Armed Forces: Post-service Welfare

Lord Glenarthur Excerpts

Thursday 27th January 2011 Lords Chamber

[Lord Glenarthur]

My Lords, I, too, am most grateful to my noble friend Lord King for raising this important issue. I certainly join with all those who pay tribute not only to the fortitude of those who are so grievously injured on operations but to their families, friends and the professionals who have the difficult task of supporting them on their return. I have various interests to declare. I was a member of the National Employer Advisory Board for the reserves of Britain’s Armed Forces for 14 years, for seven of which I was its chairman. I have been honorary colonel of a Territorial Army hospital support medical regiment for 10 years and for six years, concurrently, I have been honorary air commodore of a Royal Auxiliary Air Force medical unit. These specialist medical units regularly provide individuals—or even many individuals—to reinforce, and to provide specialists for, both regular and reserve medical units that are deployed.

As I have had substantial contact with many doctors, nurses and others, such as from the professions allied to medicine, who have the initial and subsequent care of servicemen with profound physical and mental trauma as a result of operations, I should like to concentrate my remarks on the reserves, particularly the medical reserves. From what I know, it is clear that many people deployed on operations in the medical field are seeing the most dreadful trauma that only a couple of years ago would not have been survivable. They often witness what was described to me yesterday as the “ultimate” in terms of trauma that they will ever see. They see perhaps the most awful experiences of their professional lives. The degree of preparation that the United Kingdom armed services gives all those who are due to deploy might be a major factor in helping the rate of post-traumatic stress disorder remain at a low level. However, we cannot afford to be complacent and we cannot be sure when repeated deployments will begin to take their toll and very real long-term issues of mental illness, requiring long-term rehabilitation, will become evident.

So far as the Defence Medical Services are concerned, a large number of their strength is made up of reservists. Some of these reservists, largely from the TA, deploy as formed units—perhaps as a field hospital taking over the manning and the operation of the medical facilities at Kandahar, Camp Bastion or in forward locations. These medical staff are almost the only formed reserve units to be deployed nowadays on operations. However, they also rely heavily on the additional expertise of specialists from national units, such as my own represents.

Many of these staff, with wide experience in the NHS and the private health sector, are used to dealing with fairly horrific scenes—whether in an A&E department of a hospital or in the subsequent treatment of the sort of trauma that I described earlier—but, however professional or inured to witnessing the most distressing scenes these people are, there must be a real risk that the effect on the individual clinician might become cumulative. These clinicians are supremely professional, but they are human beings who are prone to the same emotions as any of us. One has to wonder whether there will come a time when continued regular exposure to the extreme horrors of war could lead to a substantial cumulative effect on the individuals, with worrying consequences for the future. Even the most experienced, hardened doctors who have been deployed many times often say that it takes a good three months to recover and to come to terms with what they have seen, and it takes much longer for those who are not so experienced. Can my noble friend say what steps are being taken within the MoD to be alert to this possibility? What steps might be taken to deal with that outcome should it occur?

The trauma facilities in Camp Bastion are absolutely first class—I saw them two years ago and I should like to see them again—and they have probably improved hugely since I last saw them. As the noble Lord, Lord Kakkar, said, what is being achieved there in terms of the ability to treat trauma is quite astounding and, indeed, humbling. However, one cannot ignore the fact that, although the need to preserve life is a pre-eminent role of clinicians, there are huge, complex ethical issues involved, which can take their toll on even the most stoical and professional of clinicians. While our doctors and nurses are treating our own injured servicemen whom they know will have the very best clinical attention on their repatriation to the United Kingdom, they are also treating very seriously injured Afghan civilians and Afghan servicemen. In treating those people and saving their lives—however horrific their injuries and however limited might be their subsequent quality of life—one can all too readily understand that the clinicians face awful ethical and moral dilemma, because those people will not go back to the same sort of facilities that we have.

The British serviceman—man or woman—is an extraordinarily resilient being. One hears amazing stories of their sense of humour, their determination to overcome quite shocking injuries and their success in doing so. For those who can remain within the services while fulfilling other tasks, all is made easier by the sense of camaraderie that always prevails within the unit. I hope that the Government will accept that those who treat our servicemen may at some point also need special care and attention because of the effect of what they have had to deal with.

As my noble friend Lord King clearly stated, for reserve medical staff returning to their civilian places of work, however supportive and understanding senior management may be of their experience on operational tours, that is not always the case with junior civilian colleagues. The latter may not easily have the same depth of understanding of what clinicians have gone through and have witnessed in the theatre of war. Those clinicians, however robust and resilient, can talk among themselves as a sort of safety valve when they are with their military unit colleagues. I urge my noble friend the Minister to impress upon his Ministry of Defence colleagues that they should be alert to the possibility of traumatic reaction requiring a degree of mental rehabilitation over time for these individuals in the future.

The reserves of all three services make up a crucial element of the deployable Defence Medical Services. I would go so far as to say that operational deployment of any sort would be impossible without them. We must be alert to the risks of continued deployment which these very well meaning and extraordinarily professional clinicians face.