Thursday 1 May 2008
Support for Armed Forces
The Petition of residents of Chorley and others,
Declares that British Service personnel should receive the necessary help and support they require, particularly medical support.
The Petitioners therefore request that the House of Commons urges the Secretary of State for Defence to honour the covenant between Government and service and ex-service personnel in providing the necessary support and medical assistance they require.
And the Petitioners remain, etc.—[Presented by Mr. Lindsay Hoyle, Official Report, 27 February 2008; Vol. 472, c. 1207 .] [P000132]
Observations from the Under-Secretary of State for Defence:
The Government provides a wide range of support to our Armed Forces and veterans and their families. We have made a number of improvements recently including enhancements to operational equipment, accommodation, compensation and medical support. The Command Paper, due in the spring, will outline steps taken so far and future initiatives to enhance the Government’s support.
The provision of medical care to Service personnel has recently been highly praised by the cross-party House of Commons Defence Committee which declared in their February 2008 Report on “Medical care for the Armed Forces” that:
“The clinical care for Servicemen and women seriously injured on operations is second to none. DMS personnel, working with the NHS, provide world-class care and we pay tribute to them.”
The HCDC report provided welcome confirmation that we have made the right decisions about the way that we provide this care and the way we maintain and develop the skills of our doctors, nurses and other medical professionals by working closely with the NHS.
Ministry of Defence Hospital Units
In addition to the Royal Centre for Defence Medicine (RCDM) in Birmingham, we have arrangements with five major NHS Trust hospitals to provide experience and training for our military medical personnel. These NHS hospitals have all agreed to host Ministry of Defence Hospital Units (MDHUs) to facilitate the continuing training, development and maintenance of clinical skills of DMS personnel in their hospitals, The NHS hospitals that host the MDHUs are also close to military population centres, and so can offer more “local” secondary care facilities for military patients living or working in the region.
Looking to the future, RCDM patient care will be moving to the new NHS hospital being built in Birmingham, and so will benefit from the major investment which will deliver the largest and most modern critical care teaching hospital in Europe.
Service patients can already be treated in any NHS hospital (although this will most frequently occur within those Trusts which host MDHUs), which is the most effective way of enabling them to benefit from the latest advances in medical treatment and the recent major investments in NHS facilities. The HCDC report recently stated:
“We were impressed by the MDHUs which we visited and are satisfied that they deliver high-quality care to military and civilian patients.”
Operational Health Care
On deployed operations the DMS aim to provide medical support on operations encompassing preventive medicine, evacuation, primary, secondary and tertiary care. When Service personnel are seriously injured, we aim to ensure that they receive a very high standard of care, including returning them to the UK for specialist treatment if necessary.
RCDM, based at the University Hospital Birmingham Foundation Trust (UHBFT), is the main receiving unit for military casualties evacuated from an operational theatre. In the Birmingham area, military patients can benefit from the concentration of five specialist hospitals (including Selly Oak Hospital) to receive an excellent level of clinical treatment. Selly Oak is at the leading edge in the medical care of the most common types of injuries our casualties sustain.
In Iraq and Afghanistan, we deploy highly skilled and experienced uniformed mental health nurses to provide in-theatre care and treatment for our personnel. Away from operations, our mental health services are configured to provide community-based mental health care in line with national best practice. We do this primarily through our 15 military Departments of Community Mental Health (DCMH) across the UK (plus satellite centres overseas), which provide out-patient mental healthcare.
The DCMHs are staffed by Community Mental Health Teams comprising psychiatrists and mental health nurses, with access to clinical psychologists and mental health social workers. In-patient care, when necessary, is provided regionally in specialised psychiatric units under a contract with the Priory Group. The HCDC recently supported the MOD’s community based approach to mental healthcare, stating:
“We believe that it is sensible to approach mental healthcare from community based provision, delivered in conjunction with local military units, in-patient treatment being a last resort.”
There are 15 MOD Regional Rehabilitation Units (RRU) in the UK and Germany. They focus on the assessment and treatment of musculoskeletal injuries and sports medicine and are staffed by specially trained doctors, physiotherapists and rehabilitation instructors. They enable patients to be assessed and treated in a timely fashion, with the aim of returning them to operational fitness when this is clinically possible. In their recent report the HCDC concluded that:
“The MOD’s approach to musculo-skeletal injuries is forward-looking and sensible, and we are persuaded that it has been of significant benefit to Service personnel as patients...”
More seriously injured patients may be referred to the Defence Medical Rehabilitation Centre (DMRC) at Headley Court in Surrey, which is the principal medical rehabilitation centre run by the Armed Forces and widely praised for its work. Indeed, the HCDC report described its services as “exceptional”. DMRC provides both physiotherapy and group rehabilitation for complex musculoskeletal injuries, plus neuro-rehabilitation for brain-injured patients, after they have completed their hospital care.
The healthcare of veterans is the responsibility of the Department of Health and the devolved Administrations. In November 2007 the Health Secretary announced an extension of NHS priority treatment to enable access to priority treatment in the NHS to veterans who may not yet have claimed a war pension.
