Armed Forces Bill

Baroness Tyler of Enfield Excerpts

Tuesday 1st March 2016 Grand Committee

[Lord Craig of Radley (CB)]

My Lords, I support the thrust of this probing amendment. Clearly there are enormous differences between trying to deal with people who are still in the services and may be suffering from mental illness and those who have become veterans and, maybe many years later, develop or show symptoms of mental illness. How does that get related to their time in service? There are a number of other practical points that I think have been very well made. I would like to put on the record that I am for this in principle but I can see that there are many difficulties. No doubt the Minister will have a chance to tell us about them.

[Baroness Tyler of Enfield (LD)]

My Lords, I add my support for Amendment 14 and apologise for my very croaky voice. I do not normally engage in these discussions, but I have a very strong interest in mental health. As other noble Lords have said, with so much focus on mental health now, it really has gone up the agenda. We have had a succession of extremely important reports, most recently the mental health task force report. Parity of esteem between mental health and physical health runs right the way through that report and all the thinking behind it. If we accept that report—certainly in the debates that I have recently taken part in on this subject, the Government have shown their strong support for the reports and the principles behind them, and that is welcome—it is absolutely vital that parity of esteem between physical and mental health is applied equally to members of our Armed Forces, who do the very difficult jobs that they are asked to take on, as it is to the rest of the civilian population. I simply add my support.

[Earl Howe]

My Lords, I hope that it will not surprise noble Lords to hear that I fully share the sense of importance that they attach to mental health and parity of esteem in the way that mental and physical health are treated by our health services. Both these amendments seek to address provision for the care and support of members of the Armed Forces who suffer from mental health conditions while in service. This is something that we take very seriously, as I will go on to explain.

Taking first the issue of compensation for those who suffer from mental health conditions, I should explain that the Armed Forces Compensation Scheme already makes awards for injuries and disorders predominantly caused by service, including mental health conditions. The scheme is tariff based and aims to make full and final awards as early as possible so that individuals can have financial security and focus on getting on with life and living. Claims can be made while in service or when an individual has left.

The AFCS tariff has nine tables of categories of injury relevant to military service, and these include mental health disorders. While the scheme does have time limits for claims, there is also a provision for the delayed onset of mental disorders. The Ministry of Defence recognises that owing to stigma and perceived impact on career, people may delay seeking help. The practical effect of this is that if a person who left the Armed Forces some time ago is diagnosed with a mental disorder as a result of his or her service and makes a claim under the AFCS, a compensation award will be paid as soon as the claim is accepted.

Noble Lords may recall that, having been asked to review the AFCS, including the associated tariffs, the noble and gallant Lord, Lord Boyce, made his recommendations in February 2010. As a result, the Ministry of Defence increased the maximum lump sum award for mental illness from £48,875 to £140,000. This was to accurately reflect the impact of the most serious mental health conditions. In addition to the lump sum, those with the most serious conditions with likely adverse functional effects on civilian employability receive a tax-free guaranteed income payment for life on discharge from the services or from the date on which the claim is accepted. A lump sum of £140,000 attracts a GIP based on 75% of military salary with enhancements for service length, age, rank and lost promotions.

Another of the noble and gallant Lord’s recommendations led to the Independent Medical Expert Group, a non-departmental public body, being established. It advises Ministers on the scientific and medical aspects of the scheme. The noble and gallant Lord, Lord Boyce, identified mental health as an area requiring further investigation. The subsequent IMEG review involved a literature search and discussions with civilian and military experts, as well as with veterans’ organisations. The findings were published in its second report on 17 May 2013. The conclusions and recommendations on diagnosis, causation, assessment of disorder severity and the use of interim awards were accepted and subsequently incorporated into the scheme.

The second amendment in this group would create a specific obligation on the Government to have particular regard in their annual report on the covenant to,

“parity of esteem between mental and physical healthcare”.

As I have said previously, the Government are committed to meeting the healthcare needs of the Armed Forces community. For this reason, the Armed Forces Act 2011 already requires the Secretary of State to include in his annual Armed Forces covenant report to Parliament the effects of membership, or former membership, of the Armed Forces on service people in the field of healthcare under the covenant.

I was grateful for the remarks of the noble Lord, Lord Empey, and I agree with his general point about managing expectations. However, I agree with him only up to a point in this context because I think that the healthcare which we provide to our armed services personnel, both at home and when deployed on operations, is now truly world-class. Last year the principles of the covenant were enshrined into the NHS Constitution for England. That gives a commitment to ensuring that those in the Armed Forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area where they reside. Indeed, we have made several improvements, including: the provision of some £6 million a year to support the provision of enhanced prosthetic devices and services for veterans who have lost a limb as a result of service; the launch of the hearWELL programme to look at hearing loss among the service community; and the allocation of £10 million to address service-related hearing issues among veterans. I know that these are related to physical injuries; nevertheless, I hope that they show the appropriate intent.

With increasing awareness of the issues, we have taken steps to meet the mental health needs of our Armed Forces community. On this specifically, we now have a network of 16 departments of community mental health across the UK, providing out-patient care to the service community. When in-patient care is necessary, it is provided in eight dedicated psychiatric units. Additionally, the Armed Forces covenant gives a commitment that veterans should be able to access mental health professionals who have an understanding of Armed Forces culture, while NHS England is currently completing an audit of veterans mental services, put in place following the Fighting Fit report by my honourable friend Dr Andrew Murrison MP in 2010.

I can therefore assure the noble Baroness that the Government are committed to meeting the health needs of the service community, that we will continue to report on the provision of healthcare in the Armed Forces covenant annual report, and that our work to address mental health needs will be an integral part of that report. However, the principles of the covenant are to ensure that the Armed Forces community are treated fairly in comparison to the civilian population. Parity of esteem is there to ensure that all health services treat mental health with the same importance as physical health, and it applies to everyone accessing NHS services, not just the Armed Forces community. For this reason, it does not need to be legislated for under the covenant.

Given our clear commitment to support those who suffer from mental health conditions and the tangible steps we are taking to do so, I ask that the noble Lord and the noble Baroness withdraw or do not move their amendments—hopefully, reassured.