marked. Lincolnshire has huge capability in one area, but Essex has none. That is not uncommon.

Q34 Guto Bebb: May I address a couple of supplementary questions to Mr Wolfendale? I think you initially commented that you thought that something like one in five of your clients would have been ex-servicemen. That probably compares to one in 12 of the people of Wales who would be ex-service people. Do you think that the figure of one in five is a reflection of a failure of other services in north Wales to catch the problem earlier? My second question is this. Do you have any comparable figures from other parts of the UK for similar organisations to yours and whether they also have such a high level of ex-servicemen as clients?

Clive Wolfendale: To answer your second question first, talking to colleagues in agencies around the UK and elsewhere in Wales, there has been a similar experience. I would not say, on that evidence, that Wales has a particular situation. Of course, yes-unequivocally-the reason we are finding high numbers of people on our books is that the support has not been there at the right time or in the right place. That is something that we all need to think about.

Coming back to the issue about a centre in Wales, may I add another rider to that? Wales is a good place to be doing this sort of work because we have space, a strong tradition of supporting the military-there are lots of people around who can help-and the environment in terms of the therapies, the space, the mountains and the sea. Veterans find it an attractive place in which to recover; they feel at home.

Alistair Maxwell: Forgive me, may I just add something?

Chair: Sorry, I had probably better push on a little if I may, because we will have to cut things short.

Q35 Jessica Morden: The Chair mentioned earlier this issue about the interaction between compensation schemes and welfare benefits. I know from your written evidence that the Royal British Legion has concerns about the reform of welfare, particularly of housing benefit. Would you like to elaborate on that?

Alistair Maxwell: Only inasmuch as we are very aware of the changes that are coming up. We have seen no evidence as yet, as you would expect, of any disadvantage, and we are keeping a very careful watch on it.

Q36 Jessica Morden: What are your particular concerns about housing benefit?

Alistair Maxwell: The removal of that benefit and the inability of the individual to find suitable housing. There are many views on this. The economic cycle may mean that there is not an issue because landlords might reduce the rates and rents to accommodate what is on offer. Alternatively, and this is something that may have to happen, charities may have to make up the shortfall. Certainly, that is a view that we would resist, at least initially.

Q37 Jessica Morden: What interaction has the Royal British Legion had with DWP, and what kind of answers have you had?

Alistair Maxwell: We have had no particular interaction at the moment because we have no evidence to put forward. Certainly, when we do have evidence and when we see individuals being disadvantaged, we will make that point.

Q38 Nia Griffith: You talked about there being a plethora of charitable organisations-perhaps about 1,000. We have also talked about the statutory services. Do you feel that organisations such as St Dunstan’s and the British Legion are doing things that should be done statutorily? The same applies to the number of services that Mr Wolfendale is involved with. Do you think that there should be a broader safety net? Obviously, you have talked about the crucial role of the NHS. Do you feel that you are picking up the tab sometimes for things that should be dealt with by the state?

Mark Lovatt: If the world was perfect, yes, but I just cannot see how the state could pick up the work of 1,000 different charities. I just do not see how that would be affordable or realistic. We do not have any Government support, so we are completely self-funded. Perhaps one way would be to look at individual charities to work out how it could be done together. Ideally, yes, but practically, no.

Q39 Nia Griffith: Taking your example, the quality of what you do for people is absolutely superb. Are you saying that it is almost too expensive to afford on the state?

Mark Lovatt: We talked yesterday about having 50,000 visually impaired servicemen in Britain. One of the difficulties that we have as a charity is reach. How do we find them, where are they, who are they and how do we encourage them into the charity? If that was done on the state, everyone would know. You would probably have to provide for all 50,000. That would be the difference. As a centre that runs rehabilitation and training for visually impaired people, you do not want to serve just the 3,000. We want to serve the 50,000, but how realistic would that be?

Clive Wolfendale: Thank you for the question, which cuts to the heart of the treatment debate in many ways. The first answer is that the health service probably cannot afford to do much of this work, and we must accept that that is the case in this day and age. The second is that charities and the third sector are sometimes in a better position to deliver such services. There are two fine examples here today, and I hope that CAIS is also part of that agenda. Often, we can work more effectively because we are embedded locally, with the tradition and history to go with it. We can certainly work more cheaply because we do not pay as much, and we do not have the overheads and infrastructure to support in the way that the health service does.

There is definitely a role for the third sector and charities in this arena, but it can work only with proper corporate governance of the charities: proper oversight of what is going on, accountability, extremely tight financial governance to make sure that every penny is properly accounted for in income and expenditure, and clinical governance arrangements-the quality of the therapies and treatment-that stand scrutiny with the best the health service could offer if it were minded to. For me, the argument is clear. The health service cannot pick up the tab completely, and in some ways it is better if it doesn’t, but I return to the point I made earlier that where the health service can certainly add value, and not necessarily at much expense, is through exercising oversight, co-ordination and leadership of the whole agenda. I don’t think that can be properly bettered anywhere else.

Q40 Nia Griffith: Some of us have seen very good organisations doing very good work with, say, lottery money, but no one ever comes down from the lottery to check up on whether the office has been opened and three people have been employed, or whether the project exists only on a piece of paper and someone has run away with the money. You are effectively saying that there should be a much higher profile approach, possibly from the Cabinet Office, to oversee what so-called charitable organisations are doing in terms of value for money. Do you see a role there? Is a central role necessary for rationalisation and to bring things together, and will that happen spontaneously, or is something needed to push it?

