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I have four questions for the Minister. First, is there a single booklet or similar that is made available to such personnel giving details of supportive career opportunities and where and how they can access the relevant training and the financial support to undertake it? Secondly, does the Ministry of Defence have any records of the number of personnel serving in the three services so redeployed after severe injury or disability, whether that be of a physical or mental nature? The noble Lord, Lord Patten, increasingly focused his remarks on the mental situation. Thirdly, how positively are commanding officers encouraged and, indeed, expected to provide career opportunities in the circumstances that we are discussing tonight, albeit acknowledging possible financial constraints and their prime responsibility of delivering an effective operating force? Fourthly, I refer to something that I read relatively recently. Professor Alexander McFarlane, the head of the Australian Centre for Military and Veterans’ Health, said that Australia and America were better at supporting their soldiers when they returned from conflict than we were. I should be grateful if the noble Baroness could look into this fairly serious assertion.
8.08 pm
Lord Astor of Hever: My Lords, the House will be grateful to the noble Lord, Lord Burnett, for raising this important issue. I agree with the noble Lord, Lord Lee of Trafford, that his noble friend’s distinguished service with the Royal Marines fully qualifies him to be taken very seriously by the House tonight. As the noble Lord, Lord Burnett, said, many men are alive today due to the miracles of modern medicine, but many of them are seriously wounded. Most want to be with their comrades and, as the noble Lord said, their comrades want them back. I also agree with the noble Lord that most units and regiments are like extended families—when you join, you are in for life. I am very proud that my former regiment, the Household Cavalry, which has suffered a number of deaths and serious injuries in Iraq and Afghanistan, like the Royal Marines has active associations both in this country and overseas
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Can the Minister tell the House how many members of the British Armed Forces have been seriously injured in the past 12 months? As the noble Lord, Lord Lee of Trafford, asked, do the Government keep records of the number of service personnel serving with their original regiments or units in administrative or clerical roles since being wounded or disabled while on active service? Are any programmes in place to allow and indeed encourage wounded soldiers who wish to continue serving to stay with their units? We on these Benches welcome any progress to enable wounded soldiers to continue serving.
Although that is paramount, it is also vital that wounded soldiers, after leaving military care facilities such as Headley Court and Selly Oak, have access to proper civilian healthcare. Can the noble Baroness tell the House what government procedures are in place to ease the transition from military to civilian healthcare for disabled soldiers? What programmes are used to facilitate greater co-operation and communication between the Ministry of Defence and the NHS? I should like also to join the noble Lord, Lord Burnett, in paying tribute to our local and national newspapers and the television for highlighting the very positive contributions that severely injured servicemen can make.
Many years ago, Lord Nelson said that this country expects every man to do his duty. Two hundred years on, our soldiers, sailors, airmen and marines are still responding to the call and many are being severely wounded in the defence of this country. The difference is that our Government expect a first-rate military on a second-rate budget. After a decade of Labour’s neglect, our military is overstretched, undermanned and in possession of worn-out equipment. It is our duty to ensure that these brave heroes who fight on our behalf receive proper care and recognition both for operational requirements and, as my noble friend Lord Patten said, for urgent post-operational requirements.
8.12 pm
The Parliamentary Under-Secretary of State, Ministry of Defence (Baroness Taylor of Bolton): My Lords, this is a debate about severely injured service personnel, but before I turn to the points that have been made, I am sure that the whole House will wish to join me in offering sincere condolences to the families and friends of those who have been killed on operations in the recent past: Marine Jason Mackie, Fusilier Petero Suesue, Sapper Jordan Rossi, Lance Corporal Robert Martin Richards, Lance Corporal Kieron Hill, Lance Corporal Nigel Moffett, Corporal Stephen Bolger and Rifleman Cyrus Thatcher. It is appropriate that we remind ourselves of the ultimate sacrifice that they have each made, and our sympathies are certainly with their families this evening. This is a salutary reminder of the very harsh consequences of the operations in which we are involved, and of course one of the consequences of those operations is the issue of injured service personnel that the noble Lord, Lord Burnett, has raised today.
