Health and Care Bill

Written evidence on the Health and Care Bill submitted by The Royal British Legion to the House of Commons Public Bill Committee (HCB24)

The Royal British Legion, August 2021

1. Summary

1.1 The Royal British Legion seeks to represent the unique health and care needs of the Armed Forces and we believe that the Health and Care Bill is an important opportunity to improve awareness of these needs.

1.2 In particular:

· Guidance accompanying the Health and Care Bill should recognise the Armed Forces community’s entitlements under the Armed Forces Covenant.

· All partners in Integrated Care Systems (ICSs) should ask about Armed Forces status and record positive responses within a shared care record.

· An updated version of Health Education England’s e-learning package on the needs and treatment of the Armed Forces population should be made mandatory for all partners in ICSs.

· Flexibility should be incorporated into guidance in regard to the delivery of future Armed Forces specialist services that may benefit from being commissioned at national level.

2. About Us

2.1 The Royal British Legion (the RBL) is at the heart of a national network that supports our Armed Forces community through thick and thin – ensuring that their unique contribution is never forgotten. We were created as a unifying force for the military charity sector at the end of the First World War and remain one of the UK’s largest membership organisations. The RBL is the largest welfare provider in the Armed Forces charity sector, helping veterans young and old transition into civilian life. We help with employment, financial issues, respite and recovery, through to lifelong care and independent living. For further information, please visit www.britishlegion.org.uk

2.2 The RBL collaborates with partners at a national and local level and can provide local and regional expertise on the Armed Forces community to care systems. We have been pleased to work with NHS England and Department of Health and Social Care (DHSC) colleagues on shaping health provision for the Armed Forces community and enjoy a productive relationship with the Armed Forces leads in these bodies.

3 General Comments

3.1 The RBL welcomes the opportunity to submit written evidence on the Health and Care Bill 2021-21. As the largest welfare provider in the Armed Forces charity sector, the RBL seeks to represent the unique needs of the Armed Forces community that we support and for whom we advocate. We will therefore only be commenting on elements of the Bill’s policies where we currently see the largest potential impact for the Armed Forces community.

3.2 The Armed Forces community consists of the following groups:

· Serving personnel (also known as Regulars)

· Reservists

· Veterans

· Families or dependants of the above

3.3 The RBL is clear that the proposed integrated place-based approach laid out in the Health and Care Bill will need to be supported by social care reform. This is a significant issue for our beneficiary population that urgently needs to be addressed to ensure that the Armed Forces community can access good-quality social care that understands their needs.

4 Awareness of the Armed Forces Community and the Armed Forces Covenant in Integrated Care Systems

4.1 As laid out in the Armed Forces Covenant, and subsequently integrated into the NHS Constitution for England, the Government and the NHS have pledged to ensure that provisions of services recognise the unique sacrifices the Armed Forces community undergoes. It is therefore important for all ICSs, and the provisions in the Health and Care Bill, to be aware of and note the principles of the Armed Forces Covenant, that:

"Those who serve in the Armed Forces, whether Regular or Reserve, those who have served in the past, and their families, should face no disadvantage compared to other citizens in the provision of public and commercial services. Special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved." [1]

4.2 The Bill will impact how health and care is organised and delivered for the Armed Forces community in England. Members of the UK Armed Forces receive healthcare through the Ministry of Defence’s (MoD) Defence Medical Services, while veterans, spouses, partners and children of Armed Forces families are treated through mainstream NHS services.

4.3 The delivery of appropriate and targeted support is predicated on all organisations which are accessed by members of the Armed Forces community being aware of any Armed Forces or veteran status and associated needs. The RBL advocates a holistic approach to care of the Armed Forces community and recommends that all statutory bodies and those delivering statutory services ask all individuals whether they or a member of their family have served in the UK Armed Forces . Asking this question opens conversations about the link between military experience and health and care needs, helping members of the ex-Service community and their families feel better understood and more aware of their entitlements. Consistently asking the question "Have you or a family member served in the UK Armed Forces?" and coding a positive response on e-health record systems also enables front line staff to access bespoke charitable and statutory support provided for the community.

4.4 In line with this, the RBL recommends that improved awareness of members of the Armed Forces community, and this community’s entitlements under the Covenant, are laid out in guidance accompanying the Health and Care Bill. All ICS partners, including NHS organisations, local councils, and others, should be asking this question and recording it within a shared care record. This should be supported by making an updated version of Health Education England’s e-learning package on the needs and treatment of the Armed Forces population mandatory for all partners in ICSs.

5 Commissioning of healthcare for the Armed Forces community

5.1 The NHS Act 2006 gives the Secretary of State power to require NHS England to commission certain services instead of Clinical Commissioning Groups (CCGs), which includes services for members of the Armed Forces or their families. NHS England is responsible for directly commissioning some services for the Armed Forces community, and for ensuring consistent standards across the country. The services directly commissioned by NHS England include specialised services such as specialist limb prothesis and rehabilitation services for veterans, while CCGs are responsible for commissioning most primary and secondary care for veterans and Armed Forces families. It is important that members of the Armed Forces Community with specialist health needs can access consistently high-quality care that meets their needs.

5.2 The proposals in the Health and Care Bill would change how NHS services are commissioned in England, with some direct commissioning functions being delegated to ICS level. In regard to specialist services, a proportion will be delegated to ICS level while eligibility and standards will still be set at a national level. Interim guidance on Integrated Care Boards, published in August 2021, states that:

"Commissioning healthcare for serving members of the Armed Forces and their families registered with defence medical services, veterans’ mental health and prosthetic services will remain with NHS England and Improvement." [2]

5.3 The RBL welcomes this clarity and hopes that good practice and partnerships

6 Summary of Recommendations

· Improved awareness of members of the Armed Forces community, and this community’s entitlements under the Armed Forces Covenant, are laid out in guidance accompanying the Health and Care Bill.

· All ICS partners, including NHS organisations, local councils, and others, should be asking the question about Armed Forces status and recording it within a shared care record.

· An updated version of Health Education England’s e-learning package on the needs and treatment of the Armed Forces population should be made mandatory for all partners in ICSs.

· Flexibility should be incorporated into guidance in regard to the delivery of future Armed Forces specialist services that may benefit from being commissioned at national level.

August 2021

 

Prepared 15th September 2021