Armed Forces: Post-service Welfare

Lord Astor of Hever Excerpts

Thursday 27th January 2011 Lords Chamber

[The Parliamentary Under-Secretary of State, Ministry of Defence (Lord Astor of Hever)]

My Lords, we have had a very good debate and I thank my noble friend Lord King of Bridgwater for raising the important subject of the physical and mental rehabilitation of military veterans.

I always listen to and greatly value my noble friend’s informed views on all aspects of defence policy. While he was Northern Ireland Secretary and then Defence Secretary, our Armed Forces were deployed in Northern Ireland and the Gulf where, as my noble friend said, combat operations to liberate Kuwait from occupation by the forces of Saddam Hussein began 20 years ago last week. Then, as today in Afghanistan, we witnessed the professionalism, dedication and courage of our servicemen and women. We should be justifiably proud of what they do on our behalf.

During these past two decades, our Armed Forces have been deployed in the most demanding areas of conflict. They have always risen to the challenges they faced, and done their duty unflinchingly. For those who have made the ultimate sacrifice, our condolences and sympathies are with those families and friends left behind. However, as my noble friends Lord King and Lord Glenarthur, and the noble Lord, Lord Kakkar, said, injuries that were once fatal can now be survived, which is testament to the skill of our medical services. Indeed, the expertise honed on the battlefield is now subject to research at Queen Elizabeth Hospital Birmingham to determine how best that expertise can be used in the healthcare of civilian society. Just last week, we opened a brand new, ground-breaking surgical reconstruction and microbiology research centre in Birmingham.

However, today’s soldiers, sailors, airmen and women will one day become veterans. They will look at how the previous generation is being cared for and supported. If we are found to be wanting, it will be a question not only of moral failure, but of paying the price in recruitment and retention in our future Armed Forces. For some personnel who have been injured, a lifetime of care and treatment will be needed. As the noble and gallant Lord, Lord Craig, pointed out, as a nation and a Government we have a moral responsibility to ensure that such injured personnel receive the care they deserve. As a Government we are committed to ensuring that they do. I reassure the noble Viscount, Lord Slim, that we will be honouring the covenant between the Armed Forces and the nation.

The Government share the concerns that have been expressed regarding the mental well-being of our former service personnel. We acknowledge that it can take many years for a psychological problem to manifest itself. In the most serious cases—and these are the minority—experiences on operations can result in post-traumatic stress disorder. We continue to work with Combat Stress in the fight against that most debilitating condition.

For other veterans, their mental health needs will continue to be met by the National Health Service, which should remain the main provider of healthcare for former service personnel. The NHS is working hard to develop the best models of care and support for the few with mental health problems. The MoD has contributed £500,000 towards six community-based NHS mental health pilot schemes for veterans in Stafford, Camden and Islington, Cardiff, Bishop Auckland, Plymouth and Edinburgh. They aim to make it easier for former service personnel to access help. I hope that that addresses the question asked by the noble Lord, Lord Kakkar.

On 20 December, my right honourable friend, the Minister for Defence Personnel, Welfare and Veterans, announced the publication of an independent evaluation into these pilot schemes, conducted by the University of Sheffield's Centre for Psychological Services Research. The report identifies key components of successful services and makes a number of recommendations about the future planning of NHS mental healthcare services for veterans. I would also like to highlight the Medical Assessment Programme at St Thomas's Hospital, which continues to provide specialist mental health assessment of former service men and women with mental health problems who have undertaken operational service since 1982.

The coalition agreement set out our intention to provide extra support for former members of the Armed Forces with mental health needs, including PTSD. As part of that undertaking, Dr Andrew Murrison MP, who served as a medical doctor in the Royal Navy, was asked by the Prime Minister to conduct a study into the health of both serving and ex-service personnel to see what more can be done to assess and meet these needs. In the light of that work, on 6 October, the Defence Secretary announced that there would be funding for a 24-hour helpline for veterans and for 30 extra mental health nurses in mental health trusts. To answer the question asked by the noble Baroness, Lady Warwick, my noble friend Lord Sheikh and the noble Lord, Lord Tunnicliffe, we will continue to work closely with the Department of Health and others to work towards implementing all Dr Murrison's recommendations, as well as those produced in the evaluation of the pilot schemes, to consider how they can be taken forward to provide the best possible mental healthcare for former service personnel.

