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Baroness Hooper: My Lords, I thank all those who have participated on all sides of the House for their contributions and the concern that they have demonstrated. This voyage of discovery into the world of Private Bills has been an interesting and educational experience for many of us. No doubt that will continue at the further stages of this Bill. Nor do I have any doubt that the promoters will have listened carefully to the points that have been made this evening. Certainly, they have taken the trouble to be here in some force to listen to the comments that have been made. They will also look closely at Hansard; and they may even wish to look again at some of these matters ahead of, as well as during, the Committee stage. By the same token, we can be confident that the Committee will wish to pay due regard to what has been said by your Lordships this evening. I am sure that my noble friends the Ministers in both the Treasury and the DTI and their colleagues will be made fully aware of the points raised by both of my noble friends who were until recently sitting on the Front Bench.
A wide range of markers has been put down tonight. I do not want to detain noble Lords further by responding in detail to each and every one of them in view of the further business in the House this evening. However, I point out that there have been 49 private bank Acts passed by Parliament since 1969, so this Bill is no more unusual than those that have gone before it. But it adds an interesting kick to the suggestion of my noble friend Lord Dixon-Smith that the Government should charge a facilitating fee in this matter.
A number of your Lordships referred to the level of job reductions. Particularly in response to my noble friend Lord Lyell, I point out that, overall, the banking industry has shed 90,000 staff since 1990. Lloyds TSB aims to achieve any job reductions through natural wastage. Approximately 6,000 people leave the group of their own accord each year. There is a general trend in the traditional financial services sector towards reduced workforces, but, in view of the many new entrants into the field of financial services, to whom I referred at some length in my opening speech, overall many new jobs must be being created, bringing with them potential new members for the unions. However, as the noble Baroness, Lady Turner, pointed out, I recognise that change can be unsettling. We cannot and should not avoid change but we can endeavour to make it more acceptable. That is certainly the intention of the promoters, and I believe that the debate this evening has been useful in underlining that point.
Both my noble friend and the noble Lord, Lord Taylor of Gryfe, raised questions about the Lloyds TSB Foundations, of which I know the group is very proud. The foundations combine the charitable activities of both banks. They form one of the largest general grant-giving organisations in the United Kingdom and support a wide range of grass roots voluntary organisations, particularly in relation to disadvantaged and disabled people. The foundations received from Lloyds TSB the equivalent of 1 per cent. of pre-tax profits averaged over the preceding three
The noble Lord, Lord Taylor of Gryfe, asked specifically about the compromise agreement in relation to the Scottish activities. While I do not have detailed information on that matter, I believe that the declaration that I made in my opening speech covers the point. Further, in recognition of your Lordships' concerns in respect of union recognition, which is certainly an important issue, I reaffirm that the promoters are keen to conclude a recognition deal with the two unions. Noble Lords will recall that the unions have been invited to make suggestions in this regard. I hope that that firmer statement satisfies the noble Lord, Lord Peston.
Similarly with regard to pensions--we can all declare an interest in pensions in view of our advancing years--I am grateful to my noble friend Lord Clark for coming to my rescue and responding to points raised by the noble Lord, Lord Monkswell. The promoters wished me to stress that the pension rights of every member of staff remain unaltered by the merger, which took place, after all, over a year ago.
I thank the noble Lord, Lord Cobbold, for raising his specific pension issue. I have no doubt that it will be dealt with in Committee, as he suggested. I have no doubt that the Bill's promoters will wish to look most carefully at each and every point that has been raised this evening, and that those are matters which are properly going to be dealt with in more detail by the Committee. The measure is, as I said, purely a housekeeping measure. I commend the Bill to your Lordships.
On Question, Bill read a second time, and committed to a Select Committee.
Baroness Park of Monmouth rose to ask Her Majesty's Government what action is being taken to remedy the serious deficiencies in the provision of medical services, including welfare, for servicemen and their families.
The noble Baroness said: My Lords, the presence of so many distinguished noble and gallant Lords at this hour testifies to the importance of the subject of the debate. I am deeply grateful to them for their support.
The logo of the Defence Secondary Care Agency is "Serve to Care". The business objectives--how typical!--include ensuring timely and appropriate professional development and training, providing the best possible medical care and achieving the highest levels of morale, motivation, health and safety. I could quote many more such politically correct objectives, key targets and operational plans from its literature.
How is it then that the Armed Forces Pay Review Body, as long ago as May last year, was deeply anxious
and what it perceived to be a growing crisis over retention and morale? The manning problem had, it said,
It placed on record its acute frustration at the slow pace of development in the MoD, particularly in the matter of a new service analogue.
How is it that the Defence Committee in the other place has concluded that:
It said that the state of morale in the Defence Medical Services was lower than it had ever encountered in the Armed Forces. It recommended that some of the money stripped out of defence medicine by the Defence Costs Study would have to be put back again to repair the damage. It concluded:
The Army Families Federation testified:
Speaking of the MDHU, the evidence adds,
The British Medical Association has also stated that the DMS has, according to its members, been held together by overstretched doctors, many of whom are disillusioned and many of whom will seek to leave at the earliest opportunity. This cannot be a healthy basis on which to operate what is a crucial front-line service in times of peace and war. The evidence speaks of the turbulence which has been increased by peacekeeping commitments and a general feeling of lack of job satisfaction and diminishing quality of life.
