Conclusions and recommendations
Mental health of Armed Forces personnel
1. We welcome the
introduction of the Trauma Risk Management system and the MoD's
work in reducing the stigma attached to seeking help for mental
health problems. We also welcome the fact that personnel are seeking
help for mental health problems earlier than in the past. The
Armed Forces have seen a significant increase in the number of
personnel requiring treatment by the Defence Community Mental
Healthcare Teams without a proportional increase in the number
of staff. Given evidence that Service personnel are coming for
mental health support sooner than in the past and while they are
still serving, pressure on existing resources will only increase.
In response to this Report, the MoD should inform us of its plans
to deal with the increased volume of work and tell us how quickly
it can ramp up its support for personnel in the event of any further
acceleration in the number of personnel coming forward for help.
(Paragraph 18)
2. The higher incidence
of mental health problems developing in reservists deployed to
Iraq and Afghanistan has been known for some considerable time.
Given our earlier recommendation in 2011 that it investigate the
factors contributing to that higher incidence, we are disappointed
that the MoD is still in the process of commissioning this research.
This has meant that the MoD has yet authoritatively to identify
or to address these issues and provide support specifically tailored
for reservists. This is of great concern to the Committee given
that the importance of identifying and addressing the particular
problems facing reservists is increased by the growing dependence
on Reserve Forces in Future Force 2020. (Paragraph 25)
3. We welcome the
MoD's acceptance of our previous conclusion that it needed to
recognise the seriousness of the problem of alcohol consumption
in the Armed Forces and that it has strengthened its response
to the problem. However, we remain concerned that the MoD's response
has not had any noticeable impact on the level of excessive and
binge drinking in the Armed Forces. We are not convinced that
sufficient focus has been given to dealing with the problem at
every level of the chain of command. We also question whether
the MoD has examined whether excess alcohol consumption may, in
some Service personnel, be masking other mental health problems.
(Paragraph 32)
4. We are disappointed
that the MoD took well over a year to commission research into
the drivers of excessive alcohol consumption. The conclusions
of the study are very worrying. Clearly, urgent action is needed
to tackle the harm caused by the abuse of alcohol to both Armed
Forces personnel and their families. In its response to this Report,
the MoD should tell us how it intends to implement the study's
recommendations and in what time frame. (Paragraph 33)
5. The MoD should
determine a comprehensive strategy and plan to tackle alcohol
misuse, identifying how it intends to change the culture within
the Armed Forces and identifying practical measures to reduce
consumption including, if necessary, reviewing pricing policies
and availability of alcohol on bases. The plan should incorporate
the recommendations of the study on excessive alcohol consumption.
It should also include performance measures which will indicate
whether the plan is working in reducing excessive alcohol consumption.
(Paragraph 34)
6. Increases in violent
offending behaviour are linked to deployment in combat roles and
subsequent misuse of alcohol and other risk taking behaviour.
The MoD should identify those most at risk of such offending and
put in place measures to assist these personnel to manage the
aftermath of deployment in combat roles better. (Paragraph 37)
7. The MoD needs to
understand better the links between deployment on combat operations,
alcohol misuse and domestic violence. The MoD must be more proactive
at all levels and should re-examine its policies on domestic violence
and develop plans to intervene to prevent domestic violence or,
at least, reduce the incidence of domestic violence by Armed Forces
personnel. These plans should deal with both regulars and reservists.
(Paragraph 41)
Support for families
8. We are disappointed
that the MoD has taken so long to act on the recommendation in
our December 2011 Report to review the support it offers families.
