Thursday 17 July 2008
[Mr. Edward O’Hara in the Chair]
Armed Forces Medical Care
[Relevant documents: Seventh Report from the Defence Committee Session 2007-08 HC 327 and Sixth Special Report (Government Reply).]
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Blizzard.]
It is an enormous pleasure and an honour to open this debate under your chairmanship, Mr. O’Hara. It is about a matter that is crucial to the armed forces, who give so much for our country. The debate is about medical care for the armed forces, and follows on from a report that the Select Committee on Defence began in October 2006.
It may ruin the suspense, but I shall summarise our report by saying that the headline result was that Defence Medical Services gives our armed forces world-class care, which is every bit as good as, and sometimes significantly better than, that provided in the United Kingdom. It is right for me to open the debate by paying tribute to Defence Medical Services and to the men and women who, often in extreme danger, give such high-quality care to the men and women of our armed forces.
The person who acted as my bodyguard in Kabul last week said that he had been injured in the C-130 Hercules that was attacked in Helmand and that if he had not been completely under the influence of morphine at the time, he would have liked very much to go back and thank the medical people who had given him such dedicated, professional and tender care when he was injured. I told him that we were having a debate in the House of Commons this week, and that I could do so on his behalf. He was genuinely grateful to be able to discuss the sort of quality care that he had received; he was just one example among the many thousands of people in our armed forces who receive such quality care.
At the outset of our inquiry, there was a flurry of media reporting about shortcomings at Selly Oak hospital, but that did not prompt our inquiry. The Defence Committee covers all the different strands of what the Ministry of Defence does, and we wanted to examine the full range of health care provision for armed forces personnel and their families. The inquiry was launched against a background of increasing concern for the general welfare of the armed forces. Nowadays, our soldiers—I am referring to all members of our armed forces—must contend not just with the enemy and with privations in the field, but with the media. They must contend with coverage of what they are doing that did not previously exist. That is a thoroughly good thing— the more the people of this country know about what we as a nation ask our armed forces to do, the better. Media coverage of operations in Iraq and Afghanistan has been positive and helpful, but I shall come to some aspects of the coverage of our defence medical services.
The Committee held four evidence sessions during 2007, including one in Birmingham and one at the Scottish Parliament, partly because of our drive to try to make the Committee less Westminster-centric. I pay tribute to the Committee for its care and professionalism in conducting our inquiry, and to its staff. The Clerks did a fantastic job in sorting out the large amount of information, not just from oral and written evidence, but from a web forum, which is the new way of communicating with the public, and a thoroughly good thing. The Committee’s final session included the Minister—it is good to see him in the Chamber—and officials from the Ministry of Defence and the Department of Health, and it is good to see them, too. It was a useful and productive exercise in interdepartmental scrutiny.
We visited medical facilities throughout the UK and in Cyprus, Iraq and Afghanistan. Whenever we go to Iraq and Afghanistan, we try to see some of the medical facilities. The web forum that I mentioned brought in many interesting and helpful views of ordinary servicemen and women, and their families. We received responses from people who would not have been able to participate if the intake of evidence had been limited to those who appeared before us. Our report addresses six main areas: the treatment of casualties from operations, rehabilitation and aftercare, co-operation with the national health service, care for veterans and service families, mental health, and the role of reserve medical personnel.
On operational casualties, we visited the Royal Centre for Defence Medicine at Selly Oak in Birmingham because that is the main receiving centre for casualties from operational theatres. We found that the clinical care was excellent, and that the staff, both military and civilian, were first class, and we were hugely impressed by the personnel we met at some of the Ministry of Defence hospital units outside Selly Oak, many of which we also visited.
In Selly Oak, we were briefed on the Birmingham New hospital and midland medical accommodation projects, which will create a Defence Medical Services centre based on Birmingham and Lichfield. In their response, the Government stated that progress is on course for the Birmingham New hospital to be completed by 2012, and I welcome yesterday’s statement from the Ministry of Defence, which set out the development of Whittington barracks in Lichfield. We hope that the two sites will provide co-ordinated, high-quality medical training and administrative services. The medical staff we met in Selly Oak were very much looking forward to what they clearly regard as an exciting new hospital that will provide even better care than is given at the moment.
I said that I would come to the issue of press coverage. It is necessary, but we must consider whether it is good coverage. The Committee’s report was strongly critical of some of the media coverage of supposed incidents at Selly Oak. We concluded that some stories had been printed without being verified, and in some cases despite the trust flatly denying them. We described that as irresponsible and reprehensible. We know that those stories had a serious effect on the morale of staff at Birmingham—we heard that some of them had been in tears as a result—and that service personnel and their families were worried about whether they or their families would receive decent care if they were wounded.
Was the right hon. Gentleman as shocked—or perhaps distressed—as me to learn of the time that had to be dedicated to dealing with those press inquiries? If I remember correctly, I think we were told that the time spent on the matter was as much as that of a full member of staff—one of the matrons.
Yes, we did hear that. It is not right for people who ought to be devoting their time to looking after our wounded servicemen and women to be running around putting out bush fires from stories that are incorrect. The words in our report were pretty harsh on that. Since then, the defence correspondent for The Daily Telegraph, Mr. Harding, has written to me to protest at the characterisation of the media coverage, which he said was wrong. He gave us details of the incident about which he had written, and I have asked for and received his permission to forward those details to the Ministry of Defence for its comments. I shall be doing that either later today or early next week. If we were wrong about those reports, of course, we will say so. We have no wish to perpetuate a falsehood. However, we took evidence on those matters and it was not challenged for six months, although it was displayed on our website. I look forward to hearing what the Ministry of Defence has to say about that.
The right hon. Gentleman will remember that I raised that issue directly with the trust when we took evidence in Birmingham. Is it not the case that the trust has not only refuted what are in some cases wild stories, but that it told us it has received no direct complaints from any member of the armed services or their families that can be linked to any of the more outrageous stories that have appeared in The Daily Telegraph, which were repeated the other day in that paper?
Yes, that is the case. It is also the case that we asked the trust about the general level of complaints at Selly Oak. My impression of the answer we received—this is something that I am remembering from about a year ago—is that the general level of complaints was running at about 10 per cent. of the level for other trusts in the country. That fact backs up our impression that Selly Oak is providing a good service to our injured service personnel.
In support of what the hon. Member for North Durham (Mr. Jones) has just said, the inquiry was not short. It took place over a long period of time and we received much publicity for the hearings that were held. I was rather surprised that no journalists submitted evidence of their view that the services provided at Selly Oak and elsewhere were not up to standard. No evidence at all was provided to the Committee by anyone who had engaged in smearing the Selly Oak facility. Is the Chairman of the Committee rather surprised that nobody came forward during the evidence stage to back up the stories that had appeared?
I am grateful to the hon. Gentleman for that intervention. Yes, I was surprised. However, the fact that nobody came back to us reinforced in our minds the view that our conclusions—harsh though they were—were pretty correct. Now we have permission to pass the details of the matter to the Minister, we shall do so. He will consider them and no doubt we will reach a conclusion on whether we were right or wrong. If we were wrong, we will say so; and if we were right, we will say so as well.