Much of that dissatisfaction, which has led to doctors leaving the services, is coming from exactly the type of person the DMS should be retaining: doctors who have nearly completed their specialist training or new consultants. These people have commented that they see no end in sight. The situation is getting worse, destroying family life. Service life, they say, offers few
The two key issues that lie at the heart of this devastating situation are morale and the service ethos. It is no use treating the DMS as though it were a support service supplying tank spares, or a badly run commercial enterprise where downsizing can be applied without regard to any national commitment to peacetime care for the services on the sole basis that the management's accountants think fit to apply their only principle--save money.
The Armed Services and their families joined one of the three services because of tradition, the desire to serve and a readiness to risk their lives, which is a part of the military ethos. It all breaks down if there is no longer trust and confidence in those who command them, and no belief, as there has always hitherto been, that if things go wrong they will be looked after. That is a far cry from the remark of the chief executive of the agency, speaking to the committee in the other place, saying of service dependants abroad:
That is what we have come to. I wonder how long we shall continue to have a magnificent volunteer Army if that is now the chief claim of service dependants to medical care in this country.
I could say much more and quote many statistics. What I want to do is to urge the Government to act before it is too late, not just through better pay and conditions, for they are only a sticking plaster on a serious wound, but by reversing the Defence Costs Study's decision--that swingeing and disastrous series of decisions whose only aim was to save money--and reverting to the widely accepted Options for Change proposals for three single service hospitals. That is the only thing which might retain DMS staff on the point of departure, including those most important people, the nurses; restore morale throughout the services with the return of the service ethos; and could be a perfectly viable financial and professional operation, since the service hospitals have always attracted and served large civilian catchments and the DMS training and skills have benefited accordingly, as they were meant to do. Build at Aldershot; re-open Ely.
It will call for some capital to be put back into the DMS, but I am sure that the Defence Secondary Care Agency's commercial expertise will find PFIs--we have all heard about them. We cannot, incidentally, rely on the reservists to bail us out if there is another Bosnia, for the decision to release them lies not with the NHS but with the trusts, and they have given no hard commitment to do so.
Time does not allow me to quote the very disturbing figures which I have received both from the BMA and from many other quarters, to which I am much indebted, or to discuss other possible palliatives such as a closer integration between the MDHUs and the TA. Radical
The problem of retention is not confined to the DMS. While money, better terms and conditions and early action on a new analogue for the doctors, dentists and nurses are not only desirable but feasible since they can be settled without waiting for the general decisions on pay arising out of the independent review, they are still only a palliative. They will not be enough to stop the voluntary retirements. Most of the DMS and all service families have lost confidence and trust in the ability or even willingness of Ministers to look after their welfare. They believe that they are perceived not as members of a service with traditions of loyalty and professionalism but as, at best, employees in a failing industrial enterprise, at the mercy of the accountants and of no particular value themselves. They joined a proud service, whether it be the RAF, the Army or the Navy, with traditions of caring for both the men and their families. Their lives are now being managed in a way that shows, I submit, a greater command of computerisation, PFIs, charters and benchmarks than the management of men.
Unless immediate action can be taken to revive the military ethos, which is the reason that they join and serve, the consultants will go, the nurses will go and there will be no new generation of either. There will be no one to train those who might, exceptionally, wish to join a service without a soul. I urge the Minister to consider undertaking the one act which could go far to restore confidence, retain waverers and create an effective DMS. I ask him to go back to Options for Change and restore all three service core hospitals. I ask him to forget the tri-service formula.
The Minister will tell us that the MoD is at long last reviewing such matters as the deplorable accommodation for nurses and that interesting military analogue--an MDHU without a mess. However, that review must not be used to delay action on the critical major issue--the survival of the DMS.
9.19 p.m.
9.26 p.m.
"unprecedented low morale in the DMS, to the extent that it was difficult to see how the MoD could meet its operational commitments",
"deteriorated to the point where it is having some impact on the ability of the Secondary Care Agency to fulfil its task in peacetime".
"The Defence Medial Services are not sufficient to provide proper support for the front line in any realistic planning scenarios and show little prospect of being able to do so in the future"?
"The staff shortages in the Defence Medical Services are so serious that it is not clear whether it will recover. It is possible that the military ethos of medicine in the regular Armed Forces has been destroyed. It seems incredible that the scaling down of the Defence Medical Services has been effected by MOD in such a manner as to allow a major and potential critical staff shortage to develop".
"The provision of secondary health care in military hospitals for UK-based dependants has completely ceased. And in the majority of areas primary health care is also now provided by the NHS. Families are now totally at the mercy of their local NHS facilities and some doctors are reluctant to take on Army families. Should secondary treatment be necessary it is unlikely that consultation and treatment will be commenced, let alone completed, before a posting forces a change of locality and the whole process has to start again. When the military hospitals were available to families this situation did not arise and continuity was assured".
"These wings are staffed and funded by MOD but priority is not given to the serving personnel, but allocated on clinical need rather than the requirement to get soldiers fit and back to work. A recent survey showed that the average age of occupants of military beds at Frimley Park Hospital was 73".
"We believe the DMS is suffering from a lack of perceived credibility among serving officers and the medical profession in general. Until this is addressed, it is unlikely that morale will improve or retention problems will be solved".
