Armed Forces

Lord Kakkar Excerpts

Monday 23rd June 2014 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking the Minister for his thoughtful introduction to this debate and in congratulating the noble and gallant Lord, Lord Richards, on his magnificent maiden speech.

I will focus on an issue that the Minister raised in his introduction with regard to the longer-term approach to the provision of healthcare services and the management of veterans with complex wounds. It is well recognised that Defence Medical Services has, through the provision of quite remarkable services in theatre, transformed the outlook for our service personnel who sustain injury. These services are considered second to none in the world and ensure that the immediate care provided to wounded service personnel has improved the rates of survival from some of the most horrific and complex injuries that very recently would not have been survivable.

Coupled with that, the provision of care in such institutions as the facilities at Selly Oak in Birmingham have ensured that the intermediate care provided after that immediate recovery and rescue phase is also of the very highest standard. What has been learnt as a result of the development and provision of these services to our Armed Forces has transformed the way that we have started to look at the management of civilian trauma.

Beyond that, rehabilitation provided at institutions such as Headley Court has also had a transformational impact. The quality of those services, the thoughtful way in which they are delivered and the holistic approach to the management of those brave service personnel who have sustained the most horrific injuries is again recognised throughout the world to be of the very highest standard. It is also recognised by those service personnel who have to avail themselves of those facilities.

However, there have been substantial concerns raised on repeated occasions about what will happen to those complex-wounded personnel once they have left the services and returned to civilian life. It is well recognised that care under those circumstances must return to the National Health Service, ultimately supervised by a general practitioner. In his opening remarks to this debate, the Minister spoke about some of the changes that have recently been provided for the longer-term management of these particular veterans. These are warmly welcomed.

I would like to explore a little further the actual disposition of those services. The report published by Dr Andrew Murrison from the other place laid out a framework for the provision of these services, specifically focusing on two important areas. The first was the provision of disablement services centres so that veterans injured as a result of their service could depend on the provision of services for the management of their amputation and prosthetics in the way that they would have expected to receive while serving in the Armed Forces.

The Minister mentioned 24 centres of excellence. How do those equate to the nine centres originally described by Dr Murrison in his report? How are both the quality of care and the outcomes achieved by those centres currently being assessed? What ongoing assessment will there be to ensure that these centres deliver what was expected of them—the provision of services equivalent to those that personnel had a right to and were receiving as part of their active service while members of the Armed Forces?

The second element was specialised commissioning, for example through the National Health Service in England. I understand that that specialist commissioning function is provided by a Veterans’ Prosthetics Panel, which receives applications from veterans who have been complex-wounded and discharged from the services, so that they can apply for the necessary funding for advanced prosthetics, which are made with remarkable technology—bionics and robotics with complex software—and can have a transformational impact on their quality of life.

I understand that the funding for the Veterans’ Prosthetics Panel for 2012-14 was set at about £11 million and was guaranteed for that two-year period. What arrangements have been made to continue the funding beyond 2014? What assessment has been made of whether that funding level is sufficient for the needs of those veterans who may have to avail themselves of the services of the panel? If, after analysis, the funding level is considered not to be of sufficient magnitude, what arrangements will be made to increase the funding, bearing in mind that the NHS itself is facing substantial financial constraint?

Beyond the provision of those important facilities, on which Her Majesty’s Government should be congratulated, there is ongoing concern about whether there is sufficient research effort to inform the longer-term healthcare needs of those veterans—who, as I said, have been wounded in horrific ways that would previously not have been survivable. Little is known about their holistic healthcare needs over the long term—not only years but decades hence—because previously such individuals would not have survived.

All good medical practice is informed by a strong research base. What if any funding from the National Institute for Health Research is directed towards that group of individuals? How is that research organised? To repeat a question that has been asked on previous occasions, are active efforts made at the time of discharge from the services—for instance, using the NHS number—to ensure that that cohort of complex-wounded individuals continues to be followed as a group, so that their clinical outcomes can be used to inform their own ongoing healthcare needs?

Beyond all that Defence Medical Services is able to provide, including the excellent facilities at Headley Court, there has been recent debate about whether further facilities can be created for rehabilitation. We heard from the noble Lord, Lord Holmes of Richmond, about the important work with regard to rehabilitation centres across the country. Another proposal has been to bring together a defence and national rehabilitation centre at Stanford Hall. Where do those proposals stand and what progress has been made? The proposals would bring together a defence and a national rehabilitation facility, the two informing each other and therefore driving up standards of practice and clinical outcomes not only for those discharged from the armed services who require further rehabilitation but for civilians injured in civilian life.

We have heard in this debate about the important obligation that our nation has to its Armed Forces, the covenant and therefore the ongoing responsibility we have to veterans. The provision of healthcare not only while in service but beyond for those who have sacrificed so much is a vital responsibility of government.

In case I did not do so at the beginning, I should remind noble Lords of my interest in this area as a commissioner of the Royal Hospital in Chelsea and a trustee and governor of the King Edward VII Hospital.