The Committee visited the defence medical rehabilitation centre at Headley Court in June 2007, which is an experience I dearly wish everybody in the country could share—unfortunately the work involved would overwhelm such a wonderful centre. We have much praise for the work that goes on there. The staff are committed and enthusiastic, and patients are being rehabilitated after injuries that only 10 years ago would have been fatal. Headley Court is a good news story, and the Ministry of Defence should certainly not hide its light under a bushel in that regard. In taking evidence from the Minister and from the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), we were reassured that stories about Headley Court being under-resourced were inaccurate and that the Government are looking at the future needs of the DMRC and the resources required.
Incidentally, during our visit to Headley Court, we met several soldiers who had recently been extremely severely injured, so I welcome the recent announcement about compensation for those who are seriously wounded. Even though that is not strictly relevant to this inquiry or report, it is a welcome development.
One of the most important aspects of our inquiry was the extent to which the defence medical services co-operate with the national health system. We received many representations, some of which were vociferous, about the closure of stand-alone service hospitals—in particular, about the impending closure of the Royal hospital at Haslar. I am pleased to see my hon. Friend the Member for Gosport (Sir Peter Viggers) in the Chamber because he has fought an extraordinarily dogged and long-running campaign to save Haslar hospital. I pay tribute to him for all that he has done in that respect. He persuaded me that I ought to visit Haslar—it was not difficult for him to do so because he is a persuasive man.
However, the Committee was clear that it finds the arguments in favour of the closure of the service hospitals irresistible. We fully support the Ministry of Defence’s current stance of working through Ministry of Defence hospital units based in national health service trusts and found that there was no evidence that the standards of care offered to service personnel have suffered. In fact, it was clear to us that the current arrangement brings a number of benefits in terms of training, skills and maintenance. I do not want to raise false hopes in Haslar, but I hope that its incredible skills and dedication can be put to good use. Our general impression was that closing service hospitals was the right thing to do.
My right hon. Friend specifically mentioned Haslar hospital and I am grateful to him for his courteous remarks. Is he aware that there are active discussions taking place with service charities and others about the possible use of Haslar as a convalescent centre? Those discussions are ongoing, but will he wish them well?
My hon. Friend keeps me closely in touch with those matters. I am not in the least surprised that Haslar, the people around it, and those involved in the campaign are producing imaginative suggestions, such as the one to which he has just referred. I certainly wish them well, because it is a valuable suggestion that will preserve the incredible skills of the people in that place.
That was the main issue on our website forum. However, when I visited Frimley Park MDHU, there was only one military patient in that vast hospital. One cannot run a dedicated hospital on that basis, particularly when one recognises that there is a need to make the best use of specialities, such as trauma and burns expertise, and eye treatment. We have to be able to move military patients to places where those specialities exist. We also have to recognise the great healing effect that being in a military environment can provide, but that healing effect, which we saw operating so effectively at Headley Court and which is also operating on the military-managed wards at Selly Oak, does not of itself suggest that we should bring back dedicated military hospitals.
Does the right hon. Gentleman agree with this argument? One advantage that was put to me when I visited the Northallerton MDHU was that such units allow staff who are deployed on operations to gain not only experience of dealing with trauma and so on, but broader experience of areas such as paediatrics, which are increasingly important as our armed forces are deployed in military/civil situations. Last week in Afghanistan, we saw the military hospital dealing with children from the local town.
The hon. Gentleman is right. He raises another argument in favour of integrating the NHS with care for our armed forces, because that creates a wide range of experience that people looking after our armed forces in the field need.
We were told on some visits that service personnel can be fast-tracked through the NHS when that is appropriate. Those arrangements, although theoretically a very good idea, seemed to be unclear. We called on the Government in their response to set out them with a good deal of clarity, and we are grateful that they did so. However, the fact that we had to ask for such clarity shows that there is still a bit of work to do on ensuring that the arrangements are transparent, understandable and understood by those who can take advantage of them.
Our greatest concern arose from our evidence session in Edinburgh, at which we took evidence from officials from the Scottish Executive. We were extremely disappointed by the laissez-faire attitude that characterised the Scottish Executive’s approach to injured armed services personnel and their families, and the issue of whether those people had proper access to appropriate facilities. The Ministry of Defence has to work with a number of agencies to deliver the full range of services for the armed forces. It must be a very high priority for the Ministry of Defence to ensure greater co-operation between it and the devolved organisations. Given that our armed forces are spread all over the country and given their needs, which can be very great, unless there is better co-operation, our armed forces will suffer, which would be wrong.
On care for service veterans and families, we have no doubt that the clinical care provided to service personnel is first class, but the Government have a responsibility to veterans and services families, too. During our inquiry, the Government announced that veterans would receive priority access to NHS treatment. We welcome that, but we must see action, not only on how the access is available but on how those who are eligible for priority access are identified. We are concerned that the Government have no real plan to identify and to track people once they leave the armed forces.
The treatment of service families is also vital. How the relations of armed forces personnel are provided for is a very important factor in retaining those personnel. That responsibility is shared between the Department of Health and the Ministry of Defence. Both Departments must ensure that service families are afforded the highest possible quality of care. People should not be penalised because members of their family have joined the armed forces.
Mental health was one of the most important aspects of our inquiry. It is a heavy responsibility, and takes a heavy toll on those who have served their country. The Committee was satisfied that the provision of mental health care for service personnel is adequate, and DMS is right to pursue a community-based approach to those services. I have heard in recent weeks that there can be a worrying delay in discharging patients from the Priory. Will the Minister consider that in his reply? Veterans are extremely important in this context, because mental health problems can take a long time to develop. We were told that it took on average 13 years after discharge before someone presented for care as a result of mental health problems. The Government therefore have a continuing responsibility to those who have served in the armed forces and may have been traumatised by their experiences.
The Committee pays tribute to the excellent work that Combat Stress does in providing respite care for veterans. We greatly welcomed the additional funding that the Government announced last November, but problems will remain as long as there is no robust and systematic way of tracking veterans in the NHS. We concluded that the lack of such a process meant that the NHS had one hand tied behind its back when trying to deal with veterans’ mental health needs.
Reservists play a vital role in the provision of armed forces medical care. The Territorial Army has so far provided about half the medical personnel for the deployments to Iraq and Afghanistan. We visited a TA field hospital that was about to deploy to Afghanistan and we were enormously impressed by the enthusiasm and professionalism of the soldiers whom we met. Regular and reserve personnel seemed to work seamlessly alongside one another, and there were benefits for both sides.
When we visited Camp Bastion in Helmand last week, we heard that there were some glitches. Will the Minister consider that in his reply? We heard that the field hospital reservists who trained in the UK had not been trained on precisely the same equipment as they went on to use in Afghanistan. We heard that the paperwork was slightly different in Afghanistan. We heard that the intensity of casualties was not something for which they had been prepared, but that was perhaps because we visited the hospital on a day when there was a sudden jump from nine casualties to 30 casualties. Either way, we were enormously impressed by the quality of what we saw in Camp Bastion, but it would be helpful if the Minister ensured that the equipment that people train on is the same as that which they operate when they get into the field, that the paperwork is easy to manage and the same as that which they use in the field, and that people know that there can be a sudden influx of serious casualties. The Government must not take the contribution of reservists for granted. They must ensure that reserve personnel have the support that they need and are not disadvantaged in the labour market.
