Armed Forces: Post-service Welfare

Lord Kakkar Excerpts

Thursday 27th January 2011 Lords Chamber

[Lord Kakkar]

My Lords, I, too, thank the noble Lord, Lord King of Bridgwater, for having secured this important debate. I reiterate the important points that he made about the success that is currently achieved in the acute management of injured service personnel in the battlefield and their successful early rehabilitation, which has resulted in saving these complex-injured casualties.

I shall focus on two issues. The first is how we should go about commissioning the longer-term care of injured service personnel once they are discharged from the services and the second is how we can organise long-term prospective research cohorts for research studies to allow us to understand the long-term physical and mental health needs of these veterans.

Veterans leaving the services represent a broad spectrum of complexity in their healthcare needs, from the complex-injured multiple amputee, where some of the early needs after discharge are very obvious, to those with more subtle injuries and the very large number of veterans who are apparently healthy at the time that they are discharged from the services but who are at risk of deteriorating health in the years and decades that follow their discharge.

The provision of medical care for veterans after discharge is, at best, haphazard. The majority of NHS civilian personnel have no military experience. As the noble Lord identified, some NHS personnel have military experience, but they are quite few. Therefore, the majority of doctors and clinical staff who will take responsibility for the care of discharged veterans will have little insight into the experience of that patient population. Under those circumstances, they may not always be in the best position to understand these specific patients or to provide the care that is necessary.

There are also important concerns about the transfer of medical information from Defence Medical Services to the NHS. This is a serious problem. At the moment, a final medical examination occurs prior to discharge and an FMed 133 form, which provides, at best, rudimentary medical information, is completed to provide civilian medical practitioners in the NHS with any pertinent medical history during service in the armed services. At best, this information is rudimentary and very frequently it does not reach the NHS general practitioner. In these circumstances, early arrangements for medical care are going to be poor and, importantly, as time progresses, whatever information was available that might be pertinent to the long-term healthcare needs will be lost. Service personnel may not be able to recall all that information, putting themselves at a great disadvantage in their longer-term medical care. Is any work taking place on trying to understand how better the transfer of medical information can occur between Defence Medical Services and the NHS, with particular reference to the establishment of the electronic patient record to transfer as much information as possible to ensure that the medium-term and long-term care of veterans after discharge from the services can be best secured?

There is an important opportunity to improve the training for civilian NHS staff on some of the information skills and knowledge that they will need to deal with quite important numbers of veterans who will present with physical or mental health needs. At the moment, some 24,000 military personnel leave the services every year, and 10,000 of them have recent combat experience. There are about 32,000 GPs, which means that on average a general practitioner will see one new veteran every 16 months. GPs are not going to have a large volume of patients, so the training and experience that they need to develop have to be specifically tailored.

I turn to how we should commission services in future. The Health and Social Care Bill was presented last week and will begin its passage through the other place shortly. It recognises the need to change all commissioning services, with greater emphasis on primary care commissioning of the majority of services by general practitioners. It also recognises that there are certain patient populations with very complex needs, for which there should be more central commissioning of services—so-called specialist commissioning. Does the Minister agree that complex-injured veterans discharged from the services represent a population of patients with complex, long-term, ongoing healthcare needs that could be considered to fall into a specialist commissioning group where either the NHS board commissions services specifically for this population of veterans, based on advice that it receives from Defence Medical Services, or commissioning responsibility is transferred to Defence Medical Services so that the services can be provided in centres that have the opportunity to provide all the specialist requirements in a holistic fashion to achieve the best possible clinical outcomes?

I believe that there is also a need to initiate a programme of research to address four important questions with regard to the health of veterans. The first is to look at what the long-term, ongoing physical and mental health needs are. As has been identified in this debate, our ability to provide acute medical care ensures that many more service personnel are surviving horrific injuries, but we have little knowledge about what the long-term needs will be in the years and decades hence. This research needs to be conducted on a prospective basis. Secondly, we need to understand how to provide rehabilitation to achieve the best healthcare outcomes for these personnel. Thirdly, we need to understand how to adopt new technology and innovation that will be available in the years to come to achieve the best quality of life. Fourthly, we need to be certain that we can assess what resources need to be provided over time to ensure that some of the potentially most vulnerable of our citizens, who are those to whom we owe the greatest debt, have healthcare services provided for them that they justifiably have a right to expect.