"clearly they can be treated in any NHS hospital in the UK because they are EEC citizens".
9.37 p.m.
Lord Craig of Radley: My Lords, I am most grateful to the noble Baroness, Lady Park, for raising this Question and, my goodness, did she not spell it out well? I support her completely in what she said.
The MoD has created a horrendous problem. The Defence Committee's recent report also makes depressing reading. I hope that the Government will heed it closely. DCS15 is now seen to be in open-heart surgery without the anaesthetic.
The draw-down in medical strength below establishment, particularly the loss of those with the best leadership and medical skills, makes a mockery of claims that there have been improvements in the efficiency and effectiveness of so-called secondary care. I hope that it will occur to Ministers that the lack of information about the way in which pesticides were used in the Gulf could be due as much to under-resourced staff as to any blatant failure of duty.
But I do not wish to carp. The question is how best to restore medical morale and effectiveness. The MoD appears to be approaching that with a small bag of gold to encourage those contemplating leaving to think again and stay; and that may work briefly. But it is no long-term solution. Service medical students already receive considerable financial incentives to persuade them to join the services in the first place. We cannot expect to have to bribe them to come in and then to stay.
Greater job satisfaction not only as clinicians but as members of Her Majesty's Forces is needed, not just money. Service medical personnel seek to combine two distinct and honourable professions: that of medicine and that of the Armed Forces. When the forces were larger, for most, choice of service was a dominant consideration. Medical personnel experienced daily their chosen service's culture and the camaraderie which at first engaged their loyalty and commitment. Constant exposure provided a feeling of belonging to a family which continued throughout their service, past retirement for the rest of their lives. They were proud of their involvement and contribution to service life.
Against the background of forced reductions and pressures for economies, clinical considerations were judged by outside experts to be more important, even to the extent of proposing an amalgamated "purple" force. The titles--Defence Medical Services and Defence Secondary Care Agency--regrettably underscore that very idea. The distinction between separate services, which was the attraction, and medicine, which was their training, has been blurred by those titles.
We have not sought to lose the individuality of the three services in any other role or branch, but we have foolishly allowed it into the dental and medical branches. MoD needs to think again on the matter. It should drop the Secondary Care Agency for a start. In a thousand years that will never conjure up coping with the wounded from the field of battle under operational conditions. It is an appalling title. It sounds like some temporary nursing agency.
However, titles apart, Ministers repeatedly claim that DMS will provide the Armed Forces with the best that can be found within the National Health Service. I do not wish to disparage the NHS but that is not a satisfactory yardstick. It sets a standard lower than was available to service personnel and their dependants in the past. Servicemen and their doctors recognise that fact. I have had service medical care for nearly 50 years and I have seen it decline. Although still entitled, I now pay for my own BUPA cover. A vital condition and requirement of service has been allowed to melt away.
The MoD claims that DCS15, which scrapped single service hospitals, saves £600 million over 10 years. That is a mere £300, or less, per serviceman per year. Surely that is a worthwhile sum to give them all quick personal medical care in peace and war. BUPA could not match it and the military hospitals provided the heart for each service's medical identity. DCS15's steps sadly cannot be retraced as quickly as they were implemented.
So the challenge now is to identify a better way to combine the special requirements of military medicine without losing, as we have done, the essential draw and loyalty of doctors, dentists and nurses to the service of their choice. I urge the Government, in their search for a better answer, to give more emphasis to non-medical factors. They should give greater weight to the essential element of loyalty to service and pay a bit more for it. It is the glue on which the whole structure and efficiency of the Armed Forces depend. It is surely the glue for service medical personnel as much as for the frontline.
9.42 p.m.
Lord Lyell: My Lords, I, too, am immensely grateful to my noble friend Lady Park for giving us the opportunity to discuss this most important and vital question. Your Lordships may know--or, indeed, may soon be aware later this evening--that the Defence Study Group made a visit today to Warminster. Once again, we saw the enormously high morale of the British Army. However, I returned to the House and was rather startled to find myself batting at number three in the Speaker's list and placed in a higher position than two noble and gallant Lords. That was an enormous surprise and a very great treat. I hope that I shall surprise your Lordships by being both brief and simple this evening.
I have one particular point to make. My noble friend Lady Park will remember that, when we made a visit to Frimley Park last autumn, both she and I had the chance to listen to a particularly quiet but effective, competent and very experienced warrant officer who was serving in the Royal Army Medical Corps. He was in charge of all the service medical staff at RAMC at Frimley Park. Even allowing for what I call the overspill factor, let alone the, "Thank you Mister. Atkins" factor, we seem to take for granted the enormous service that we have heard about from my noble friend, and indeed we shall hear a good deal more about it during the debate. As I said, even allowing for that factor, I was indignant. So far as concerns my noble friend the Minister, that is particularly rare because I know how hard he works and the huge effort that he puts into his work at the department, not to mention the way that he takes our points on board.
