Armed Forces Bill

Lord Kakkar Excerpts

Wednesday 6th July 2011 Lords Chamber

[Lord Kakkar]

My Lords, I shall confine my comments to health. In so doing, I welcome the inclusion of the Armed Forces covenant provision in Clause 2. The provision of healthcare services for those serving actively is well recognised as being of a very high quality. Review of battle and in-theatre services by the Healthcare Commission identified them as delivering excellent clinical outcomes and very high quality care. We recognise that services for those who have been wounded and returned to the United Kingdom are also of the very highest quality, including the rehabilitation services that are vital in ensuring that the best clinical outcomes are achieved.

However, there are important concerns about how information will be gathered to enable the Secretary of State for Defence to meet his obligation to make an annual report to Parliament on the health consequences of membership of the Armed Forces. While personnel are actively participating and continue to serve, it is possible to collect information about their access to health services—be it services provided solely by Defence Medical Services or services that need to be provided by the broader and wider National Health Service. It is equally possible to track the clinical outcomes for these service personnel, in terms of whether they are developing physical or mental health problems associated with their service. It is also possible to determine whether one is achieving good clinical outcomes and whether, indeed, those who have healthcare problems are achieving a good experience in the delivery of the services required.

After discharge from the services, however, there are more important concerns about how we track veterans’ health, and how we track their access to services. The problems relate very much to the fact that many who have served will, fortunately, have no obvious healthcare problems at time of discharge. However, in the years and decades following their service they may start to develop healthcare problems directly related to their period of active service.

If mechanisms are not in place to track these individuals, it will be impossible to understand the health implications of membership of one of the armed services. Therefore, any report that a Secretary of State makes to Parliament would be inaccurate and potentially miss important information. It may have to depend purely on anecdotal reports of the description of mental health problems or physical health problems, and from that draw conclusions that are erroneous with regard to the broad burden of disease associated with a particular period of service or a particular service in a certain environment.

It is therefore important that, if we are to accurately report the consequences of membership of the armed services with regard to health outcomes, we set up prospective research programmes. These programmes should track individuals from the time of discharge from the services back into civilian life, and ask specific health questions with regard to mental health status, physical health status, access to healthcare facilities, clinical outcomes and experience of healthcare services, if we are to have accurate reporting that will inform the Secretary of State’s report and his or her obligation with regard to the armed services covenant, when it deals with the question of health.

A second area where there is considerable concern relates specifically to the commissioning, in the long term, of healthcare services for complex wounded service personnel. As the noble Lord, Lord Empey, said, treatment in theatre is now so successful that many service personnel are surviving injuries and wounding in a way that would not normally have been expected. This is, of course, excellent progress. However, they will be discharged with complex injuries and wounding that will necessitate review of their health status for many decades to come. Under these circumstances, there will inevitably be advances in healthcare and innovation that should be provided to these individuals to ensure that they continue to achieve the best possible healthcare outcomes. It is not reasonable for us to expect that individual general practitioners will be able to do this. I very strongly believe that this group of individuals, the most severely wounded, need to be considered a group worthy of specialist commissioning of their services—either by an NHS commissioning board or by Defence Medical Services—so that the expertise that will inform these clinical decisions can be informed through an appropriate clinical evidence base, searching the world for advances and developments that 20 or 30 years from now could improve the livelihood and the health experience of those who have done so much for our country.

It is equally important that, in making an annual report to Parliament, the Secretary of State is properly informed about the commissioning arrangements, and the success in commissioning appropriate services and achieving the best clinical outcomes for those veterans. I hope that the Bill provides an opportunity for these issues to be reflected in more detail. I also hope that the forthcoming Health and Social Care Bill might possibly be used as an opportunity to ensure that the commissioning arrangements for this particular group of veterans is more clearly defined, and that, in addition, prospective evaluation and research programmes are established to understand their longer-term healthcare needs and the resources that need to be provided to ensure the best clinical outcomes.