Charities: Veterans Care Sector

Tom Tugendhat Excerpts

Thursday 24th March 2016 Commons Chamber

[Johnny Mercer]

Yes, it comes back to what I said about these groups, which, often out of a sense of duty, or as a result of identifying a gap in their local area, just step up and do it, for no other reason than to deliver care to our servicemen and women. We are very lucky to have that as a country.

Over the years, matched by this gratitude in many of us, there grew an increasing bewilderment at the MOD’s reticence to genuinely commit to the care of our men and women when they return home. I say “genuinely commit” carefully. Efforts have been made—of that there can be no doubt, but the truth is that we must measure the success of those efforts not simply by what we have put into them, but by the experience of those going through the system, readjusting to life after service, or finding a suitable quality of care for complex injuries suffered on the battlefield.

Now is the time to do this. In 2014, the UK ended combat operations in Afghanistan. That ended over a decade of two very intense and very public conflicts, which inspired the great British public to donate. Those days are now gone and we will not see them return anytime soon, such is the global political appetite for large-scale interventions of that type. This end of public operations and subsequent awareness of it, is conversely matched by a huge increase in demand for veterans services across the United Kingdom. In just the past year, referrals to Combat Stress went up 28%. The hidden wounds programme run by Help for Heroes has seen 500 referrals from a standing start a year ago. Regrettably, there is little evidence of a Government Department attempting to gauge the true scale of the needs of the veteran, serving and military family community as a whole. Nor is there evidence that the Government are trying to track progress against that need. How do we, as a nation, know, year on year, whether we are doing a good job or a bad one in this area? There were no universal measures of lives rebuilt or lives yet to be rebuilt that accommodate the good work that is already being done by the Ministry of Defence, the NHS, the Department for Work and Pensions, charities, British businesses and volunteers. Without strategic and structured measures implemented in a timely manner, therefore, a lack of action now will ultimately cost the nation more in the future in terms of the healthcare we offer to our veterans and their families and the finance required to maintain a fundamentally unsustainable model.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

I congratulate my hon. Friend on highlighting an important national resource that may be going to waste. Today in this House we said goodbye to Principal Doorkeeper Milburn Talbot, who served in the Royal Navy and served this House with great distinction. There are many, many other veterans who transition very capably. For those who need a little extra help, is this not an investment in the whole country, not just in veterans?

[Johnny Mercer]

Absolutely. I could not agree more with my hon. Friend. I shall not stray from the lane of this debate, but across the public service we have a special asset in individuals who commit themselves to public service and sacrifice their family life for the nation. If we do not look after them properly, that will eventually go. We need to make sure we get that right.

--- Later in debate ---

[Johnny Mercer]

I could not agree more that local and national Government should be involved in delivering that. We need to be careful about the involvement of local elected officials in veterans care. There is nothing political about veterans. It is a national issue and one that I wrestle with in Plymouth. We need to make sure that we stay in the lane of delivering a service for veterans, and the local professional side of the council is well placed to do that.

To sum up, the individuals who are suffering most from the changing tides in the debate are the blokes. Too many are falling short. Too many struggle to access care. Every weekend another case is reported in the Sunday papers. While the national debate moves on to Europe, national security, the deficit and other important issues, those soldiers’ lives stand still, awaiting an intervention by somebody who cares. They are the lucky ones: their stories got in the paper, and they inevitably get helped by that knight in shining armour—the Great British public. However, for every one of them, there are many who do not get helped.

What is it really like for someone to be two or three years out of the Army—holding down a civilian job and providing for their family—when they start hitting rougher waters, and the thoughts just will not leave them alone? Where do they go? To whom do they turn? Do they self-refer to a charity and hope for the best? How do they know that it provides care that works? How do they know that it is professional? What happens if the course of treatment it provides does not work? Who will help them through the process? Who really cares?

The pre-Christmas report by the Ministry of Defence on the armed forces covenant made wide reference to what is going into the arena of military support, and that is to be commended. However, the report fails to provide any meaningful statistical reference to the single most important measure of success: what our military community got out of that support. The single biggest shift in mindset that must be achieved is about reconfiguring services around users.

There are problems: waiting times are simply too long; there are distinct regional variations in the services available; there is a huge challenge to veterans navigating a complex set of unclear treatment pathways; and there is a lack of regulation of the quality and efficacy of the treatments being provided by some, with some of the more unscrupulous outfits still receiving Government finance. The truth is that our veterans today use an array of treatments, which vary wildly in effectiveness, professionalism, access points and delivery, and that is especially so with mental healthcare.

I hope I have outlined why this debate is so important and so timely, and why it is tough for those of us who have been through these wars to let go of this issue, for which I am afraid I make no apology. I therefore want to add to the debate—to offer a solution to the Government so that we can get this issue right. I want the Prime Minister, who has always understood this issue, to accept that getting it right in this Parliament is part of his legacy, and I know that he does accept that. Chiefly, however, I want the MOD to really understand the challenge we face in getting this issue right now, and I make that appeal to the MOD today. There will always be better times to reform; there will always be opportunities to duck difficult issues because of the lack of a 100% solution; and there will always be those who have lost focus on who is at the centre of these services—the men and women to whom we owe so much.