I was indignant in three particular ways regarding service personnel treatment at Frimley. They find it desperately difficult to try to come to terms with the amalgamations and the programmes for secondary care referred to by the noble and gallant Lord, Lord Craig. First of all, personnel in one of the wards found the cleaning and the housework difficult--what I as a young soldier used to call the set drills. In a service ward it was always someone's job to give help at the end of the day, perhaps for two minutes or five minutes. That was, and still is, part of the ethos of the Royal Army Medical Corps. As regards the changeover at Frimley, the outstanding matron in the Queen Alexandra Royal Army Nursing Corps explained to us quietly and with great dignity that she found particular difficulty as regards that vital aspect.
Secondly, the warrant officer talked to us about the accommodation for young single service personnel who had come to work at Frimley. They may have come
from Aldershot or elsewhere. The story he told me took me back to 1958 when I served in BAOR. I recall the officers' ablutions, as they were tactfully called. It appeared that at Frimley such facilities were just the same as they had always been. There had certainly been no refurbishment, let alone a major refurbishment, since 1958. That is nearly 40 years ago. I hope that my noble friend will be able to examine this matter.Thirdly, the most important point the warrant officer made concerned the training of the medical personnel at Frimley. He stressed to my noble friend and myself time and time and time again that the service personnel are first and foremost soldiers. Their classification as regards their personal weapons and their fitness had become a complete logistical nightmare for them, their warrant officer and the hospital. As I have said, these are first and foremost soldiers. They are highly skilled. As the noble and gallant Lord, Lord Bramall, may remember from 1944, they are highly courageous.
I conclude by asking my noble friend when he enters his office tomorrow to consider the words of Sir Winston Churchill, "Action this day". Will he consider the point about training and classification for the medical staff? It is not just a matter of Army personnel--I think of the noble and gallant Lord, Lord Craig--but also of Air Force and Royal Navy personnel. Will my noble friend consider that these are first and foremost service personnel but they have huge talents as medical personnel? If my noble friend has any time left over tomorrow, will he also consider the accommodation of the young and single dedicated service personnel at these single service hospitals?
9.48 p.m.
Lord Vivian: My Lords, I am also most grateful to my noble friend Lady Park of Monmouth for bringing this short debate to your Lordships' attention tonight. At this stage I should declare an interest as I am honorary colonel to 306 Field Hospital TA.
I intend to confine my remarks to the problem areas that were identified by the Defence Study Group visit in November when we visited the Royal Hospital Haslar and Frimley Park MDHU, and to inform your Lordships of the action that has been taken by the MoD so far to remedy some of the unsatisfactory points that we found while on that visit.
The main problems that the Defence Study Group identified were shortages of staff as regards consultants, nurses and medical assistants; the failure to retain military ethos; the lack of job satisfaction and efficiency; and the poor standard of single military accommodation at Frimley MDHU. The shortage of welfare accommodation for next of kin when military personnel are listed on the very seriously ill list and the seriously ill list was identified at both those locations.
Shortages of staff make those available work considerably harder and deny them the opportunity to pursue their military skills, and attend upgrading courses, which in turn denies them promotion and increased pay due to the lack of their qualifications. Because of priority nursing duties, military training, military skills and adventure training are not
implemented and yet those are normally the very reasons why the young joined the Armed Forces as opposed to the National Health Service.The defence group recommended that, as the shortage of consultants, nurses and medical assistants was reflected in the National Health Service, it would be difficult to recruit those staff from within the United Kingdom for the next few years. It has been proposed, therefore, that these medical personnel should be contracted from overseas, preferably from Australia and New Zealand. If retention and recruitment is to be successful in the future, it is essential that the terms and conditions of service are improved and made attractive and that the pay should be significantly increased.
The Ministry of Defence has confirmed that the shortages of staff are being addressed urgently, and with the forthcoming closure of the British Military Hospital at Rinteln in Germany more consultants and nurses will be available to fill the gaps at Frimley MDHU. In this connection, I have to report that I am aware of two regiments in Germany which find the new appointments system with German hospitals more satisfactory and efficient than the previous system. A study team has now been set up to reassess the Defence Medical Services organisation and the MoD has agreed that the Defence Secondary Care Agency will investigate the possibility of employing nurses from overseas.
The effects of a lack of military ethos lower morale and lead to people leaving the Army. They restrict military personnel from getting together where friendship, team spirit and competition normally occur, and once military training and skills cease a lack of pride in individuals develops.
The defence group recommended that staffing levels at the Ministry of Defence Health Units should take account of the mandatory requirement for military personnel to attend the basic training requirements, sport, adventure training and upgrading courses leading to a proper structured military career.
The concept of small military wings should be investigated and in the short term bays solely for military personnel should be organised within wards. A mess facility should be started and controlled by the Royal Army Medical Corps at Frimley MDHU.
There has been some progress on these subjects, with two extra military administrative posts established at MDHU Frimley to assist with the military aspects of life there including adventure training. There is difficulty over the recommendation of establishing military wings as service personnel are generally young and fit and therefore do not present the variety of patient cases that is vital for medical training purposes to retain accreditation by the appropriate Royal Colleges. However, the DSCA will investigate with the host trusts the possibility of service nurses being dedicated solely to treating service patients. May I ask my noble friend what action has been taken in establishing a mess facility at Frimley MDHU?
Job satisfaction was also identified. That problem is now being resolved as closer working practices continue to be developed. It has been agreed that working rotas between host trusts and the MDHUs are to be reviewed.