The Government response to our report is helpful and reasonable. I pay tribute to the co-operative and consensual way in which the Ministry of Defence has treated this inquiry. From the outset, we emphasised that it was meant to be a constructive process, and the Ministry of Defence has responded in kind. Where we asked for further information, the Government have in the main provided it. The emphasis must be on transparency and progress. The Ministry of Defence should continue to inform us and the House of developments in medical care for the armed forces and must continue to make improvements in the way in which such services are delivered. We hope that our report has contributed to improvements. First-rate care is already given by Selly Oak hospital. We have nothing but praise for the armed forces and defence medical care. We are grateful to the Government for the way in which they have responded to what we hope has been a constructive report.
I, too, pay tribute to those members of our armed forces who provide medical care for people injured in the line of duty. I think not only of those who work here but of those deployed on operations, whom the Committee saw during the last two weeks on our visits to Iraq and Afghanistan. It gives me great pleasure to see them—many are reservists or volunteers—taking such a great pride in their work, which they do with commitment and dedication.
I shall cover four points. The first is the question of Selly Oak hospital. The second is how veterans are treaded in society. The third is mental health. The fourth is about operational issues to do with medical cover in Afghanistan and Iraq.
The Committee’s report did not get a great deal of coverage in the press, but we were not surprised because it was quite positive. That is sad because the issue has been kicked around a lot and even used by certain people as a political football. It is too important an issue to be treated in that way. Having visited Selly Oak with the Committee, I am sad at some of the misreporting and criticisms that have been made about the dedicated men and women who work there. Although such criticisms might get headlines, the press must remember that the staff, who work long hours with dedication—sometimes working more hours than they are paid for in order to look after the individuals in their care—find that criticism harsh.
When the Committee took evidence in Birmingham, I was keen to find out how many of the urban myths that have been generated were true. The way in which the press have dealt with some of those issues is disturbing. I shall read out some of the headlines that Selly Oak hospital has had to face. One was “Muslim accosts injured Para in hospital”. Another was “Hero squaddie told by British hospital to strip uniform as offensive to Muslims”. A third was “Muslim women abuse soldiers at troops’ hospital”.
The Committee took evidence from Ms Julie Moore, chief executive of the University Hospital Birmingham NHS Foundation Trust, and Dr. David Rosser, the hospital’s medical director. I asked what had been done about those allegations. I also asked whether the trust had received complaints directly from the patients or their families about the treatment of the injured soldiers, given some of the more outlandish accusations made in the press. Surprisingly, the hospital had received no direct complaints. I wonder where the press gets its headlines. Some newspapers produced headlines without asking the hospital trust to comment.
The other thing that disturbed the Committee was the fact that when the hospital trusts were asked to comment and had said that the stories were not true, the press still went ahead and printed them. That was irresponsible. I am concerned that The Daily Telegraph is saying even at this late stage that the headlines stand up for themselves. I would like to see evidence for that.
Another thing that disturbs me is that someone wrote in The Daily Telegraph a couple of weeks ago what should have been the good news story that investment in Selly Oak was going ahead under the headline “Troubled hospital gets extra investment”. The writer did not make any of the more spurious accusations, but he repeated some of what he had written earlier. The press is right to report when things go wrong. They should do so. Such matters should be considered. The Committee would not have ignored such reports if we thought they were correct. However, I believe that the press should instead tell some of the good news stories.
What is remarkable about Selly Oak is not only that the staff are dedicated but that many of the young men and women there who have been terribly injured would not have survived those injuries a few years ago. Some of the pioneering surgery is not only state-of-the-art here, but is of high quality and internationally groundbreaking.
I wonder whether my hon. Friend has noted the suggestion in the recently published recognition study that the armed forces parliamentary scheme should be a model for the media? Although there are specialist journalists, it seems that some of them have a great deal to learn.
I am not sure that I would want to inflict that on the military. The press have a responsibility to report accurately. We should remember that their criticisms are causing damage. It is disturbing also that Members sometimes repeat such reports without checking the facts.
Some say that this terrible Labour Government are cutting back defence medical services and closing military hospitals on financial grounds. I have said in the House before that the last Conservative Government got some things right. Commencing the closure of military stand-alone hospitals was one. The MDHU is clearly the best model. It is not that it will save money, but it will ensure that the staff have up-to-date clinical experience, which is not always available given the size of today’s armed forces.
When I visited Northallerton MDHU, I was impressed by the range of experience among the staff there, including expertise in paediatrics and other relevant areas. For instance, when we were in Camp Bastian last week the commanding officer said that the staff were dealing with a number of children and that it would be a disadvantage if the hospital did not have that experience but could deal only with the small throughput of members of the armed forces. I am convinced that that is the right way forward.
We agreed in our report that the Government’s decision to close Haslar was right. I accept that the hon. Member for Gosport (Sir Peter Viggers) has a constituency interest in the matter, but if he reads the report I hope that he will be convinced that it is being done for clinical reasons.
The other factor about Selly Oak that impresses me is that MOD surveys of people that have been through Selly Oak during the past 12 months show that the overall majority rate it as excellent, very good or good. I am sure that the Minister realises that members of the armed forces are not shy of making criticisms when things go wrong, so that is a good testament to the hard-working staff at Selly Oak.
Related to that is the question of Headley Court. I agree with the right hon. Member for North-East Hampshire (Mr. Arbuthnot), the Committee Chairman, that it is a world-class centre. We also visited the rehabilitation centre in Edinburgh, another first-rate facility for getting people back into the military—not only those severely injured in operations but people with sports injuries and others. The staff’s dedication to ensuring that people can return to an active life in the military is important. It is certainly highly regarded by those whom we met there.
I want now to discuss veterans. The Government should be proud that they are one of the first Governments to have recognised the role of veterans in society. They set up the Veterans Agency, and today’s Command Paper, which is a very good one, recognises the needs of veterans, so that we do not just forget about individuals who have given dedicated service to this country at times of need. The Command Paper tries to fill in some of the gaps, but we need to do more work on the issue.
There was a recommendation in the report—I think it was something on which I put in an amendment—about how we track veterans once they leave the military. Increasingly many doctors do not have experience of military life, and we need a system of trying to track individuals, because some illnesses or mental health issues will present themselves later in a person’s life. The option that was put forward was a system of automatic tracking when individuals leave the forces, with the possibility for people to opt out somehow if they wanted to. I appreciate that not everyone might want the information included on their medical records. A system from which people could opt out would at least mean that in future years if someone attended their GP’s surgery it would be possible to tell from their records that they had been a member of the armed forces. If we are to take seriously the prioritising of medical services for veterans we need a method of tracking people through the system.
I agree with the Select Committee Chairman about what I must describe as the lack of concern on prioritisation in Scotland when we took evidence. Frankly those concerned did not think that veterans deserved a great deal of extra service compared with anyone else. All that we kept getting from the NHS there was the fact that they would be treated just as well as anyone else, which I do not think is acceptable.
