Defence and National Rehabilitation Centre

Thursday 13th October 2011 Written Statements

[The Secretary of State for Defence (Dr Liam Fox)]

In June 2009 the previous Government announced that a feasibility study into the establishment of a defence and national rehabilitation centre (DNRC) would be undertaken. I am today announcing the outcome of that study and the next steps that will be taken. But I wish to do so in the wider context of what is being done for members of the armed forces in the field of both rehabilitation and recovery.

Rehabilitation is primarily clinical treatment for medical conditions arising from illness, wounding or injury. The Defence Medical Services (DMS) are responsible for the provision of rehabilitation. Defence relies upon the availability of medically fit and healthy personnel in order to generate forces for operations. A tiered structure of rehabilitation is provided for all personnel who need it, whatever the cause of their injury or illness. The DMS run local primary care rehabilitation facilities in barracks and stations in which minor cases can be treated. More significant conditions are referred to one of 13 regional rehabilitation units (RRU) in the UK and two in Germany.

In the operational theatre, a deployed rehabilitation capability is available to treat personnel with minor injuries, so avoiding the need to repatriate them. The most seriously wounded are treated first in the theatre of operations before aeromedical evacuation and admission to the military ward of the Queen Elizabeth hospital, Birmingham. When their injuries are sufficiently healed, most such patients start a rehabilitation programme at the Defence Medical Rehabilitation Centre at Headley Court in Surrey, which treats complex or persistent cases regardless of how they are caused.

Let me turn now to recovery. Recovery is primarily a non-clinical activity, which may involve individuals taking rest periods during their rehabilitation treatment programmes. Recovery activity ensures that wounded, injured and sick personnel have access to all the key services and resources needed to help them return to duty or make a smooth transition to an appropriately skilled civilian life. This care is delivered across the defence community by the combined efforts of the services and the service charities, responding to carefully tailored individual recovery plans setting out a recovery pathway.

Single service recovery provision is co-ordinated by the defence recovery steering group (DRSG) and collectively forms the defence recovery capability (DRC). The Army’s wounded, injured and sick are managed at brigade level by 13 regional personnel recovery units (PRUs). The naval services, including the royal marines, are supported at each Royal Navy base but have special facilities at Devonport with Hasler company. The Royal Air Force has a recovery flight as part of their recovery pathway which is followed by all RAF personnel who are unable to return to duty after sickness or injury.

A programme is under way to support the DRC by the creation of personnel recovery centres (PRCs). These centres are already being built in garrison towns in Colchester, Catterick, Tidworth and, in the case of the naval services, at Plymouth. The Pathfinder Centre, opened in Edinburgh in 2009, supported by Help For Heroes for the first two years, is now being run by the Ministry of Defence (MOD) and supported by the Royal British Legion and Erskine homes.

The PRCs and other facilities are being built by Help For Heroes in Tidworth, Colchester and Catterick and by the Royal British Legion in Sennelager in Germany. This has been made possible by the generous initiatives of Help For Heroes and the Royal British Legion. Long-term funding will be the responsibility of the MOD. Additional support is being provided by many other charities and Government agencies to ensure that the DRC is able to deliver effective and co-ordinated support from regional support hubs.

The Battle Back programme provides adaptive sport and adventure training opportunities to wounded, sick and injured personnel at all stages of recovery. The programme will be further developed through a defence adaptive sport and adventurous training centre at the Sport England Centre of Excellence at Lilleshall. Funding for this Battle Back centre is being provided by the Royal British Legion and wider Battle Back activity is supported by Help For Heroes through the PRCs.

This partnership between the MOD and the service charities is a long-standing tradition. This multimillion pound programme, using funds raised by a generous and benevolent British public, is already supporting wounded and injured personnel. Once completed, the DRC will provide a comprehensive support network to both serving personnel and their families, and to those who leave the services through injury.