Families need improved support, in particular, the families of
reservists who find it harder to identify sources of support than
regulars. The MoD should provide us with its study of the support
to the families of wounded, injured and sick personnel as soon
as it is available. It should also tell us how it intends to implement
the recommendations of the SSAFA report on support to bereaved
families and the above report. We call on the MoD to use the reports
it has commissioned as the basis for a revision to its policy
for the support of families. (Paragraph 49)
Support for the recovery of wounded, injured or sick
personnel
9. The shortfall in
the capacity of the Defence Recovery Centres has meant that some
wounded, injured or sick serving personnel have not been able
to benefit from them and reservists, in particular, have found
it difficult to access them. We welcome the opening up of the
Centres to veterans but recognise that this will also increase
demand. Whilst we welcome the Army's decision to increase the
number of Personnel Recovery Officers, we doubt that this increase
will be sufficient. In response to this Report, the MoD should
outline both its estimates of expected demand on the Defence Recovery
Capability from serving personnel, reservists and veterans and
its estimates of the additional resources, in particular, numbers
of staff, needed to meet those demands and also clarify whether
staff will be provided by the MoD or the charitable sector. (Paragraph
57)
10. The MoD should
inform us of the latest progress in implementing the recommendations
of its review of the Defence Recovery Centres. In particular,
it should tell us how many additional Personnel Recovery Officers
have been appointed, and when and how the new evaluation and assurance
scheme for the Defence Recovery Centres will be implemented. (Paragraph
58)
11. The Defence Medical
Rehabilitation Centre at Headley Court has been a valuable resource
for those injured in the Armed Forces. We welcome the announcement
of a new Defence and National Rehabilitation Centre and commend
the generosity of those charities and individuals who have committed
to fund the Centre. In response to this Report, the MoD should
tell us what its financial and other commitments to the establishment
will be over the next ten years. The MoD should also inform us
of the results of its negotiations with the trustees about the
future of Headley Court. (Paragraph 61)
12. The Government
should tell us how it intends to respond to the conclusions and
recommendations on the treatment of musculoskeletal conditions
raised in the Chavasse Report for serving personnel, reservists
and veterans. (Paragraph 64)
13. The Government
should tell us how it intends to respond to the recommendations
on the support of Service personnel and veterans with hearing
loss and tinnitus and on the prevention of hearing damage in younger
members of the Armed Forces as set out in the Royal British Legion
Report on hearing problems in the Armed Forces. (Paragraph 66)
14. Despite the assurances
provided by MoD that the processing times had improved and backlogs
reduced, we understand that serving personnel and veterans are
still experiencing long delays in having their claims processed.
We recognise that the backlog of cases awaiting award by Veterans
UK has fallen but we are concerned that the throughput is still
too slow. In response to this Report, the MoD should set out how
it intends to reduce the time taken to adjudicate on claims under
the Armed Forces Compensation Scheme and the War Pension Scheme.
(Paragraph 71)
Longer term sustainability of support
15. We welcome the
establishment of a longitudinal study looking at the long-term
impact of injuries sustained in operations in Afghanistan. We
will continue to take an interest in the progress of this long
term study, its conduct and its management. (Paragraph 75)
16. We remain very
concerned about the long term impact of deployment in Iraq and
Afghanistan on those personnel who were injured physically or
psychologically. Other aspects of Service life may also have a
long term impact on the health of veterans. However, there are
issues which need to be tackled now; these include provision for
those requiring musculoskeletal treatment and wheelchairs and
those suffering hearing loss. (Paragraph 80)
17. We are not aware
whether the MoD has made concerted and comprehensive efforts to
keep in touch with people discharged from the Armed Forces due
to life-changing injuries. The MoD should tell us how it intends
to remain in contact with such discharged personnel to ensure
that it can monitor whether individuals are receiving the support
they deserve. (Paragraph 81)
18. It is too soon
to judge the long-term effectiveness of the measures to address
the mental health needs of veterans. The MoD with the Department
of Health should monitor the provision of mental health support
to veterans and remedy any shortcomings identified. It should
include the results of this monitoring in the annual report on
the Armed Forces Covenant. The MoD should also monitor the implementation
of the improved services for amputees, act on any shortcomings
and again report the results in the annual report on the Covenant.
(Paragraph 82)
19. Despite assurances
from the MoD and the Department of Health, we are still worried
that, as operations in Iraq and Afghanistan fade from the public
eye, the necessary long term support for those injured will not
be maintained. In response to this Report, the Government should
make explicit its continued support for those damaged physically
or psychologically in the service of the country. (Paragraph 83)
20. The system intended
to improve the transfer of the medical records of Armed Forces
personnel leaving the Services has been in operation for less
than a year. The MoD told us it will be monitoring performance
closely. The MoD should provide us with a progress report on the
success or otherwise of the system and the timetable for making
the improvements that it was planning. (Paragraph 87)
21. We have heard
a great deal about the multiplicity of governance arrangements
for healthcare and the processes for liaison between the MoD,
the Department of Health, NHS England and the Devolved Administrations.
We do not believe that these arrangements ensure that veterans
get appropriate treatment for their needs and that this treatment
is consistent across the whole of the UK. The Government should
explain how the MoD's recently created Partnership Board with
the Department of Health, NHS England and the Devolved Administrations
will ensure that serving personnel and veterans are receiving
appropriate and consistent treatment wherever they live. (Paragraph
89)
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