A good feature of the Command Paper, which I hope will be extended to health, is the idea of ensuring that its contents will be followed through. I was reassured when I put my question to the Secretary of State today that there will be a Committee to consider those issues, to ensure that there will be joined-up working between, for example, the Department of Health and the Ministry of Defence as well as, I hope, the devolved Administrations. It would be terrible if, despite today’s very good Command Paper setting out what we expect for members of our armed forces and veterans, those things were to fall through the system at the point of delivery locally. We should consider that carefully. The Government have rightly put veterans on the political agenda, and we should keep them there. I pay tribute to organisations such as the Royal British Legion, and others who have worked closely with the Government on the Command Paper, but it is important to remind people that veterans have needs, and to make sure that those are met.
Mental health, even in civvy street, is a taboo subject. Even in the NHS it seems to be the poor relation within medical provision. I work with my local Mind group and its director says that it is possible to see that someone has lost a limb or broken an arm, but the problem with mental illness is that it cannot be seen. As has been said, many mental health issues will not appear while the people concerned are in the armed forces, but will emerge many years later.
I noticed last week, when we were going round the field hospital at Camp Bastion, that mental health services are now in theatre. That is important. I talked to the commanding officer there, and he said that if mental health issues can be dealt with while they are developing in theatre, that is the best way to do it, rather than trying to unpick them later. The subject needs a lot of research and the Government and the Department are right to try to organise such work. The King’s Centre for Military Health Research is now doing that on behalf of the Government. We do not understand how the experience of combat affects people later in life and it is important to pull together that body of evidence.
I offer congratulations on the work of the regional pilot schemes, because it is open to veterans to come forward and ensure that their experiences and any issues that they have are fed into the process. Once such data and research are secured, priorities can be allocated for serious issues that need funding. As with the treatment of other veterans, we need a way to ensure that people are tracked through the system.
The final issue that I want to deal with is the deployment of medical facilities in the field. To hear some people talk, one would think that those were of a very poor standard. In Camp Bastion last week the commanding officer was very proud of the facilities that he was showing us. He said on occasion that they might be better than some of what was in the NHS in the UK. It is staggering to think that in the middle of the arid desert, where Camp Bastion is, there are CT scanners and some of the most high-tech equipment. We also need to recognise not only the good quality of the care being given, but the very efficient system for evacuating seriously ill servicemen and women back to the UK. Within 12 hours seriously injured servicemen are getting the best of treatment at Selly Oak, because there are aircraft on 24-hour call.
I want to pay tribute to some men and women who do not get a great deal of notice, but whose job I think—having talked to them last week—is very difficult and, on occasion, dangerous. They are the medical emergency response teams who fly into the combat zone, often under fire. When we flew into Camp Bastion last week we saw tracer fire, but it was not aimed at us, but at a helicopter crew going in to evacuate injured UK personnel. Those people are tremendously dedicated and are often volunteers, who put their lives at risk to ensure that our men and women serving on the front line get good treatment and are taken back. The dedication and bravery of those medics and helicopter pilots should be recognised in this debate.
Overall I am very impressed with the state of the Defence Medical Services. We should keep them under constant review and it is the role of the Select Committee to return to the issue in a few years to see what is happening. However, the story is good overall and I am very sad that it has not received more coverage. I also think that the role in which some volunteer medics work in Afghanistan and Iraq should attract more credit and more media coverage. We can be proud of the job that they do. I am satisfied that the servicemen and women who put their lives on the line for us should get the best medical treatment. From what I have seen in theatre and in this country we can be reassured that they get exactly that.
I am delighted to take part in the debate. I congratulate the right hon. Member for North-East Hampshire (Mr. Arbuthnot), the Chairman of the Select Committee on Defence, who with his customary unbelievable fairness put the case for the Committee’s report and the evidence that we were given. He should be congratulated on the way he presented that case this afternoon, and on having the patience to continue to chair the Defence Committee in the way he does. There are three of its members present this afternoon who would, I am sure, share that view.
I, like the hon. Member for North Durham (Mr. Jones), want to congratulate all the staff involved in the Defence Medical Services, which have been an easy target for the press and others to criticise. What the experience of preparing the report did for the Committee, and, I hope, for many other hon. Members who will have taken the time to read it, was to show that the story is not just doom and gloom. There is a lot of hope, and a lot of good work continuing to be done.
I remind hon. Members of a comment made by the Minister at the end of the Select Committee sitting on 27 November, about Headley Court:
“We are absolutely committed to providing the best possible treatment and service and care for our people. As I said, the report is going on at the moment”
to review expenditure on the site. I think that that is true. I spoke recently to two young men who benefited from Headley Court’s expertise. The experience gave them an opportunity in life that they would not have had five years ago, let alone 10 years ago. They will be able to have a career outside the military, mainly owing to the efforts of the staff at Headley Court, who need to be congratulated. I am delighted that the Government lived up not only to their promise to provide the facilities and the money to carry out the review of services at Headley Court, but to deliver on their commitment.
The tracking of veterans is vital. Many general practitioners have told me of their experiences of helping ex-servicemen when they arrive at surgeries and say that there is a lack of coherent records of what servicemen have been through, what treatments they have had, and what injections they have received, for example. That was especially true in the early 1990s and throughout the decade following the first Gulf war, but, sadly, the problem still needs to be addressed. Although systems within the MOD have changed, the link between it, the local GP and the primary care trust needs to be maintained via an understandable and clear system. The tracking of veterans, especially for medical purposes, is vital. We should make every effort to ensure that PCTs, especially those in areas where large groups of ex-servicemen live—in Hampshire, for example, there is a large concentration of ex-Navy, Army and Royal Marines, and, to a lesser extent, around Odiham, Air Force personnel—are made aware of servicemen who are leaving but who will continue to live in the area. That way, GPs would have accurate records. Ministers have said on a number of occasions that they are trying to improve the system, but there is still no clear indication of how it works. At some stage, as the hon. Member for North Durham said, the Defence Committee should concentrate, and produce a report, on the tracking of veterans and how services are delivered to them.
The Chairman of the Committee and the hon. Member for North Durham spoke about the decision, which was initially made many years ago, to close Haslar hospital. Anyone who knows Haslar could not fail to be impressed by the services that it has provided for generations in the Gosport and greater Portsmouth area. Nobody who comes from Portsmouth would willingly wish to see the facility go. When we consider the amount of money that has been spent in Haslar in the past 10 years—I am sure that the hon. Member for Gosport (Sir Peter Viggers) will make clear the commitment that was put into it—we realise that the loss of the facilities will be a great loss to the community. I am optimistic that solutions will be found for the future use of the site, but the best use was as a military hospital that had a huge involvement with the community. I am expressing my personal disappointment, but I accept the Committee’s decision and what the Government have said on the closure. I visited the MDHU at the Queen Alexandra hospital and was mightily impressed by it. It was unlike the situation that the Chairman of the Committee found when he went to Frimley Park, because there was more than one serviceman there, and a number of service families. The exciting prospect about the former unit relates to the service personnel. One would find it remarkable if one went into QA hospital and did not see a member of the services walking around, be it a nurse or a doctor. They are proud to wear their uniform, and the people who use the hospital are proud to be served by them.
