Support for Armed Forces Veterans


BMA House, Tavistock Square, London, WC1H 9JP


T 020 7383 6520 F 020 7383 6830  E

Mr David T.C. Davies MP

Chairman of the Welsh Affairs Committee,

House of Commons,




28th March 2012

Dear Mr Davies,

Supplementary BMA written evidence to the Welsh Affairs Committee inquiry into support for armed forces veterans in Wales

We thank the Committee for the opportunity to provide further information on protocols in place for discharging physically injured veterans in England, Scotland and Northern Ireland, referred to in the evidence submitted by the Royal British Legion (question 55) and on the fulfilment of the commitment on prosthetics provisions for veterans (question 81).

The Committee asked the panel for information on the process by which an injured veteran is transferred from the Defence Medical Services into NHS care. The Service Personnel and Veterans Agency ( UK-wide, with a Welsh office) liaise with local civilian services three months prior to discharge. Further info rmation about the process available here: . Although there is a single, standard, protocol, the way that that protocol is implemented depends on an individual’s clinical needs.

The Ministry of Defence provided the b ackground to the protocol in its evidence to the Defence Select Committee inquiry into the Armed Forces Covenant in Action: military casualties [1] :

The Transition Protocol process has been developed under the auspices of the MoD/Departments of Health Partnership Board which is co-chaired by the Surgeon General and Sir Andrew Cash, Chief Executive of the Sheffield Teaching Hospital NHS Foundation Trust. Alongside extant arrangements governing the coordination of medical and welfare support to those leaving the Services, the MoD has negotiated a Transition Protocol with the Department of Health (DH) and the Association of Directors of Adult Social Services (ADASS) to ensure a seamless transition for ill and injured Service personnel from military to civilian life. The Protocol was agreed by departments in September 2010 and the initial trial period concluded in March 2011, at which point it became policy for the three Services, DH and the Devolved Administrations.

The Protocol sets out the responsibilities and procedures for planning the transition of health and social care for injured Service leavers to local public providers. The Protocol ensures that a bespoke Transition Plan is agreed by the receiving care providers at an early stage. A Multi-Disciplinary Team consisting of MoD, plus local service providers and Veterans Welfare Service (VWS) representatives are brought together by an MoD Case Co-ordinator at least 3 months in advance of the discharge date to assess the medical and social needs of the leaver. The Protocol provides a mechanism for the development of an appropriate care package which will be drawn together by the MoD Case Coordinator in liaison with the relevant health and social care experts within the Primary Care Trust and Local Authority. This should ensure that a care package provided by local service deliverers is in place from the moment an injured Service leaver is discharged.

A number of the Voluntary and Community Sector organisations have considerable expertise in delivering support to injured and ill Service personnel which is complementary to that provided by the public sector. The VWS is responsible for coordinating the Voluntary and Community Sector participation in the Multi-Disciplinary Team assessment to ensure that the appropriate elements of the sector are present.

The protocol does not absolve the Department of a moral responsibility to remain engaged with medical leavers for as long as the requirement endures. The VWS retains an important role as the prime point of contact to whom Veterans can turn for assistance. Routine VWS engagement is reduced at around the 2 year point but the VWS never close a medical discharge case file. It continues to provide support for as long as it is required. VWS has established arrangements to call every medically discharged veteran each year for the next two years. This process will be tracked to provide management information which will inform a review of the effectiveness of these extended contact arrangements.

In 2011, the UK Government asked Dr Andrew Murrison MP to undertake a review of the provision of care for military amputees both within the Defence Medical Services and the National Health Service. A key recommendation , supported by the BMA, from Andrew Murrison's report A Better Deal for Military Amputees [2] was:

The trial of the MOD Seriously Injured Leavers' Protocol and the MOD/NHS Transition Protocol has the potential to improve handover from Headley Court and Personnel Recovery Units to DSCs and should be expedited with attention given to a refined system of case management, including a comprehensive statement of needs and prescription on transition to the NHS.

The BMA agrees with the Royal British Legion’s assessment that the protocol for continuing care and transition should be adopted in Wales and that the NHS Wales should work within the protocol that has already been developed elsewhere in the UK. It is also our understanding that the Welsh Government has committed to matching the prosthetic provision available through the DMS within the NHS. Anecdotal evidence from BMA members working with the continuing care and transition protocols in England indicates that the process is operational and working well. A s previously outlined to the Committee, we have long been campaigning for improvements to the system of transfer of medical records for all discharged personnel between the DMS and the NHS to ensure continuity of care. We also have concerns that staff in Artificial Limb and Appliance Centres (ALACs) may have little experience in dealing with the needs of the younger, fitter veteran cohort, often with multiple limb loss, and that provision of replacement advanced prosthetic limbs should not be hindered by delays in approval of individual funding requests.

We would be very pleased to provide the Committee with any further information you require. Please contact Amber Cobb, Senior Parliamentary Advisor, on 020 7383 6520 or

Yours sincerely,

Julian Olver

Dr Julian Olver MBE Dr Andrew Dearden

Deputy Chair, BMA Armed Forces Committee Treasurer of the BMA

[1] MoD evidence to the Defence Select Committee inquiry into the Armed Forces Covenant in Action: military casualties:

[2] A Better Deal for Military Amputees , 2011 re port by Dr Andrew Murrison MP:

Prepared 26th May 2012