How do we fix this? Users should be able to choose the service they wish, but they should be provided with unbiased assistance and helped to navigate their way through a highly complex array of services. We must be realistic in our reform. Currently, many of these services are not evidence-based, and some appear, unhelpfully, to compete for business, while a few are even unsafe or unethical in their approach.

If we are to produce the first-class service that the military service community and, indeed, the nation—having committed so much of its own money—deserve, wide-reaching but fair reform will be needed. That reform must be focused exclusively on the key principles of the following four streams: evidence-based treatment; a cultural shift, with the aim of creating not good veterans, but good citizens who have served; a service configured singularly around the service user, which will include service families; and clear and accessible care pathways.

It is worth noting at this stage that a sustainable model of future veterans care and support in this country cannot simply be modelled on how other nations have done this. We face a similar but subtler challenge in the UK, given our cultural and societal perceptions of serving and retired military service personnel and their families. Let me repeat that key point: veterans care must be singularly and exclusively configured around the needs of the user, with ease of access and dedicated casework management, rather than just signposting, at its core.

What do those four points look like in a little more detail? The future actually looks very similar to the present, but with key organisational, control and attitude changes. We are not looking at a huge demand or fiscal commitment to get this right. The Government must step up and take command of the national veterans challenge. Ultimately, it is the nation’s responsibility to care for our servicemen and women, and that must be realised.

The Government’s role in all this would be clear. They would provide access to service records. They would ensure there was a uniform access process across all providers, taking responsibility for a single point of contact. They would need independently to control the impartial case management of individuals, which would be focused entirely around individuals and their specific needs, which must be met. The Government must commit to providing interoperable case-management software and access to, or information about, NHS and other care providers’ data. Chiefly, however, they must accept some sort of legal responsibility for ensuring that there is that care pathway. The actual delivery of services would remain with the current providers across the charitable and NHS sectors.

What sort of reform is needed in the service charity sector? With our young men and women potentially at vulnerable stages in their lives, approaching almost anyone who can claim to provide a service, there can be no doubt that we need some sort of regulation—with a small “r”—of our service providers, which is something only the Government can do. It is not good enough to ask the veteran to shop around and bounce from charity to charity without resolving his issues. Too much has already gone into the system: too much time has been invested and too many cases have been exposed to allow that to continue.

I and everyone else in the sector are clear: nobody can tell a charity what to do—that is not what these reforms are about—but it would be naive to suggest that the entire sector is optimised at present to deliver care for veterans, which is a nation’s responsibility. With more than 2,500 military charities and funds, it is not realistic to suggest that there is no duplication, waste, bad practice or financial misdemeanours.

[Tom Tugendhat]

My hon. Friend is, rightly, speaking passionately about military charities. I know I can speak today without fear of opposition about the fact that many charities have tried to come together at various points. Indeed, when I served in the Ministry of Defence and worked under General Richards, the then Chief of the Defence Staff, efforts were made to bring them together. There is, however, opposition to streamlining in many areas when so many different charities seek to fulfil a role in our society.

[Johnny Mercer]

Absolutely. This is the nub of the challenge when it comes to military charities and funds: how do we go about getting everyone to pull in the same direction? Some service providers need to consider whether they are exclusively configured around the user for whom they were originally set up to serve. Only a robust, dedicated and strong leadership team is capable of having that conversation, but I hold out hope that, with a vision of single-minded delivery in an increasingly challenging environment, charities can come together to identify their individual but equally special roles in the veterans care pathway and work together better as part of a greater machine and a greater cause than just their own. That requires leadership, including from the Government, but that will not happen unless we make a conscious move to provide it.

In my view, all groups that wish to provide a veterans’ service of any kind and raise money for anything related to veterans care, be it palliative or holistic, should be required by law to be part of an approved group, perhaps along the lines of Cobseo—the Confederation of Service Charities—but with teeth. In order to gain access to that group, service providers should adhere to a basic set of agreed standards on their suitability. Those standards could include showing a clear practice of evidence-based treatment, outcomes, a complaints system, independent financial oversight by a board of trustees, and refusal to accept individual cases that do not come through a single and agreed point of contact.

I am going to start wrapping up, because I want to give the Minister time to reply. I hope the House forgives me for going on for longer than I wanted to, but I wanted to take as many interventions as possible.

In summary, now is the time to get this right. The truth is that other allies are treating their veterans better than we are, and that cannot be right. We have this ever-closing window of opportunity. We owe it to this current warrior generation, who, like so many before us, gave the best years of our lives willingly in service of the nation, hoping that we would not be disadvantaged for doing so. The Conservative Government can deliver that, but current structures need to be reconfigured. A department for veterans affairs would be a huge step forward, but it must be given the cost-departmental authority required to deliver those changes. Veterans care is a multi-agency operation within Government. At the very least, the veterans Minister must have that cross-departmental authority.

Finally, I pay tribute to the veterans Minister, with whom I have worked closely on this area. He has achieved much already and I am sure that he will continue to do so throughout this Parliament, but the truth is that he has no cross-departmental mandate or resource to empower him, or a clearly identified budget. In the United States, the Veterans Administration budget for 2015 was more than £160 billion.

This Government have done more in this cause than any previous Government. That is unarguable. We have made real progress, but there is some way to go—there really is. This Prime Minister presents us with an opportunity to get this right for my generation. Thank you, Mr Speaker, for the opportunity to bring this issue before the House.