I spent a couple of days there fairly recently, and received medical care from two young doctors who were about to go to Afghanistan, one of whom had been to Iraq. Talking to them was encouraging. They spoke with a great deal of sympathy for the people who did not want Haslar to close, but talked about the experience that they had gained in a large general hospital and their ability to transfer that expertise to the places to which they were going. The young lad—I say “young lad”, but he was a lieutenant in the Royal Navy and probably in his early 30s—spoke with a great deal of feeling for the way in which he had been able to use the experience he gained in the hospital in Iraq. It is a testament to the co-operation between the health services and the military that they can make such units work as successfully as they do. The way in which they try to maintain the military ethos to a level that would perhaps not have been possible in the past at Haslar was interesting. The ethos was maintained at a level that encouraged people to think that they were not simply wearing the uniform, but were part and parcel of the military.
The criticisms that were levelled at the Selly Oak facilities were, in the main, very unfair to the hospital, the staff and everyone concerned. They put a lot of fear in the minds of the families of people who were at the hospital. Some people from the Portsmouth area were at Selly Oak, and I received letters from parents who were worried about the care they were receiving. It was unfair that those people, on top of the trauma of a loved one being brought back from a battle front, were confronted with the idea that their loved ones had been taken to the wrong place and that they would not survive. The hon. Member for North Durham was right that many of those young men and women who have been to Selly Oak would not have survived had it not been for the care and ability of the staff there. I hope that the Committee’s report puts the record straight on Selly Oak.
If we look at the report, we will see how many reports the Defence Committee has undertaken in the past few years. Not one has been so well received both by the Committee—many of us had serious reservations at the beginning, but when the report was prepared, the whole Committee was impressed by what we had discovered. I was impressed that the Minister came with the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) to give evidence to us. There was a willingness to work together. The latter was vague on who was paying for what, but there was undoubtedly co-operation and a willingness to co-operate. That things have moved on considerably in the past five years or so is transparent in the report, which is welcome.
I do not wish to delay hon. Members and I must apologise because I will be absent for 45 minutes to chair a different meeting, but I will be back, if the sitting does not adjourn early, to hear the winding-up speeches—I apologise to colleagues who will speak after me.
I wish to ensure care for those affected by mental illness by raising the issue of the preparedness of young men and women who are going to places such as Iraq and Afghanistan. They should be given greater preparation for the things that they will experience. I spoke to a psychiatrist who deals with some of the repercussions of what such young men and women have been through. He told me that there was a lack of preparedness for some of the things that young men and women would be confronted with and the sort of scenes with which they would have to live daily. It is easy, from the safety of the House of Commons, to say, “Those things are part and parcel of being in the military.” However, 19 or 20-year-olds are bound to be affected by confrontations with ghastly scenes and horrific incidents—a bomb outrage or whatever—and the deaths of friends and colleagues.
I do not know how people can be prepared for that, but some effort ought to be made to ensure that people are given access to proper counselling before and after. One of the problems is the lack of medical counselling on return. Everyone is happy to get back safely, but some people come back terribly scarred by their experiences and what they have seen. Perhaps intervention in those early days back in the United Kingdom would be helpful in softening the burden that they will probably carry for the rest of their lives. It is important that we as a nation recognise the debt that we owe those men and women and do everything that we can to prepare and help them. Let us not wait until they become serious psychiatric cases, desperately trying to hold together a marriage and hold down a civilian job while coping with the burden of what they have experienced in the services.
That will not be easy, and the problem will not be solved overnight, but I would like the Minister to reassure us about a matter mentioned in the report. The hon. Member for North Durham made an effective contribution to our debate in the Committee about the number of servicemen who end up in prison with serious psychiatric problems. Perhaps their journey to prison would not happen if they were given the right care and attention upon leaving the service or returning from combat.
With those thoughts and suggestions, I thank you for calling me to speak, Mr. O’Hara. I wish the Minister well in the work that has to be done in future, and I am grateful for his effort in ensuring that medical services have improved significantly between the last time the Committee examined the matter and our producing this report.
It is a pleasure to be able to join colleagues to debate one of the most interesting and satisfying inquiries in which I have been involved on the Defence Committee. The report rightly pays tribute to DMS personnel and their NHS colleagues, who together provide the world-class care that the Chairman of our Committee, the right hon. Member for North-East Hampshire (Mr. Arbuthnot), mentioned at the beginning of his speech. To quote the report:
“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.”
In his statement on the Command Paper published today, the Secretary of State rightly said:
“We must aim to offer the best possible continuous care from the point of injury, through to recovery and beyond, for the rest of their life.”
Notwithstanding the fact that our inquiry found that that care was world class, we need to continue to push the boundaries of what can be achieved. I am sure that the Minister concurs.
When we visited Selly Oak, we saw men and women—predominantly men—who might never have had the chance to get the care that they were receiving had it not been for the advanced health care that can now be offered in the field in the golden hour when it is so important. I learned a great deal about how our armed forces work and support each other when they are deployed, when they are preparing for deployment and during post-deployment decompression. I learned how important it is that their families are there in the background to support them stoically and uncomplainingly, often putting up with situations that they should never have had to put up with.
As I got to know the defence community in Plymouth by visiting the Crownhill community centre and the various associations that such communities are blessed with, I was concerned to learn of the waits that people sometimes experienced for hospital treatments and dentistry. Goodness knows when dentistry was ever as hard-pressed as it has been in recent years, and people find themselves moving just when they might have got an NHS dentist. I would also mention in vitro fertilisation treament. I know that in today’s Command Paper, the MOD undertakes to make improvements on some of those matters, further to those that have taken place since we published the report.
The response to our report stated that the MOD was in the process of reviewing the future requirements of the defence medical rehab centre at Headley Court and the regional rehabilitation units. Things have moved on since that response, and I hope that the Minister will be able to tell us something about the outcome of the review. Like others, I have seen some reports about the level of expenditure that will be provided and the commitment that has rightly been made. I found the dedication of the people at Headley Court to care for injured service personnel, and the terrific commitment of those personnel to get back to fitness for service, one of the most moving and interesting parts of the inquiry.
Would my hon. Friend like to debunk the myth that charities have to raise money for a swimming pool at Headley Court because of a shortage of money? When we went there, the directors and others involved said that that was not one of their top priorities.
Rightly so, and we mentioned in the report the importance of getting the right relationship between the MOD and the third sector, which has always enhanced what the MOD can make available, and will continue to do so. In today’s Command Paper, there is a commitment to get that right through the mechanism that has been set up for continued consultation with the service charities and associations, the Army Families Federation and so on. I hope that that will make for a much better relationship and better understanding between everybody. The British Legion has raised money for additional things. I will return to the work of Combat Stress in a moment, because achieving a balance and getting the relationship with the third sector right is very important. Certainly my hon. Friend is correct that the matter of the swimming pool was another example of getting things completely out of proportion. Perhaps some Members played into that process in an inappropriate way.
Headley Court is a world-class facility, and the people there are rightly proud of what they do. When we visited Selly Oak, we saw the provision of cutting-edge medical care for the injuries and polytrauma that military casualties sustain. To illustrate the importance of that defence medical centre as the focal point for the whole practice, we were told on our visit that repairing one injury to a serviceman’s hand required 13 specialisms to be brought in from across the teaching hospital.