Clive Wolfendale: At the moment, I see no contraction in the number of charities, and the situation is becoming more chaotic by the month. I use that word, because you just don’t know who to talk to next, or who will approach you next.

In terms of setting up anther quango or level of bureaucracy to oversee all this-

Nia Griffith: No, the Cabinet Office already exists. Should it take a role?

Clive Wolfendale: Someone would have to do it, and it would be a big chunk of work.

Q41 Chair: Some sort of benchmarking?

Clive Wolfendale: Benchmarking certainly. The Charity Commission has a role, and I think there must also be self-governance. It must look internally in association with charities, and we must hold our head up high and be absolutely appropriate and clean in everything we do. That is essential.

Q42 Chair: Do you think we need some form of benchmarking, without necessarily a quango, to summarise Ms Griffith’s question?

Clive Wolfendale: Some sort of oversight is essential.

Chair: Do you agree, Mr Maxwell?

Alistair Maxwell: Yes, I have some sympathy, and I see exactly the points my colleagues are making. Third sector charity services are overcrowded. There is no doubt about that. What will assist is greater partnership working with the NHS, Government and charities, and realisation by the charitable sector, especially that dealing with the veteran community, that there is overlap. We must be much more mature and decide collectively ourselves-this is where a little nudge would help us-that we cannot do everything.

My view is that we should have fewer but more specialist charities, more closely tied in with the national health service, local authorities and Government, and who work in closer partnership, because it is far too easy for an individual or a group of people, who may be well intentioned, to decide to start up a charity without, as Clive has said, robust clinical oversight or any governance that we might recognise.

Chair: Do you agree, Mr Lovatt?

Mark Lovatt: Model answer.

Q43 Chair: I was going to follow that up with a question about the regimental charities. I know that the Air Force and the Navy work slightly differently. Nobody would question what they are doing, but one interesting point that has been raised by a serviceman-this is specifically in relation to the Army-is that some Army regiments seem to have far more success in raising money than others, meaning that an injured serviceman from one regiment might benefit to a much greater extent than an injured serviceman from another, simply because one regiment may have lots of people working in financial services in London and another one may not. Is there some truth in that and is there an argument for centralising the regimental system? Incidentally, other servicemen that I have mentioned this to have said, "Absolutely not. Over my dead body."

Alistair Maxwell: If I were an ex-member of the Black Watch, I would say over my dead body as well. The Army regimental system-we do not have time to rehearse it-has such strength and we should not meddle with that. We meddle with it at our peril. Yes, you are right, the regimental support systems are very variable in terms of size, scale and the amount of revenue they have, but they are very proud, and from my perspective, when they come to the end of their useful life, they see that and they amalgamate. In terms of whether a rich regimental charity gives more than a poor one, obviously it does, because it has more funds to give, but the great joy about delivering benevolence to the ex-military community is that we all work in partnership. Where there is a shortfall in giving to meet the benevolence requirement, other charities will step in. It is not just a small regimental fund that cannot afford to do that. They will almonise invariably from the larger charities, especially the Royal British Legion, which will contribute to make up the shortfall. I do not think that disadvantage is rife.

Q44 Chair: We are running very short of time, so, if I may, I will put one question to you-I ask you to be as concise as you like-which is: what would you do, if you had a blank cheque and could do anything you wanted to help veterans in Wales? If you did not have a blank cheque, what do you think that we should be doing, because the money is there anyway? Are there any suggestions that any of you want to put to us?

Alistair Maxwell: The blank cheque question is slightly unfair.

Chair: It’s probably unrealistic.

Alistair Maxwell: And totally unrealistic. We can go back to whether we want to set up centres of excellence and so on. Without a blank cheque, which I don’t have, we don’t have and we are hardly likely to have, there are three things: co-ordination through the development of the national health service forums, partnership, both within the service sector and with Government and local authorities, and a commitment on our behalf to eradicate overlap in getting better use for our resources.

Chair: Thank you for the brevity of your answer.

Clive Wolfendale: They are similar themes, I think, if you reflect on the last question in the briefing note about three things that you might do. The blank cheque, for me, would be a comprehensive system of veteran rehabilitation-let’s talk about operating in Wales-which would have a residential component to it, based in Wales and would clearly be picking up on the substance misuse agenda associated with veterans’ needs.

In terms of the three things, first, I agree with Alistair that the ownership and co-ordination through the health mechanisms is mission critical. Secondly, if we have got your ears, I would be inviting you to badger the MOD to do something about the drinking culture inherent in the armed services, because that leads on to so much later on, and I think that needs some fundamental thinking. The third thing, which we also have touched on-this is becoming very dysfunctional-is somehow to stop the explosion of charities that is taking place; it is becoming quite difficult. There should be a default situation for anyone who wanted to set up one to be asked, "Prove the need, because why can’t these other 800 charities do what you are saying you’ll do in this particular area?"

Mark Lovatt: The blank cheque-this is going to sound ridiculous-is some kind of utopian world where we are just not putting people in an environment where they will get their legs blown off. Let’s try to end that kind of conflict. That would be great in terms of cutting off need at the source.

I think, as a charity, we are going to spend quite a lot of money and time trying to find people who could benefit our charity. If something could be done centrally in terms of communication, that would be fantastic, and I am sure that other charities would benefit as well. We should have a co-ordinated approach to let ex-servicemen know what services are available, from whom, when and where. Then we can focus our effort and money on service delivery.

Chair: Thank you all very much for coming along and giving evidence this morning. We appreciate it.

Prepared 8th February 2013