From 1 January all veterans, not just war pensioners, should receive priority access to NHS secondary care for conditions which are assessed by their GPs as being as being due to service, subject to the clinical needs of all patients. The Department of Health has issued guidance on the new provision. Defence and Health officials and the ex-Service organisations are now working together on communicating the new arrangement to GPs and the veterans' community and monitoring its effectiveness.
Ex-Service personnel receive good treatment from their GPs but we recognise that many health professionals have limited experience of dealing with veterans who have mental health symptoms arising from their Service experience.
Officials from the MOD and the UK Health Departments have therefore been working together to develop a new community-based mental health service. The first of six regional health pilots was launched on 23 November, a further three pilots have launched with the remaining two pilots due to launch shortly. It is intended that the mental health pilots will run for two years ahead of evaluation and nationwide roll out. The service is designed to provide regional networks of culturally sensitive expertise in military mental health to support NHS health professionals.
To cover the interim period we announced in the summer the expansion of our Medical Assessment Programme (MAP) based at St Thomas' Hospital, London, to include assessment of veterans with mental health problems with operational service since 1982.
Additionally the MOD is the single biggest contributor to Combat Stress (a charity which specialises in helping ex-Service personnel suffering from nervous or mental disabilities); in 2006-07 MOD gave Combat Stress £2.5 million in fees. In October 2007 the Department agreed to phased increase in the fees we pay rising to 45 per cent from 1 January 2008 to enable them to enhance their capability to treat veterans. This demonstrates the Department's continuing commitment to help Combat Stress play an appropriate part in treating veterans with mental health problems and help Combat Stress deliver an enhanced capability to treat war pensioners.
The MOD holds regular discussions with the Department of Health on how the health care provisions for Service personnel, their dependents and veterans can be improved.
The Ministry of Defence places a very high priority on the welfare of its Service personnel and their families. The procedures are under constant review to make sure that the provision reflects the needs of the individuals.
The Ministry of Defence fully recognises the importance of adequate welfare provision for our in-patient Servicemen and women at RCDM and a package of measures is in place to support them. This includes an incidental expenses allowance of £5 per day (£10 per day in overseas hospitals) to pay for TV/internet cards and sundries such as newspapers. In addition to this patients who remain in hospital for longer than 10 days are eligible for the payment of Longer Separation Allowance at a rate of between £6.22 and £26.26 per day.
Operational casualties will continue to receive the tax-free Operational Allowance of £12.75 per day and are also eligible to retain any paid acting rank that was awarded for participation in the operation that resulted in their injury. They are also entitled to the accelerated award of any campaign medal that may be awarded and their unit can continue to claim welfare monies for families support whilst the individual is hospitalised.
The family of an injured Service person, who is listed as ‘Very Seriously Ill’, ‘Seriously Ill’ or ‘Incapacitating Illness or Injury’ and has the required medical recommendations, is entitled to travel, accommodation and subsistence at public expense. The Dangerously Ill Forwarding of Relatives (DILFOR) rules allow funding to cover the travel, accommodation and subsistence for two close family members to travel to the bedside of an injured Service person. In addition, the Joint Casualty and Compassionate Cell (JCCC) can extend this to allow other family members also to travel to be at the bedside.
Initially, the DILFOR allowance is for 7 days but can be extended for as long as required subject to medical advice. The regulations on DILFOR equally apply to the families of Foreign & Commonwealth Service personnel.
House of Commons Commission
Members' Priority Access
The Petition of Members and staff of the House of Commons and others,
Declares that the Petitioners are astonished at the announcement made on the 9th October 2007 that hon. Members should have priority access to services throughout the Commons part of the Parliamentary Estate. The Petitioners agree that such an approach may be expedient during a division, but not everywhere all the time. The Petitioners consider that this announcement serves to create a rigid two-tier system which is counter to an enlightened image of Parliament and further believe that there is merit in a general presumption of equality on the Parliamentary Estate
The Petitioners therefore request that the House of Commons ask the Administration Committee and Sergeant at Arms to reconsider their decision.
And the Petitioners remain, etc.—[Presented by Lembit Öpik, Official Report, 22 January 2008; Vol. 470, c. 1470 .] [P000112]
Observations from the House of Commons Commission:
An announcement was made on 9 October 2007 that Members should have priority access to services throughout the Commons part of the Parliamentary Estate. This was as a result of a recommendation by the Administration Committee after discussions about the inadequate enforcement of regulations on access to facilities. The intention of the Committee’s recommendation was that Members should have the opportunity to take priority at service points if they asked rather than that they should be given automatic priority at all times. Mr. Speaker agreed to the recommendation.
The Chairman of the Administration Committee attended a meeting on 16 October convened by representatives of Members’ staff to discuss the implementation of the Committee’s recommendations. There was a high turnout, including staff working for Members of all parties, as well as House staff, and representatives of trade unions. It was a valuable meeting at which views were expressed both about the substance of the recommendations and the way in which they had been communicated.
The Committee accepts that strong feelings have been provoked on the part of staff and unions but it is not intending to change the recommendation at present, and the Commission does not plan to amend the policy. The Administration Committee has agreed that it will review the operation of the Members’ Priority Access policy in twelve months’ time.