While we were there, the issue was raised of whether there was an appropriate military ethos in the management of the ward. We saw a great deal being done to improve it, and good practice has been established in the military management of the ward, as it has in military wards elsewhere in the country. I am sure that that practice will be migrated across when Birmingham New hospital, which is being built in Edgbaston, replaces Selly Oak. That will be another major improvement, because we could see that the buildings in which the world-class service was provided were not the best or most flexible. It will be good to see the Selly Oak ward move to its new facilities. I pay tribute to the MDHU at Derriford hospital, as a number of Members have done. It, too, plays an important and under-recognised part in the work of our armed services, ensuring that servicemen and women are fit for service and that those who suffer injury—most commonly musculoskeletal injury—are fast-tracked to be restored to full health and fitness for active service. I greatly appreciate, as I am sure do many of my constituents, the service provided at MDHU Derriford.
On the role of the reserves, my hon. Friend the Member for North Durham (Mr. Jones) mentioned the visit by some of my colleagues recently to Camp Bastion in Afghanistan. The report of that visit tells us that 95 per cent. of hospital staff are reservists, across the provision on deployment. Many of those reservists come from Plymouth Derriford hospital, and they have particular needs and concerns. A review will report later this year on the role of the reserves in general. No doubt it will provide another opportunity to discuss those matters. The all-party group on reserve forces, of which I am a member, as are other colleagues in the Chamber, has been working to introduce proposals, and the report due to be published next Monday will consider the issues.
Reservists face different pressures and challenges from regulars, particularly after the completion of an operational deployment. They do not return to a military environment as regulars do, but to a civilian one, as our report pointed out. Hence they do not have the same atmosphere of camaraderie and shared experience in which to readjust, and the signs of post-traumatic stress disorder can sometimes go unnoticed. For that reason, our report referred in particular to the heavy reliance of DMS on reserve personnel, which has increased as a result of the high tempo of operations.
Combined with smaller numbers of deployable regular DMS personnel, reservists keep our armed forces’ medical service going. Although reservists volunteer to use their skills, there is a danger, as I am sure the Minister is aware, of deploying them so often that the pressure on them becomes excessive. That is why the report says towards the end:
“The MoD must not take the integral involvement of Reservists for granted. It must make sure that recruitment remains buoyant and that retention is sufficient to guard against any degradation of capability.”
We also referred to the support that reservists need from both their civilian employers and the armed forces when they return from operational deployments. The public, too, need to recognise the reserve forces’ contribution to the military and society.
I shall pass a few comments on what we said about mental health in the report. I welcome the pilots that have been announced and developed, such as the community veterans mental health pilot. As other Committee members have said, it is a difficult matter. Particularly in mental health, it is hard to keep the level of contact necessary to provide appropriate service for former service personnel and veterans, who might need it many years after concluding their service in the armed forces. The pilot is designed to develop a model of community-based mental health, as recommended by the Health and Social Care Advisory Service, which is an independent body that recognises that in some areas of the country, the NHS can no longer easily access the expertise in military mental health required to meet the needs of some mentally ill veterans. It addresses the issue by establishing a basis for regional networks of expertise. We have such a network in St. Austell, and I think that the Secretary of State said in the Command Paper that others are to be rolled out. However, they were designed to take two years and to be evaluated, and I hope that my hon. Friend the Minister, in responding to this debate, will be able to update us on those pilots, the evaluation and when the roll-out will occur.
I also want to mention Combat Stress. A number of Members visited its facility when we visited nearby Headley Court. I was impressed by the work that it did, and I met somebody who came from as far away as Plymouth, and lived very near my constituency. Combat Stress plays a necessary part. Indeed, it probably provides support to the community mental health pilots that I just mentioned. We need to get our relationship right with the third sector, which is an important player in mental health services. I understand from information that we received recently from Mr. Toby Elliott, the chief executive, that there are continuing delays in resolving some of the funding issues. Despite generous increases, funding is increasingly delayed, and I guess it will continue to be delayed as the community pilots begin to identify people for whom the periodic respite that Combat Stress provides is of particular value. Again, the Minister’s remarks on that would be greatly welcome.
This is one of the most interesting and satisfying inquiries with which I have been involved through the Defence Committee. As colleagues have said, we will have a role in ensuring that the issues that we have debated this afternoon are seen through to their conclusion, if a conclusion is possible with such things, or certainly to an even higher level of service. I look forward to gaining some insight into how that will be achieved. The Government gave us some idea in their response of how matters would be taken forward. Things have developed since then, and we saw some glimpses of that development in today’s very welcome Command Paper.
Perhaps the most important part of the Command Paper is the implementation mechanism. There was a reference earlier to our session with the Minister and his colleague from the Department of Health. We had a similar session when we considered education. Only such joined-up thinking across government will ensure the full implementation and delivery of the recommendations that we laid out for the sort of continuously improving world-class service that we should be able to offer our servicemen and women and their families.
The work of the Defence Medical Services involves courage and skill, and some of it is inspirational. The Committee’s mood has been to support the work of DMS and pay tribute to it, and the report has been well received both in the House and among the wider public. So much courage, skill and good will has gone into the report and goes into DMS generally that one might think that all is well. However, all is not well in DMS, which is probably the area of the greatest difficulty and need in the armed forces spectrum.
Defence medical services are highly specialised, and the individuals involved in the armed forces tend to be youngish and fit, so those working in DMS need to be specialists in fitness and injury. Traditionally—I am going back more than 10 years, before the 1998 decision—armed forces service personnel did not necessarily receive the highest quality of medical care from the most experienced medics, because it was provided by service personnel who might not have been leading specialists in the field. In 1998, therefore, the Government in effect cut the umbilical between Defence Medical Services personnel and armed forces personnel, making it clear that services personnel would receive the best possible medical treatment within the NHS. It was decided that DMS personnel would train and work within the NHS and so broaden their experience.
It must be correct that services personnel receive the best possible medical care.
I am not sure that what the hon. Gentleman is saying is correct. When I visited Selly Oak and MDHU Northallerton, the services personnel—the nurses and doctors—wore different uniforms from the NHS staff. The few military personnel at Northallerton when I visited were treated by, and could identify, services personnel, so I do not think that the relationship has been broken at all.
I must disagree with the hon. Gentleman. When armed forces personnel come back with specialist problems, they can be treated in any of seven—I think—hospitals in the Birmingham area, if they are “casevaced” into Brize Norton. The speciality will be appropriate for the wound—whether an ear, nose and throat problem, an eye problem, a cranial problem and so on. The best specialists in the NHS will be employed to treat them. They would not necessarily be treated in a military ward.
I am sorry, but I disagree. From my visits to Selly Oak, it seems to me—the hon. Gentleman might know better—that if specialist treatment is required in another part of the NHS trust, it happens, but the teams who work on the patients do so in a military-managed ward. I do not think that there is a trade-off between the two.
Perhaps in due course the Minister will adjudicate this round of fisticuffs. My understanding, from my visits to Selly Oak and elsewhere, is that services personnel will be treated using the best available facilities in the NHS. If those providing the care happen to be armed forces personnel, so be it, but if the military defence services do not have the necessary speciality, someone in the NHS will provide it.
