Armed Forces Bill

Debate between Lord Kakkar and Countess of Mar

Tuesday 4th October 2011 Lords Chamber

[Lord Kakkar]

My Lords, I rise to move Amendment 8, which is in my name and that of the noble Lord, Lord Patel. This amendment deals with the question of the covenant but it relates to the covenant report, which will be the obligation of the Secretary of State for Defence with regard to matters of health and healthcare. First, as I think all noble Lords do, I very much welcome the fact that the covenant is to be included in this Bill because it provides so many important opportunities—none more so than when considering the important question of the consequences of current or former membership of the Armed Forces on an individual's health. Equally well, it provides the important opportunity for us as a society to understand the ongoing requirements for access to specific and specialist healthcare facilities for those who have served our nation.

In Committee, I moved two amendments and I was very grateful for the response of Her Majesty's Government to them. They relate to the same issues: the need to enshrine in the legislation an obligation for the Secretary of State for Defence to commission prospective research to inform that part of the covenant report relating to questions of healthcare, health and the utilisation of health resources. If I understood it correctly, the response recognised the importance of this prospective research in providing authoritative evidence to answer specific questions around healthcare and the future need to dedicate specific healthcare resources, particularly to those who have served our country and who have been discharged from the services. The simple reason for this is that once a veteran has been discharged from the services, responsibility for their healthcare is transferred from Defence Medical Services to their own general practitioner. Under those circumstances, it is difficult to track health outcomes or the utilisation of and appropriate access to healthcare resources, because those individuals are no longer under the direct supervision of the service in which they served for matters of their health.

The need to commission prospective research is therefore to ensure that the objective of reporting on the question of health and healthcare in the covenant is met, because if there is not prospective research we will not be in a position to understand what the consequences of membership of the services are in terms of long-term healthcare needs. What we read is that those consequences may present many years or decades after active service. Often, those individuals are lost in terms of understanding what their healthcare needs are and, as a result, the provision of services is inadequate until they present with very serious illness. If they had been tracked prospectively—in cohorts informing a proper, authoritative report as part of the covenant report made to Parliament annually—then if there were detrimental issues and features associated with former membership of the Armed Forces, those would be picked up early. Appropriate action might then be taken either to assist those individuals prospectively identified or, indeed, to ensure that we designed healthcare services which could meet their needs more appropriately. Without an obligation to commission on a prospective basis this type of evaluation to inform a covenant report, we run the risk that the very purpose of a proper evaluation and reporting of health outcomes, access to healthcare facilities, and the health consequences of current or former membership of the Armed Forces is going to be lost, along with the tremendous benefits that would attend it.

In Committee the noble Lord, Lord Patel, and I proposed two amendments. The first was very similar in nature to Amendment 8, which your Lordships are considering now. The second was more prescriptive, and concerned an obligation to collect the NHS numbers of all those who were being discharged from the armed services so that we would have a database to use for prospective research. I accept that the answer provided in the Committee debate means that that second amendment was unnecessary. However, with regard to the obligation to commission prospective research, my fear is that in the years to come the quality of information that will be provided with specific reference to matters of healthcare and provision of facilities will be eroded. As a result, it will be impossible to use this important opportunity to drive the provision of resources, and so we will be neglecting those who have served our country so well. For the many decades henceforth, when they will potentially be patients suffering the consequences of having served their country, we will not be in a position to use the important opportunities provided by the inclusion of the covenant in this Bill and in the annual reporting mechanisms to Parliament to ensure we achieve the very best for them in healthcare.

Our amendment would ensure that, when directing resources and our national effort to the healthcare of active members of the armed services and veterans, we do so on the basis of appropriate, well-informed prospective research, using the high standards and methodology both of public health research and more specific medical research, to answer questions, identify opportunities and direct our funding accordingly.

[The Deputy Speaker (The Countess of Mar)]

My Lords, on a procedural matter, I remind noble Lords that with grouped amendments it is only the first speaker who moves his amendment; the remaining Members speak to their amendments and then move them when they are called by the Lord Speaker.