Rehabilitation medicine is advancing rapidly in terms of how technology can help people recover and the extent to which modern medical science might offer new possibilities in the rehabilitative field. While the existing defence rehabilitation facility at Headley Court, established in 1947, is widely admired for achieving remarkable results for those injured in conflict, it is important that defence is in a position to benefit to the maximum degree from advances in technology and science. Realising the full benefits of such advances will not be possible in the medium to long-term because of the physical constraints of the Headley Court site and will therefore require purpose-built accommodation and facilities. It was for this reason that the feasibility study into the concept of a DNRC was conducted, involving the possibility of establishing a new facility in the midlands and looking at how the whole issue of rehabilitation should be developed in 21^st-century terms.

The study involved the MOD, the Department of Health, the Department for Work and Pensions and the Department for Culture, Media and Sport. It was conducted during 2010 and 2011 and is now complete. It took evidence from a wide variety of sources including many of the practitioners at Headley Court. It concluded that there is convincing evidence that a DNRC would build on the remarkable achievements of Headley Court by offering substantial “betterment” in virtually all areas, providing an assured level of future care that will surpass that which is offered by Headley Court’s current and planned capabilities. The MOD’s surgeon general considers that the degree of “betterment” is shown to be compelling and very significant in terms of scale, quality, design, patient flows and future-proofing. It presents a once-in-a-lifetime opportunity to develop the nation’s rehabilitation capability in partnership with the MOD, which builds on defence’s acknowledged lead in this area. This defence “core” of a DNRC has been defined in considerable detail and will include specific provision for neurological and complex trauma patients as well as “back to life” facilities.

The study also revealed widespread support for the notion of civilian rehabilitation benefiting from close association with the defence equivalent. Although less developed at this stage, the study concluded that significant national benefits could come into play. The urgent need for improvement in the nation’s approach to getting injured people back to work is well known—the cost to the taxpayer of lost working days was estimated in 2006 to be over £60 billion. A combination of defence and civilian medicine, university-led research and development, and national disabled sporting facilities in one location could provide a combination unique in the world. The focus on work-related interventions, looking at what people can do, rather than what they cannot, has the potential to bring huge benefits to the nation through reducing the social and economic costs of ill-health in working-age adults. Professor Dame Sally Davies, the chief medical officer of the Department of Health and the NHS in England, and the surgeon general in the MOD strongly support the development of a DNRC, and the trustees of the Headley Court trust also support the project. The next steps will be to develop further the concept for the national elements and to embark upon acquiring the necessary capital through a fundraising campaign. During the study a test site in the midlands was identified as able to accommodate both the defence military establishment and allow space for national facilities to be developed over time. The test site allowed the development of robust costs on the basis of designs to fit the MOD’s clinical brief.

With his permission, modestly given, I am able to tell the House that the benefactor behind this project is the Duke of Westminster. The initiative was his from the outset. Since then, the Duke of Westminster has been working on the project quietly behind the scenes for two years, and it was he who generously funded the feasibility study. His generosity has now extended to the acquisition of the test site so that, as a first step, a dialogue with the planning authority can take place to explore the site’s DNRC potential. He will also fund the necessary work to process the planning application. If the decision is made to proceed with a DNRC, it is the Duke’s intention to donate the site to the project. He will now lead the major donor fundraising campaign and make a very substantial donation to it beyond that which he has already given.

Nevertheless, I can assure the House that no final decision on the future of Headley Court has been made. I expect to be in a position to announce progress on these next steps towards the end of 2013. Should the decision be made to proceed with the project, the outcome would be a new defence establishment, opening in 2017, which would ensure that the spirit and achievements of Headley Court are carried forward into the 21st century on a new larger site, purpose-built to continue to do what Headley Court has always done so well.

Meanwhile, development of the defence recovery capability will proceed and by the end of 2012 the full capability is expected to be in place.

The Government are committed to providing the best possible care for our wounded and injured service personnel. A DNRC offers the clear and compelling opportunity to realise the full benefits of future advances and we should seize it for the medium to long-term. For now, I can assure the House that we shall continue to invest in Headley Court so that it continues to deliver to the best possible standard. A project to increase capacity and sustain infrastructure is planned to start at the end of this year.