It was reported to the defence group on these visits that the accommodation for single nurses was deplorably bad at Aldershot, as we have heard from my noble friend Lord Lyell. The chief executive of the DSCA has visited the Garrison Commander at Aldershot and it has been agreed that renovation of the nurses' accommodation should start in May. Ten large double rooms will be converted into 20 single rooms and the living-in personnel will be involved in the design and choice of furnishings. These improvements should provide good quality living accommodation.
In conclusion, the nation is in debt to our regular territorial and medical reservists. They have performed in an outstanding manner, with great loyalty and true dedication. They have acquitted themselves in an exemplary manner in the Falkland and Gulf campaigns, and currently in Northern Ireland and Bosnia. The Territorial Army medical units are in good shape and 306 Field Hospital TA is a particularly good example of a unit displaying high morale with a high sense of duty.
Finally, it is vital that the medical services are established and maintained at a level that ensures full support to our Armed Forces in peace and war. I am grateful for the action that the MoD has already taken and look forward to its full progress report in May.
9.55 p.m.
Lord Carver: My Lords, I, too, thank the noble Baroness for asking this Question, on a subject that is extremely important. Like other speakers, I have read the report of the Defence Committee in another place which was published last Thursday. It enhanced the concerns that I already felt and which I expressed, as did my noble and gallant friend Lord Craig of Radley, as long ago as 26th July 1994 in a debate on general defence costs and the Defence White Paper, and recently in relation to a Question raised by the noble Baroness, Lady Cox. I must also say that the report answered many of the questions that I should otherwise have put to the noble Earl this evening.
That report made clear that designing the right organisation for the Defence Medical Services, ensuring that both man and woman power of the right quality and quantity is provided for it and that the organisation works efficiently and smoothly, is no easy matter. There are many conflicting factors to resolve: providing satisfactory health care for members of the Armed Forces and their families in normal circumstances; training and providing a system for health care and treatment of casualties, on operations, including a reserve capacity to meet the worst case--which was the case in the Gulf; and a career for the medical personnel themselves which develops their professional skills while also satisfying their military and personal ambitions and preferences. One example of that conflict which is highlighted in the report is the problem of what is called "skill fade" for specialists serving in Bosnia, where, unless there is a near-disaster, there is little or no opportunity for them to practise their skills.
I am forced to agree with the Defence Committee report that we cannot now reverse the fundamental decisions resulting from Defence Costs Study No. 15:
that the establishment of uniformed members of the Defence Medical Services should be based on the requirement to cover those operations which could be undertaken without a major call-up of regular or volunteer reservists for the combat units; that any operational requirement beyond that should be met by a combination of regular and volunteer reserves; that there should be only one joint service core hospital and medical college, the prime purpose of both being to train those uniformed members of the Defence Medical Services; and that elsewhere reliance should be placed on co-operation with the National Health Service.However, I am very afraid that the normal operational requirement has been set too low. That has to be re-examined. There can be no doubt that the change to the new organisation was made much too hastily and without proper preparation and consultation with those concerned. It was a disastrous bit of bad management and bad man-management. The result has been that a large number of members of the service decided that there was no future for them in it, and applied for premature voluntary release or did not sign on for a further term as they might have done, so that there is now a serious shortage of specialists.
A second result has been that, although some doctors are happy with their work in the military district hospital units attached to NHS hospitals, the general terms of service in them for all ranks and skills, as described by the noble Lord, Lord Lyell, are not satisfactory. This must be looked at again and the complaints must be remedied. We have never had that trouble at the Royal Victoria Hospital in Belfast in the past 25 years or more that it has been working. I suggest that the Government take a good look at Belfast to see the way these things should be run.
Urgent action is now needed in two fields: first, to get the agreement of the Armed Forces Pay Review Board to improvements in pay and pensions, especially for consultants; and, secondly, to make it much more certain than it is today that volunteer reservists, or regular reservists who, although not called up, would like to volunteer and who are working in the NHS, will be released when required. I hope that the noble Earl will be able to tell us what is being done about that.
There is no doubt that Haslar is not an ideal site for the core hospital. Aldershot would have been more central; but one has to admit that the old Cambridge hospital there could not have been brought up to date. A completely new hospital would have been needed. Taking a long-term view, that might have been the most cost effective answer, however great the initial cost. A great opportunity was missed a quarter of a century ago, when I was Chief of the Defence Staff, when the Army had to give up Millbank. The Army and Navy then agreed to support a joint service teaching hospital to be established in Regent's Park Barracks, which was ideally sited to take advantage of the medical expertise of London. With my noble and gallant friend Lord Craig of Radley present, I am sorry to say that it was the fierce opposition from the air staff that scuppered it.
There is no doubt that the Defence Medical Services are in a critical state and urgent action is needed to remedy the situation. Unless that action is taken quickly,
we may face a scandal like that which shocked the nation in the Crimean War, in the first battle of which my great-grandfather died of cholera, far from the tender ministrations of Florence Nightingale.10.1 p.m.
Baroness Strange: My Lords, we are all grateful to my noble friend Lady Park for introducing this subject with her usual depth of knowledge and clarity of vision.
One of the most important concepts for our Armed Forces is that they should have total confidence in the medical care and back-up that they will be given at all times and their families will receive if they are away. Our dog Bonzo has a trick. It may not sound or look much of a trick, but it is this. You pick him up and hold him upside down and then you drop him over a sofa. He lies totally relaxed and falls without struggling, knowing that he will be cushioned against disaster. He has the same total faith in his back-up team as our Armed Forces need to have in their medical services.