There is another dimension. Of course, wherever possible armed forces personnel should be treated in a military environment. If someone has lost a limb, every possible care should be taken for that individual to be with his mates in an environment where his wounds will be understood, and where he can talk in the language he is used to using in a military environment with military personnel. It would be wrong for someone who has lost a limb—the hon. Gentleman pointed out that they can be “casevaced” back within 12 hours—to be in a bed in an NHS ward between two elderly civilians who have suffered strokes. It is thus important to have a military environment, as far as possible, but it is also important that military personnel have the best possible medical care, wherever that might come from.
I am disappointed in the hon. Gentleman, because actually I quite like him, but he is perpetuating myths that do this debate no good at all. Many civilian patients in Northallerton, for example, have military backgrounds, because Catterick camp is on the doorstep. It is not true that many military-managed hospitals have no connection with civilian care. I urge him not to go down that route.
I think that the disagreement, if there is one, is more apparent than real. If someone is “casevaced” out of an area of conflict with very serious wounds, they will get the best possible treatment within the NHS—full stop. If someone in the armed forces is injured more routinely, where possible he will be treated in a military environment. I do not think that there is a chasm of difference between the hon. Gentleman and me—but perhaps we can discuss it elsewhere.
There have been, and continue to be, serious deficiencies in Defence Medical Services personnel. Recruitment is good, which is not surprising because training is of a very high standard and the personnel are remunerated while training. However, retention remains a serious problem, and there are extremely serious shortfalls in the key specialities of general surgery, orthopaedic surgery, anaesthetics and general medicine. Not all is well. It is probably the most serious shortfall in defence provision. The Laurence committee, in 1997-98, considered all those issues, and on 10 December 1998 made the announcement—seared on the hearts of all my constituents—that the Royal Hospital Haslar should be closed by the Ministry of Defence. I must disagree with the hon. Member for North Durham, who unfortunately is no longer in the Chamber: Conservative party policy was not to close military hospitals, but to focus defence medicine on one hospital—the Royal Hospital Haslar— which is why it was so devastating when the announcement was made that that single hospital should eventually be closed.
There was a search for a centre of defence medical excellence. The Army would have liked Guy’s and St. Thomas’ hospital in London.
I am sure the hon. Gentleman is aware that we used to have a naval hospital in Plymouth, which was combined with Plymouth Derriford hospital trust, and there was great regret about that as well—many still regret it. However, overall, I think people understand that it was necessary. It has proved of great benefit, not just from the military point of view, but from the civilian point of view in the hospital.
There are a number of areas where there were service hospitals and where there has been intense regret—none more keen than in the Gosport-Portsmouth area over the proposed closure of Haslar, which has not yet gone ahead.
After Guy’s and St. Thomas’ failed as an option, there was some discussion of John Radcliffe hospital in Oxford, and there was the possibility that a hospital in Newcastle might have been chosen. Eventually, almost by default, the choice fell on Selly Oak hospital, Birmingham, and the Government now seek to make great play of the fact that the west midlands has become a centre for defence medicine. I point out that Selly Oak hospital is in south-west Birmingham, and Lichfield is well to the north-east, some considerable distance away, so 1,100 medical personnel will be located in an area with no particular connection to the services or attraction to them, as far as I can see.
Where do we go from here? We must accept that an effort has been made to provide high-quality treatment to casualty evacuees and that treatment within the NHS is working quite well. Many visitors to the Birmingham facilities pay tribute to the very high quality and skill of the workers there. It is certainly true that there have been improvements to the service environment of military care, and more care is taken now to ensure that military personnel are in military wards—“with their mates”—if possible.
All those who visit Headley Court talk about the quality of the physical environment, the atmosphere and the outstanding rehabilitation work done there. However, there is a need for further facilities for convalescence and aftercare. The charity Help for Heroes, which was founded by Bryn Parry and others, has hit a nerve in that regard and enthused many people to support the concept that service personnel should be enabled and empowered to help each other within a service environment.
Let me focus on the future of Haslar, which has been mentioned twice. There is a civilian dimension to the continuation of the hospital, but that is not relevant to the debate. If the hospital should remain open in some capacity, there would be persuasive arguments for continuing the out-patient and other facilities that are provided for civilian personnel locally. Many of my constituents would like Haslar to be restored as a district general hospital, but that is not likely to happen given the manner of thinking in the NHS. We must identify needs in the armed forces, with which Haslar has a strong connection, and consider how it could help to meet them. Recommendation 21 of the report says that
“providing first-class healthcare for veterans, and making sure that people have confidence that they will be able to access and will receive such treatment, is an integral part of the debt which society owes to those who serve in the Armed Forces”.
Yes, indeed; amen to that.
Some people may not require the specialist facilities at Headley Court but may have other considerable needs such as the need to convalesce in a military environment. The mental health field is important. The excellent charity Combat Stress points out that post-traumatic stress disorder tends to surface about 15 years after an individual has experienced that stress. We have a growing problem with mental health support for those who have served in the armed forces; a significant, pent-up problem is coming our way.
Haslar is zoned for medical use; its listed buildings and scheduled gardens mean that there are severe planning restrictions, and there are problems with a large number of graves at the site.
May I please finish?
There are considerable restrictions on the site’s use, but I am delighted that a number of charities are considering combining forces and putting forward a proposal for Haslar’s use for military convalescence and care. I very much hope that their meetings, which are planned for next week, will be productive.
I pay tribute to the Committee for its excellent report, and to the Chairman, the right hon. Member for North-East Hampshire (Mr. Arbuthnot), for the way in which he presented the report. He gave quite a lot of detail and presented it in a fair and balanced way. I am sure that many in the military and the Ministry of Defence will recognise that. I also pay tribute to the staff of the Committee, its advisers and the people whom Committee members met when they were out and about on the inquiry.
I say that the report is excellent not just because I was a member of the Committee during the inquiry. I was not a member of the Committee when the report was being finalised and published, but I followed the media concern that was highlighted at the time. As we have heard, much of that concern was unjustified and unfounded. I should like to hear the results of the Telegraph test and whether, given the evidence, the MOD believes that there was any justification. The report recognises good practice and where practice has improved, because good practice was lacking in the past and reform was required. It also identifies weaknesses, and I hope that the Minister will take those observations on board and use them to drive further reforms.
I pay tribute to members of the armed forces, including those who have been injured and who have required the medical service. In general, the support that they receive from Defence Medical Services is first class and the services should be commended for their work. Members of the armed forces should be confident that they have rock-solid medical services that they can rely on in their hour of need.
The first issue that I want to address relates to primary and secondary care and rehabilitation services and care. I was unable to make it to the Selly Oak facility, but I heard many good reports about it. In principle, the idea of bringing together the best from the MOD, military health care and the NHS is first class and commendable. We want the best of both, because our military deserves that. I recognise the concerns that have been raised about Haslar, because we have fought a battle over our local hospital in my constituency, but we recognise that people need the best specialist care at the best location. Although the changes are regrettable, especially for people in the Gosport area, military medical care must come first.