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The whole House has expressed its appreciation to him for securing this short debate to ensure that we are taking the right steps to provide opportunities for service personnel who are severely wounded or disabled while on active service. Noble Lords have mentioned the need to help them remain with their corps, their regiment or their units, in administrative or clerical roles, if they cannot return to their former duties. We are very clear that that is a desirable objective. It is also important that the House realises that we do not think that there is one approach that fits every individual, because these people should be treated as individuals, and the response should be tailored to their needs as much as possible.
We accept absolutely our responsibility to provide effective medical and health support to our people. The support to personnel injured on operations is, I think everyone agrees, of an excellent standard. That is not just my view. The National Audit Office noted in its May report that:
“The Department’s success in delivering lifesaving medical treatment is underlined by the number of ‘unexpected survivors’ following the most severe of injuries”.
Noble Lords have mentioned that those who might have died just five or 10 years ago are being kept alive today by the remarkable services that we now have. We should all pay tribute to the medical teams who are responsible and those who have devised the advances that allow those people to survive.
For hospital treatment, we rely almost exclusively on National Health Service facilities. Serious casualties need, and receive, advanced levels of care across a wide range of medical disciplines that can found only in a major trauma hospital. In addition, by working in the National Health Service alongside civilian colleagues, our medical staff gain the broadest and most up-to-date training and experience, which helps to save lives on military operations.
The noble Lord, Lord Patten, and other noble Lords mentioned mental health care, which is extremely important. We provide comprehensive mental health support to our casualties, including military mental health staff in theatre, at Selly Oak Hospital where most of our seriously wounded are treated, and at military departments of community mental health across the country. Real progress has been made to what, across the board, was a Cinderella service in terms of something that people did not like to talk about. There have been many breakthroughs. Mention was made of Combat Stress. In 2007-08 the MoD paid that society £3.2 million for fees for the care of individual war pensioners, which was a substantial increase and which really helps that organisation to do the work that is necessary. We are making very significant progress in that area.
Lord Patten: My Lords, I am grateful to the Minister for giving way. Would she, or if not her because she is very busy then her officials, welcome further discussions with organisations such as the one I referred to, the Warrior Programme, and others, to discuss not just how more public money might be spent, but how these different organisations might knit their care together and make access to that care easier for those people who need help with mental health problems?
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Baroness Taylor of Bolton: My Lords, my honourable friend the Parliamentary Under-Secretary in the other place has regular meetings with many of the organisations concerned and I am sure would respond to any request that was made of him. It is important that we work together with the charitable sector on these issues, not least because it has a very good record in this area, a good history and a great deal of confidence from those who are in the services.
Noble Lords mentioned Headley Court and referred to the visit. It is an important facility and there is nothing quite like it in the National Health Service. It is commonly agreed that there is world-class care for the patients there, providing clinical rehabilitation, training, a centre for rehabilitation and research, and all of it tailored to individual needs. We have to do the best we can. The department recently helped with work that is going on there, and the recent Help for Heroes commitment of £8 million to extend facilities is very welcome. We should pay tribute to the work that has been done. We have to do our best to protect our people when we can, to give them the immediate treatment that they need, and to provide the long-term support that some, though not necessarily all, will need over many years.
The focus of much of this debate has been on retention and on trying to keep people in the military family, if that is what they wish. It is always our intention to retain injured service personnel if it is possible to find worthwhile service employment for them. Each service considers each case individually and works very closely with the medical authorities, taking account of the wishes of the individual service person. This ensures that our personnel are returned to work even if their injury, sickness or disability prevents them undertaking a full range of activities. We want to do this as soon as is reasonable, but clearly we have to do it in such a way that we avoid any employment which would make their underlying medical condition worse.