With the end of a permanent threat with the lifting of the Iron Curtain, in theory we should have been able to diminish our Armed Forces and to economise. In fact, with the Gulf, Bosnia, Northern Ireland and other areas, the length between unaccompanied front-line tours has never diminished to the looked-for 24 months and our forces have become so diminished that we are again trying to recruit to make up the gaps. I am sure that the noble Lord, Lord Williams of Elvel, will say that under a Labour Government things would be different. Indeed they would; they would be far worse. If we had had a Labour Government for the past 18 years, we might have had no armed services left at all.
These cut-backs and economies have resulted in the Armed Forces medical services retaining only one, tri-service, hospital, at Haslar, and making some units inside other existing National Health Service hospitals.
I too was one of the Defence Study Group who visited one of these units at Frimley, four wards replacing the Cambridge Military Hospital at Aldershot, which was always also enormously popular with the local civilians who queued up to go to it because the nursing and the facilities were so good. I visited three of the wards--A&E (accident and emergency), medical and pathology. My noble friends Lady Park and Lord Lyell visited the one upstairs. In the A&E ward we spoke to two doctors: one a major who had served eight years on a short-term commission; one a captain who had served 20 years. They said that, because they did not have the requisite pieces of paper or certificates, they were employed in junior tasks unfitted to their military qualifications and experience. The consultant, whom we did not see, was given a consultancy room but it was in another part of the building. Both doctors were leaving.
In the pathology ward, we met a sergeant and also a colonel who had been in charge of 26 people in Germany. Here too their lack of civilian paper qualifications meant that they were not even allowed to write reports.
In the medical ward, we talked to several of the nurses. They were overworked and understaffed. They had come into the Army to nurse military patients. There
was only one: a corporal, who had a broken leg. The rest were very elderly civilians who required constant nursing. Because of the shortage of staff, they were not able to get time off to pursue their military duties and training. The married accommodation was fine. But, for the single nurses, as noble Lords have heard, after they left at 10 o'clock at night, they had to go to Aldershot, where they were accommodated in rooms with minimal furnishings, one small microwave but no other cooking facilities, not even an electric kettle, or a ring; no comfortable chairs; no television; and next to a lavatory which was in constant use during the night. Some of the nurses were leaving.There was no central area in the hospital where the military personnel could meet together. They were not happy with the situation. Nor were we, particularly as we were becoming intimidated by the constantly growing number of Defence Agency personnel, which had grown from one at Haslar to at least six at Frimley, who stood behind us like Gestapo. Nor, I suspect, would Florence Nightingale have been happy either, though she would have been familiar with Haslar, which bears a close resemblance to Scutari and which would have been 100 years old in her day.
Haslar is the one service hospital left--a former naval hospital converted to tri-service. It should have been the jewel in the crown; and in some respects it is. It is filled with much of the latest state of the art medical kit, which even I could see was splendid. It is contained in beautiful red brick listed buildings, built as a naval hospital in 1756, and with beautiful lawns and gardens and handy access to the sea for ships to come in with wounded sailors--as is Scutari, which is on a cliff above the Bosporus. To reach Scutari from the Crimea there was a long sail across the Black Sea and down the Bosporus. To reach Haslar it is a two-and-a-half hour journey by bus from central London and the hospital is poorly signposted. There are, we were told, three double bedrooms for the accommodation of families, otherwise they would have to find bed and breakfast accommodation in the town. We did not think that good enough.
Haslar was also suffering from a lack of nurses. Having made many of the naval nurses redundant, they were now finding it difficult to recruit more. Being a tri-service hospital, there were bound to be teething difficulties in settling in. Being the services, I thought that they were all managing extremely well. The naval staff was even calling the galley the kitchen. But the fourth bedfellow was the Defence Agency and the effect was like trying to blend three different sources of water with oil. Left to themselves, the three waters would combine well.
When we visited the Defence Procurement Agency at Abbeywood near Bristol, I could not help but compare it to Haslar. Here, much money has been spent in order to save much. Here, the buildings are modern, custom-built for the 21st century, and beautiful, set in grass and water with trees and much glass. Everyone who worked there really liked it. If Florence Nightingale had seen that, she would have demanded, and got, a new tri-service hospital built at Brize Norton, with proper infrastructure and ease of access. She would have
moved up all the excellent kit from Haslar. She would have said, "It is never too late to undo a wrong decision. It is never too late to start again. While life lasts, it is never too late."10.4 p.m.
Lord Swinfen: My Lords, I too would like to thank my noble friend for tabling this Question this evening. I should also declare an interest as I have two daughters who are married to servicemen.
My noble friend Lord Vivian mentioned the use of German hospitals. That made me think, because I recently heard of a case of a serviceman who was taken to a German hospital in an emergency. I had understood that there was supposed to be an interpreter on hand at all times. The Germans naturally spoke German and the British naturally spoke English, sometimes with accents that were not always easy to understand. There was no interpreter for that individual, making it extremely difficult for both the serviceman and the medical staff in the hospital. In some instances that could be extremely dangerous. I hope that my noble friend will be able to assure us that that situation will be looked at and improved for both the servicemen and their families in the future.
