In 1997 the Government announced a foreign policy-led strategic defence review (SDR) to reassess Britain’s security interests and defence needs and consider how the roles, missions and capabilities of our armed forces should be adjusted to meet the new strategic realities.
The resulting report, in July 1998, placed a great emphasis on the deployability of our forces, including the requirement to ensure that our armed forces are properly supported in the field—a key aspect of which is the provision of timely, modern and effective medical support.
A medical quinquennial review (MQR) which reported to Parliament in April 2002 developed detailed proposals for the effective delivery of deployable operational medical capability and appropriate, timely health care to maximise the availability of service personnel for deployment.
The MQR identified a need for a much stronger focus on delivery of key outputs, with responsibilities for both central and single service authorities. It recommended new managerial tools (including an annual DMS service delivery plan and a DMS management board) to achieve this.
The MQR also advocated a further strengthening of the partnership between the DMS and the NHS. This was achieved through the MOD and Department of Health signing a formal concordat (in September 2002) at ministerial level and, at official level, the establishment of a MOD/NHS partnership board to oversee effective co-operation.
The MQR also rationalised the existing medical agencies as follows:
An expanded Defence Medical Training Organisation (DMTO), renamed the Defence Medical Education and Training Agency (DMETA), became responsible for all the training and training-related activities of the Defence Secondary Care Agency (DSCA);
Responsibility for the provision of secondary health care to service personnel in the UK, previously handled by DSCA, would now be handled within DMSD;
The Medical Supplies Agency was transferred out of the DMS to become part of the Defence Logistics Organisation.
In terms of improvements to DMS treatment facilities, the DMS no longer run separate military hospitals. The decision was taken to close them because they no longer had sufficient patient volume and case mix to develop and maintain the skills of our medical personnel to the appropriate operational and NHS standards. We created Ministry of Defence hospital units located within NHS hospitals at Birmingham, Derriford, Frimley Park, Northallerton/Middlesbrough, Peterborough and Portsmouth. They provide the most effective way of giving the UK armed forces patients access to the latest advances in medical treatment and the major recent investments in NHS facilities. The integration of service personnel throughout the NHS trust also enables DMS staff to take advantage of NHS expertise and to maintain their own clinical skills in an active, up-to-date environment.
We have also introduced regional rehabilitation units (RRUs). A total of 12 RRUs have been established within the UK, with similar facilities in Germany and Cyprus, to provide assessment and treatment of musculo-skeletal disorders. They were introduced to alleviate pressure on the Defence Medical Rehabilitation Centre at Headley Court and to provide more accessible regionally-based facilities. Patients are referred from unit medical facilities, where the simpler injuries would be diagnosed and treated. The benefit is that patients are assessed and treated in a timely fashion and receive the optimal high quality treatment and rehabilitation to maximise functional outcome and return to operational fitness when this is clinically possible. Specifically, the RRU system leads to reduced overall patient waiting times, earlier access to diagnosis and therefore quicker treatment and patient monitoring throughout the rehabilitation programme on an individual basis by physiotherapists and remedial instructors at the RRU. For example, most patients who undergo a simple knee arthroscopic procedure are currently being returned fit for task within four months, and patients who undergo an anterior cruciate ligament repair procedure are being returned fit for task in about seven months.
Additionally, to improve our patient care, in 2005 the MOD set up a Defence Medical Rehabilitation Evaluation Co-ordination Cell to support personnel injured on operations. This improves the co-ordination of care from the point of entry into UK until the individual is returned to full fitness or is medically discharged from the service. It also improves the provision of a clinical assessment and decisions on the most appropriate care from a consultant-led multi-disciplinary team.
With regard to mental health care, an independent review of mental health care provision to the armed forces, undertaken by a leading consultancy in the field, recommended that out-patient care be provided in regional departments of community mental health (DCMH) and in-patient care be contracted out to a suitable independent or NHS provider. We have 15 DCMHs across the UK plus satellite centres in Cyprus, Germany and Gibraltar. The Priory Group won the competition to provide in-patient care. Patients can now be admitted much closer to their home or base.
The MOD recently announced a new mental health care initiative for recently demobilised reservists, which will include the opportunity for a dedicated mental health assessment by appropriately qualified members of the DMS. Details of the programme will be confirmed later this year, including the location(s) at which the assessments will be provided, and the date on which the service will commence.
In terms of operational improvements, DMS support to the deployed force has benefited from investment in modern equipment designed to meet the specific needs of deployed medical capability; this uplift in capability has included the development and deployment of a telemedicine capability, digital imaging, CCAST (critical care aeromedical evacuation support team) and haemostatic products. These improvements have been backed by improved operational training, doctrine and through the lessons learnt process.
There are also three current projects which will contribute significantly to improvements in the DMS:
First, the Managed Military Health System for Force Generation project (MMHS) was conceived to improve the pan-DMS management and delivery of health care (medical and dental) to the armed forces and other entitled personnel. MMHS has the threefold aim of maximising the number of armed forces personnel ‘fit for task’, contributing to deployed medical operational capability and improving morale in the DMS. The scope of the MMHS project is to cover the UK non-deployed medical capability only, but many of the changes expected from it will beneficially impact on health and health care provision across the MOD including the overseas Commands.
Second, the director general medical operational capability project (DG Med Op Cap) has been set up to determine how to optimise the delivery of medical capability to support operations and ensure the process will deliver continual quality assurance and improvement in clinical output. The intended outcome of this project is the delivery of properly trained personnel with the right equipment and sustainability, to meet the requirements of the front line commanders-in-chief in the most effective and efficient manner.
Third, the defence medical information capability programme (DMICP) is a major business change programme enabled by IT which will provide an integrated health care information system across the DMS, and will also link to the NHS’s major new national programme for IT. DMICP will provide many benefits with the overarching benefit being more service personnel fit for task. It will provide DMS doctors and dentists with immediate access worldwide to complete, up-to-date electronic medical and dental records, supported by the latest clinical decision support software and online reference material, giving greater support to service clinicians, analysts and administrators in all aspects of their work. In April 2006 my predecessor announced the award of an £80 million contract which aims to have the first stages of DMICP phased in from the beginning of next year, initially to medical and dental units in barracks, air stations, naval bases, and then, after 2008, on military deployments.