In the case of the Army, applications to retain or discharge injured army personnel are currently made by commanding officers on a case-by-case basis and on the recommendation of a full medical board to the Army Personnel Centre. Commanding officers are given advice on this and are currently employing injured personnel wherever possible within units, subject to the individual’s wish to remain and having a worthwhile role. Where the wish is not to remain within their current unit, individuals may elect to leave the Army or, provided that they are above the minimum medical standard, transfer to an alternative cap badge—for example, from the Infantry to the Advocate General’s Corps—and, again, this process would be facilitated by the Army Personnel Centre, which is developing and has expertise in this area.
The Royal Air Force follows a similar procedure called the medical boarding process. Where an individual’s permanent medical standard is below that required for their current trade, they may be considered for employment within a different trade, obviously with retraining and reskilling being available where that is necessary.
In the case of the Royal Navy, the majority of personnel with more severe injuries—specifically those injuries sustained while on active service—are young
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The real balance that has to be struck is between the wishes of the individual and how far you can accommodate their levels of injury, health problems and abilities because they may need to do different tasks and will need reskilling.
We have made significant progress. We have outstanding care and outstanding welfare care. It is important that we recognise that that is necessary—it can be an emotive area—and, as I mentioned, we work with some of the charities that have a great deal of experience in this area. We appoint visiting officers to provide information and practical support for families, and specialist welfare workers are appointed to co-ordinate the very often numerous agencies that are involved. There cannot be one package. The noble Lord, Lord Lee, asked whether information was available. Because every situation is different, we have to respond to the specific needs of each individual.
Other points have been raised but there is not time to answer them all. So far as numbers are concerned, the ones that I have are the total of those who have been very seriously and seriously injured in Iraq, which is 222, and in Afghanistan the total figure is 197. That gives some idea of the scale of the problem and the learning curve that has gone on in the recent past.
We give outstanding medical treatment and we regard these people as individuals and try to meet their individual needs. That is important. Everyone has said that we need to ensure that these people are kept within the military family if that is at all possible. That is something we understand and have tried to work for. Provided we can find a worthwhile role for these people, and provided they as individuals want to stay within the Armed Forces, that is what we try to do. As everyone has said, our Armed Forces are the best in the world. Their dedication and sacrifice are unquestioned and it is only right that the care and support they receive should be equal to that. We are committed to ensuring that that is the case.
Lord Burnett: My Lords, I am extremely grateful to the Minister for her response. Will she write to me on the matter of retraining and reskilling for those individuals who have been so severely wounded?
Baroness Taylor of Bolton: My Lords, I can give an assurance that that is one area we are very conscious of and many people have already gone through that process. When people are very severely injured, sometimes it is several years before they can be brought back into full employment in any new capacity. There is therefore the medical dimension, including the mental dimension, there can be welfare and family issues, but certainly reskilling and retraining is something that is well looked after and provisions are made wherever possible.
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Coroners and Justice Bill
Bill Main Page
Copy of the Bill
Explanatory Notes
Amendments
7th Report from the Delegated Powers Committee
8th Report from the Joint Committee on Human Rights
16th Report from the Joint Committee on Human Rights
Committee (1st Day) (Continued)
8.38 pm
Clause 5 : Matters to be ascertained
7: Clause 5, page 3, line 37, leave out paragraph (b) and insert—
“(b) when, where, by what means and in what circumstances the deceased came by his or her death;”
Lord Alton of Liverpool: We come now to Clause 5 and my Amendment 7, which is grouped with other amendments. The amendment would replace the words,
The purpose of the amendment is to bring Clause 5, and with it the statutory framework of the coroners system, into line with the recent jurisprudence of the Judicial Committee of your Lordships’ House. Under Article 2 of the European Convention on Human Rights, on the right to life, Governments are required to,
- “establish a framework of laws, precautions, procedures and means of enforcement which will, to the greatest extent reasonably practicable, protect life”.
The European Court of Human Rights has interpreted this as mandating independent official investigation of any death where public servants may be implicated.