The House will be aware that in February I tabled a Question for Written Answer to my noble friend in relation to the immunisation of infants in service families in Hohne. The terms of his answer led me to believe that the correct vaccines were produced extremely quickly--indeed, within 24 hours. However, I know that the series of appointments, when they were refused, took at least two weeks. I checked with my general practitioner at home and I understand that the new vaccines were introduced in March 1996. But there is no reason why the old vaccines, which worked perfectly well and required two jabs instead of one, should not have been used up.
Service families are posted from this country overseas and arrangements should be in place for making certain that the correct vaccines are available for their infants, especially bearing in mind that infants are not vaccinated until they are eight weeks old. That means there are eight weeks in which to arrange for the vaccination. I know that some postings are much shorter than that, but not generally. I hope my noble friend will be able to improve that situation.
With the closure of the military hospitals, Army families in this country have become dependent on the vagaries of their local National Health Service facilities. The average Army family moves house every 15 months. That involves changes of schools, doctors, dentists and so forth. Many National Health Service doctors refuse to take on Army families as patients. I understand that there are instances where the registration process has been stopped once the address has been given. The family has been told, "We do not take on Army families". The family then has to travel further afield. In one instance the nearest surgery was seven miles away. That can cause many difficulties when there are small children involved. The husband
may be away on duty and the wife, possibly without private transport, may have to take the baby to see the doctor, even for regular immunisation.I understand also that secondary treatment often takes so long to arrange that, just as the patient is ready to go to the hospital for the treatment, the husband or wife is posted; the family moves; and the whole process has to be started over again. We need to look at the proper integration of medical services in the forces with the National Health Service for the welfare of the families. If families are not happy with their welfare, the person serving will be persuaded to leave. It will be the best ones who leave because they can find jobs in civvy street more easily than those who are not so good.
One other point which could well lead to medical problems also concerns the welfare side and relates to housing. Housing is welfare; it is the welfare of the family. In 1994 the Gas Safety Installation Use Regulations came into effect and were amended last October. I understand that on "march out" a serviceman has thoroughly to clean his gas cooker and reassemble it so that he can hand it over in a clean condition. But servicemen are not qualified, in general, to put together gas equipment. What safety checks are undertaken? A civilian landlord has to have all the gas installations inspected on an annual basis and the tenant has to be issued with a certificate to say that they are all safe. What is the position in the services? Our servicemen and their families are valuable and we want to make certain that they are not damaged by faulty gas equipment, particularly when a previous serviceman has taken to pieces a gas cooker and reassembled it in a dangerous state.
I am very glad that my noble friend has put down this Question and I look forward to the answers. I do not necessarily expect verbal answers from my noble friend the Minister this evening. I should be very happy if he were able to write to me later because I know that some of the answers are probably not in his brief.
10.16 p.m.
Lord Bramall: My Lords, from what all noble Lords have said, it is very obvious that nothing that has been instigated and executed during the whole series of defence reviews, studies, squeezes and cutbacks over the past five to six years has turned out quite so disastrously as these new medical arrangements.
The worst aspect of the whole saga is that it has been almost entirely self-inflicted. Thought up hastily by who knows who in the central staff, against, I suspect, the better judgment of the Chiefs of Staff, and seemingly with an oddly supine attitude being taken by some of the most senior medical officers, this ill-thought through reorganisation was quickly incorporated in the Defence Costs Study, where, by largely destroying the military ethos of medicine among the Armed Forces Medical Services and knocking the stuffing out of them, it has brought about the very exodus and shortages of specialists which Ministers have been claiming are the causes of the present state of affairs rather than its effects. In order to meet the inevitable and insatiable requirement of the Treasury to save defence money in
the longer term, whatever the cost in other less tangible things, the MoD has tried to pass the buck for medical care of the Armed Forces in peace and, indirectly, through the reserve forces, in war, to the National Health Service, which, because of its own pressures and shortages, was in no position to shoulder them.Now I am not for a moment saying that there is no benefit in service doctors and nurses extending their knowledge and broadening their experience by a greater clinical contact with civilian patients of all ages and with the latest medical techniques. But the way this particular and worthy aspiration has been implemented, or rather extended, because it already happens, has ended up with, among other things, closing no fewer than six service hospitals, at least some of which were fundamental to the ethos of medicine in the Regular Armed Forces; putting the single surviving hospital in the wrong place in relation to the main concentrations of servicemen and their families; and precipitately integrating the RAMC personnel from the Cambridge at Aldershot into Frimley Park, which has never, for reasons possibly outside its control, had the best of reputations for patient management. In addition, this has been done without creating the proper purpose-built accommodation promised, the military wing, which might have made the whole arrangement more viable. This has led to long waiting times and waiting lists, itself an exacerbating factor in the chronic undermanning in the Army, and the military feeling, or being made to feel, poor relations, with a dramatic drop in morale, highlighted so emphatically by the House of Commons Defence Committee's damning report.