In terms of general welfare provision, there is a range of services that former Armed Forces personnel may need to call on during the course of their lives, provided by many different agencies. I assure my noble friend Lord Addington that these will be constantly reviewed. Some have argued that it would be more cost effective to provide services for veterans if these were brought together in a single administration. We do not agree. Where a service is already provided by one department for the majority of the population, there needs to be a very strong case to set up a separate organisation to do the same thing for any special interest group—even one held in such high regard as veterans who have served the nation so well. Former service personnel live among us; they are not separate from the community that they have served to protect. For the most part, their needs—whether healthcare, housing or benefits—are the same as those of their fellow citizens.

We must also recognise that some of the support for veterans comes not from government, but from the voluntary and community sector. I mentioned Combat Stress earlier and the noble Baroness, Lady O’Loan, in a well-researched speech, mentioned Help for Heroes. Sometimes, the service charities are described as filling in for what the Government should be doing. That does them a great disservice. It is not the place of the state to do everything. All of us have social responsibilities. The service charities are one of the best examples of the big society in action and I pay tribute to the vital role that they play in our national life.

The noble Lord, Lord Ramsbotham, and the noble Viscount, Lord Slim, made important points about the position of the Minister for Veterans. Several formulae have been suggested over the years to strengthen the focus on veterans' issues. They range from the full-blown, US-style, Veterans Department, to more modest changes to government machinery. Some give a greater role to the Ministry of Defence, others look to central government departments to take on that responsibility. The creation of a Minister for Veterans was partly a response to that desire. The MoD's responsibility is finite. It can act as an advocate, or as an interlocutor, for ex-service personnel. But we do not want to tell the Department of Health and its devolved equivalents how best to deliver healthcare. Rather we want to see ex-service men and women treated correctly across government.

I want to mention briefly the role of the Medical Assessment Programme at St Thomas's Hospital. This is part of the MoD and provides free and confidential advice on a wide range of issues. This can be provided in the home of a veteran, or by telephone, and is given by trained welfare managers. The Veterans Welfare service undertakes some 12,000 visits to former service personnel each year and 95 per cent declare themselves to be very satisfied. The welfare managers work closely with service charities and other voluntary organisations, local authorities and the Department for Work and Pensions.

I will try to answer as many questions as possible. If I do not answer them all, I assure noble Lords that I will write. My noble friend Lord King mentioned a possible figure of 180,000 veterans of Iraq and Afghanistan campaigns. That is an old figure. The most recent figure, as at April 2010, is 236,000 service personnel who have served in Iraq, Afghanistan or both at least once.

The noble Baroness, Lady Warwick, paid tribute to the Armed Forces parliamentary scheme and I also admire enormously the excellent work that Sir Neil Thorne and that organisation carries out. The noble Baroness and my noble friend Lord Addington made some important points about the reorganisation of the National Health Service. We continue to work closely with the NHS. As for the transfer of medical records from the MoD to the NHS, a summary of each medical history while in the Armed Forces, including the results of the discharge medical, is recorded and given to the individual to pass on to their GP. The form also includes information on how the GP can gain access to the individual’s complete service medical records if required. We are working to simplify the process and, where it is possible to do so, to enable medical records to be available to GPs electronically.

My noble friend Lord Glenarthur made some very important points about medical reserves. He raised concerns about the cumulative effects of continual exposure to really stressful situations. We are very alert to this, and the cutting-edge medical care that our service men and women receive in the front line is constantly being upgraded.

To answer my noble friend’s question, in November 2006 the MoD launched a new initiative, the Reserves Mental Health Programme. Under the programme, we liaise with the individual’s GP and offer a mental health assessment. If they are diagnosed to have a combat-related condition, we offer the out-patient treatment via one of the MoD’s 15 departments of community and mental health. The reserve forces continue to make a vital contribution to the ongoing success of military operations. In return, we have a duty of care to them, and this programme is an important enhancement of the medical services that we provide.

My noble friend Lord King asked about the review of the AFCS every five years. At this time we do not feel it necessary to conduct further reviews, but future changes will be considered by the Central Advisory Committee on Pensions and Compensation if the need arises.

I opened my speech by paying tribute to our Armed Forces. We ask them to do things on our behalf, and they do that willingly. We have a responsibility, not only as a Government but as a nation, to look after them. I hope that, by our explaining the Government’s position on the important subjects of welfare and physical and mental care, noble Lords will accept that we take this responsibility very seriously.