Strategic Defence and Security Review

Lord Kakkar Excerpts

Friday 12th November 2010 Lords Chamber

[Lord Kakkar]

My Lords, I very much welcome the opportunity of this important debate on the SDSR, and will confine my comments to paragraphs 2.B.9 to 11, which deal with Defence Medical Services. Much has been made in this debate, rightly, about the military covenant. One of the most important components of that covenant is the appropriate provision of medical care, not only in matters of conflict but back here at home and, of course, for veterans after discharge from the services.

The Defence Medical Services were reviewed and a report was published by the then Healthcare Commission in 2009. Defence Medical Services is quite a remarkable organisation. It provides care for some quarter of a million individuals through some 9,000 dedicated personnel across the three services. That review identified that the management of the injured patient—the entire journey, both in theatre and back here in the United Kingdom—was quite exemplary, that it should be widely publicised, and indeed that the NHS had much to learn from the Defence Medical Services in managing traumatised patients. When we look at the horrific injuries that are being sustained in recent conflicts and the fact that so many loyal and brave servicemen are being salvaged in theatre and are able to survive those injuries, we see how far advanced the services in theatre have become.

In paragraph 2.B.9 of the strategic defence and security review, there is a commitment to a “£20 million per year” increase in funding over that spending period. Can the Minister say whether the same increases by proportion in NHS expenditure over the past 10 years—a doubling in NHS expenditure—have been seen in the provision of finance for the Defence Military Services? What proportion of overall spending on medical services in the military does that £20 million per year increase represent? It is important to understand the baseline, because across this same period we expect to see a 1.4 per cent increase in overall spending by the NHS on the civilian population.

All good clinical practice is informed by a strong evidence base. It is very important that we ensure that funds that are available for research and development on healthcare in this country are in some way also targeted toward understanding the long-term healthcare needs of service personnel who have been severely injured. This is a very special population who would not have been salvaged in previous operations, so their long-term healthcare needs are not well understood. Will the Minister be able to pursue this with Ministers in the Department of Health and try to understand whether there is an opportunity for some of the large NHS budget for research and development to be targeted on understanding the longer-term healthcare needs of these individuals and what resources will be required to provide the very best healthcare, not only in the years but in the decades to come, because there will be very long-term healthcare needs that we do not currently fully appreciate?

It is well recognised that service personnel receive very good healthcare while in the services, but at the time of discharge the responsibility for commissioning their healthcare needs is no longer the responsibility of their individual service. They pass back into the National Health Service, where commissioning is currently through primary care trusts and in the future potentially through practice-based commissioning. This review identifies that there are going to be important and radical changes in the health service in the coming years, and I wonder whether this provides an important opportunity for us to solidify the military covenant with regard to healthcare.

Would the Minister pursue, with his right honourable friend the Secretary of State for Health, a dialogue that might focus on using the proposed new mechanisms for the commissioning of healthcare to provide opportunities for the budget for the long-term needs of the most severely injured veterans to be held by the individual services after their discharge, such that the commissioning of their long-term care needs can be informed by individuals who understand those needs? If so, we could ensure that we move towards a situation in which we are always looking to achieve the very best healthcare outcomes not only immediately, quite rightly, but in the very long-term future that is decades hence.

This is an important opportunity for us to renew the military covenant. It is also a very sensible way to utilise the opportunities that will be provided in the forthcoming health Bill that is to be presented to Parliament to ensure that commissioning for this very important group of our citizens is, once and for all, determined in a way that will help them in the long term and give them and their families the greatest confidence that as their healthcare needs change over time, so our nation will be able to deal with them appropriately.

Winston Churchill said in 1910 that the test of society was the way in which it treated its prisoners. One hundred years later, in 2010, I think it is safe to say that the test of modern British society is how we care for our military personnel and, in particular, how we provide for their long-term healthcare needs.