Things may improve--we must hope they will--with a reinjection of much of the funds already, or planned to be, removed, and other suggestions made this evening by noble Lords. But the present situation should never have been allowed to occur in the first place and already the practical repercussions are all too clear. In peacetime the flood of key specialists leaving the service and the lack of regular hospital staff has meant greatly inferior medical cover for service people and their families, thus affecting conditions of service and leading to insufficient training for existing staff and field ambulance personnel and, even in low intensity and humanitarian operations, an excessive reliance for vital medical support on the excellent Reserve Forces, which means the health service, whose reaction to releasing these specialists whenever they are needed cannot always be guaranteed. And, in the event of serious hostilities on the scale of the Gulf War, the defence medical services would not be sufficient, as the Defence Committee makes clear, to provide the proper frontline support in all the realistic scenarios envisaged-- a disgraceful state of affairs.
Noble Lords and honourable members in another place have reason to be as angry as they are concerned about this because, not once but repeatedly, at collective and private meetings; in personal letters; in parliamentary Questions and in debates over the past two to three years, Ministers have been warned about what was likely to happen if they scaled down and
removed money from the medical services as they were intent on doing. But they continued to accept the Treasury-inspired claptrap provided by officials, with the results now so glaringly exposed.Perhaps the Minister for the Armed Forces should not be held responsible for that Gulf War Syndrome fiasco, but will the noble Earl please say exactly whose fault it is that, far from enhancing the frontline, as was the proud boast of the defence costs study, named catchily Front Line First, the frontline has now been seriously impaired; that the morale of the medical services is lower according to the well-informed House of Commons Defence Committee than ever it had previously encountered in the Armed Forces; and that the ethos of military medicine has virtually been destroyed, possibly irreparably. Someone must be to blame.
10.22 p.m.
Lord Newall: My Lords, a major part of medical work for the forces relies on the proper welfare of the patient, and welfare lies at the heart of morale, which is so vital for our Armed Forces. Even in normal times of peace there are special circumstances for service personnel, not least that they are often a very long way from home and much-needed support. Service people also suffer from additional worries and problems related to their way of life. In many theatres of the world where our servicemen and servicewomen work, their ability to find necessary recreation is often limited and they frequently turn to welfare organisations for assistance. If they have an injury or illness, their needs become greater, as their next of kin is usually a long way away.
The main provider of medical welfare has been, and still is, the Service Hospitals Welfare Department. But at the moment, due to lack of planning and consultation, they find themselves inadequately provided for and are struggling to do a mammoth task against great odds. The recent report by the Defence Select Committee in another place, which has been mentioned by noble and gallant Lords and many noble Lords, appeared on 27th February. Broadly speaking, it catalogued the shortage of medical personnel and the near disaster level of military medical establishments, which have been cut to the bone.
In our one remaining military hospital at Haslar in Gosport they are short of over 90 personnel--about one-quarter of the establishment. The hospital itself, as has already been mentioned, is particularly hard to find. It even needs a ferry to get there.
In the past service families were looked after very well, in the same manner as the servicemen or servicewomen. There were sufficient hospitals with adequate facilities for families to stay near their service relative, especially if the illness or injury was serious. That was good for morale and kept everyone confident that their service would always take care of them and their family.
Now the situation is very different. In our one remaining military hospital at Haslar, there are only six beds for families, as my noble friend Lady Strange said. But somehow, since January, the welfare department has
accommodated 90 families--134 people. I know because I have seen it happening. Sometimes relatives sleep on window-sills in the hospital because there are no beds for them. Personnel serving in Cyprus, Germany, Bosnia and many other theatres are often sent to Haslar for medical treatment, and a dependant without a home in England has a terrible time, often having to pay for bed-and-breakfast accommodation nearby, with related transport problems.The welfare people have been remarkably resilient in coping with this situation, both here and in Germany, where there will be no welfare beds for dependants when BMH Rinteln closes at the end of this month. In addition, the hospitals welfare department is still fighting for adequate office space in which to operate. Welfare seems to be permanently at the bottom of the list when funding is being discussed and is often the subject of argument as to whose responsibility it is, even though the services hospitals welfare department comes with the blessing of the Surgeon General.
I have said it before: it is vital that morale is maintained now, when the services are short of manpower and our commitments appear to be growing. Instead, because of uncertainty, and with no sign of things improving, morale is low and people are leaving.
Dependants and ex-servicemen are now subject to normal National Health Service waiting lists and this causes great concern to families, especially the Army. Prior to military hospital closures in 1995, there were five hospitals in Germany, with 15 welfare personnel, providing a 24-hour service. When decisions were made to shut down the military hospitals, there was no provision for welfare and the welfare department was never consulted. It appears to have been done in great haste and with a great lack of forethought.
Often in Germany welfare personnel are actually prevented from having access to patients. There are now seven welfare officers in Germany, where there were 15, after a battle to try to cut them down to four. They cover, over a wide area, five German hospitals which have agreed to take in service personnel. There is a crying need for a tri-service re-statement of welfare policy, as this is long overdue. The situation needs to be sorted out at the highest level, and very soon.
We have been promised that something will be done in the medical and welfare fields. But when? And why is it taking so long? Morale needs an uplift and welfare is a most important part of this. The service hospitals welfare department has trained personnel to deal with medically related problems. Medical welfare is an emotional response and is much more than social or voluntary work. Discontent and disillusionment are often a direct result of unmet expectations in the welfare arena.
These issues could well be contained by affording the welfare department the appropriate terms and conditions and equipment to continue to perform its vital role. Let us hope that happens soon.
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