In the landmark House of Lords case of R v Her Majesty’s Coroner for West Somerset ex parte Middleton, their Lordships ruled on 11 March 2004 that in cases where Article 2 of the European Convention on Human Rights is engaged, the outcome of the inquest as currently provided for in the England and Wales coroners rules by the phrase,
- “in the broader sense previously rejected, namely as meaning not simply ‘by what means’ but by what means and in what circumstances”.
Those are the words that I tabled and that appear in the Marshalled List. Their Lordships were essentially seeking to imply a clearer, wider and more robust requirement upon the coroner’s investigation into a contentious or complex death to look at the circumstances around the death in addition to its factual cause. This amendment takes verbatim the very words contained in that judgment—“what means and what circumstances”—and places them into a statutory requirement upon the coroner.
Like Amendment 2, which I moved earlier, this amendment arises from a proposal put forward by Dame Janet Smith following her own experiences with the Shipman inquiry, which she chaired. It rests on Article 2 of the Human Rights Act, which imposes the duty I have mentioned to undertake a full investigation
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Those are the words that my amendment seeks to incorporate in the interests of clarity.
There are a couple of instances where the absence of this rubric might militate against the interests of the victim or their family. For example, a road traffic accident might initially appear straightforward, but what if the accident occurred because of negligence in maintaining the motorway or some other corporate failing? Detailing the circumstances in which a death occurred is manifestly important. What if a seemingly natural death in a hospital were in reality caused by dismal hygiene or neglect by the NHS? I cite the specific example of Stafford Hospital, which was highlighted in March. I quote from a BBC report entitled “Failing hospital ‘caused deaths’”. It said:
“A hospital’s ‘appalling’ emergency care resulted in patients dying needlessly, the NHS watchdog has said. About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the Healthcare Commission said. It said there were deficiencies at ‘virtually every stage’ of emergency care and managers pursued targets to the detriment of patient care”.
The then Secretary of State, Alan Johnson,
- “said a review of Mid Staffordshire NHS Foundation Trust, which runs the hospital, would be carried out, focusing on the years 2002 to 2007”.
I deliberately mention the long period of time that the Secretary of State’s review is covering because clearly these were not instances that were picked up in coroners’ investigations carried out during that time, as I think we would all agree they should have been. I agree with Mr Johnson when he says,
- “there was a complete failure of management to address serious problems and monitor performance. This led to a totally unacceptable failure to treat emergency patients safely and with dignity”.
Such failings will undoubtedly occur again. It is in the nature of the way that we run our hospitals and our public services that awful serial mistakes can sometimes be made with tragic consequences for all those involved. Part of what the Shipman inquiry tried to identify in the case of a doctor who had been taking the lives of his patients was that where a pattern emerges, it should be identified at a very early point. By not having in the Bill these words, which appear in the European Convention on Human Rights, we are perhaps failing to recognise a gap that needs to be plugged. That is why it would be good to incorporate these words in the Bill which Dame Janet Smith, who carried out the inquiry, believes to be necessary.
I hope that the Minister, who has sat patiently throughout our proceedings and listened to this speech, will think carefully about this and even if he cannot accept the terms of the amendment today, perhaps he will give it further thought between now and Report.
8.45 pm
Baroness Finlay of Llandaff: I have several amendments in this group. I should like to speak to Amendments 7 and 27 and then turn to Amendments 26 and 29.
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The term “how” appears to be too simplistic for all the reasons outlined by my noble friend Lord Alton. I want to link this to coding, however; when a death has occurred, the narrative verdict goes to the Office for National Statistics, where coding has to be undertaken. I should like to give a shortened example to illustrate why “how” is too simplistic.
Let me give the example of a drowning. A deceased person who resigned from work appeared to become depressed and did not want to bother his GP. He felt guilty towards others at work that he had not been replaced. His partner came home to find an empty house. Thinking that he had gone for a walk along the cliffs, which was near their home, his partner went to search for him but the body was found in the water. The emergency services were called, the body was retrieved from the water by the coastguard, and the post-mortem revealed drowning. That is a shortened version. The problem facing the ONS in coding was whether this was an accidental or unintentional death, intentional self-harm, assault or an event whose intent cannot be determined.
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