MOD hospital units combine the best of the military and the NHS at a more local level. I experienced that service some years ago when I was a patient at Derriford hospital, where I encountered some formidable military nurses. The care was very good, but I was rather frightened of some of the nurses—I am sure it progressed my care somewhat, because I was keen to get out of the place. I thought it was a great facility. Indeed, my son was born there, so I have a lot to commend Derriford hospital for—and the MDHU at that facility.
We have heard about Headley Court and the regional rehabilitation units. The Committee visited the unit at Edinburgh and I also visited Headley Court in Leatherhead. Both are, rightly, highly regarded facilities. I was impressed by the work ethic of staff at Headley Court and those who were injured. They recognised that it was their job to get better so that they could go back to work as quickly as possible. Treatment was not just about patients’ health care, but about getting them back to work as quickly as possible. That excellent facility should be commended. One of my constituents, Sergeant Scott Paterson, who was recently injured in Afghanistan, will, I hope, receive the support of Headley Court. He should be comforted to hear reports of its excellent facilities.
I understand that the Minister visits Selly Oak hospital quite frequently, and that the nurses cancel their leave when he visits. Initially, I thought that that was because he was accident prone, but I now understand that it is because he is so highly regarded there. It is good that he has that connection with the facility, and long may it continue. It is important to have a good connection between Ministers and those who provide the service on the ground, so that they can hear at first hand about any concerns and about good practice that should be spread elsewhere.
I have a few questions. There is a military-managed ward at Selly Oak, and there has been some talk of moving towards having a military-only ward. Has there been any progress on that? If it is feasible, when can we expect it to happen? There are MDHUs only in England, but are they being considered for the rest of the UK, so that people on military bases in other parts of the UK do not have to travel to those MDHUs for the accelerated treatment they require? I understand that clinical governance at Selly Oak and at the MDHUs is first class and on a par with that in the NHS, but what confidence does the Minister have that clinical standards and governance in the military’s primary care services are up to the same standard? Has that care been considered to ensure that it is the best possible?
I agree with the hon. Member for North Durham (Mr. Jones) that, in the past, mental health has been the poor relation both in the NHS generally and in the military, so I am pleased that progress has been made on the Territorial Army facility at Chilwell and on extra funding for Combat Stress. The base’s local community mental health facilities are excellent, so progress has been made in that area. However, I am concerned about the care provision from the Priory Group, which is neither fish nor fowl—neither a local facility nor a military facility. As we heard, when military personnel receive care, it is important that they are surrounded by their comrades, if at all possible. I know that the Priory Group’s contract is up for renewal in November, but has there been a tendering process, and will there be other bids from competitors for that work? It is important that we review what the Priory Group provides.
My other concern is whether GPs really know about the mental health facilities, services and support that are available to veterans. One of my constituents was concerned that his GP was not aware of the Combat Stress facility, and he had to wait about two years before he was referred to it. What awareness-raising will there be so that GPs know what is available to servicemen?
I understand that the Rivers centre in Edinburgh, together with NHS Lothian, is one of the pilot projects for Scotland. In the Secretary of State’s statement earlier, the pilots were referred to as successful. I do not know whether the projects have been reviewed yet, but it is rather early to regard them as successful, so I should like to hear from the Minister about any review that might have taken place.
I reiterate the comments of the hon. Member for North Durham on the identification of veterans. It is a sensitive issue, because not all veterans want to be known as former members of the armed forces, so we must take that into consideration. However, there is a possibility of connecting the Ministry of Defence IT system and the NHS IT system, so that, if required, their details can be accessed and they can receive the best and most appropriate care for their needs. It might be an opt-in system rather than an opt-out. As the programme might be England-only, will the rest of the United Kingdom be considered, so that there is proper connectivity between all the systems?
The Committee Chairman referred to Scotland in terms of a laissez-faire approach. I was pleased to be able to take Committee members to the Scottish Parliament to show off my home country and the excellent facilities and services that it provides, but I was rather embarrassed by the whole experience. People had a very laid-back approach and did not seem to know or understand the needs of the military, military families or veterans. Indeed, I was not quite sure whether the right people were in front of the Committee. They should, perhaps, have put more thought into their presentation, but the visit revealed that, because the MOD and the military are regarded in terms of reserved powers, the Scottish Parliament does not consider them to be its business. That may be an issue for the other Assemblies and Parliaments in the United Kingdom, too. We have problems here at Westminster with the holistic approach, trying to pull different Departments together, but the problem seems to be even greater between Westminster and the devolved Parliaments. We need much greater focus, so that on health, and on education, with which the Committee’s previous report highlighted problems, there is greater connectivity and information-flow.
However, there is evidence that the Defence Committee has made an impact, because, having had a quick look at the Scottish Executive’s website over the past few days, I discovered that there has been a flurry of announcements over the past six months. The Executive have produced a variety of reports, and there is clear evidence that when pressure is applied, sometimes it pays off. Some of the announcements just copy Westminster’s, but we should not be too ungrateful, because they are making the same progress as Westminster. Some of the announcements are of derisory sums of money, although as the Secretary of State said that every little helps, we should be grateful for them; but other announcements will make a difference, and that is good, so we should give credit where credit is due.
The report did not investigate British forces in Germany, but I have some quick questions for the Minister. I recently asked some parliamentary questions about the Gilead facility in Germany, which is under the Guy’s and St. Thomas’ NHS foundation trust contract. The Minister’s answer referred to a validation and review process by the South London and Maudsley NHS foundation trust, and I should like to know the outcome, and whether the Minister is content that the facility’s standards are up to the mark.
A new telephone advisory service has been set up in Germany, and there has been a pilot. Did it involve health care support workers, who are part of the system, or higher-grade nurses? There is some concern about the use of such support workers at the facility, and we want to ensure that it is as good as, if not better than, NHS Direct, or NHS 24 as it is known in Scotland. I understand that the facility has been quite under-used. Perhaps it is at an early stage and, in time, usage will increase, but is there any concern in the MOD about the lack of calls having an effect on the deskilling of the work force at the telephone advisory service?
Several references have been made to military families, and I was pleased that today’s statement recognised that families who have a nomadic existence should neither suffer nor fall to the bottom of the list for housing, health care or education. It is a welcome step, but its implementation will be an awful lot more difficult. We need to ensure that people understand that they are not being de-prioritised, and that they get the place they deserve. Getting a dentist is difficult enough as it is, so it is important that we do not penalise military families. When they are overseas, perhaps in Germany, they receive appropriate care because they are cared for by Defence Medical Services, but it does not seem to be the case in the UK, so I should welcome some progress.
The report did not make an awful lot of the shortage of key personnel, but there are a number of shortages, and the MOD must recognise that a huge amount of work will be required both to keep people in the forces and to recruit new people. The training facility is excellent and will be very helpful to their careers, so to counter those shortages, we should get the message out that those people are welcome in Defence Medical Services. The fundamental problem, however, is overstretch. We ask people to do too much in difficult conditions, and it is no surprise that they leave early. We need to address the issues of overstretch and what we ask people to do.
Overall, the report is excellent. It is balanced and considered, and the MOD must be congratulated on its improvements. I thank all the people who make the armed forces health services the success that they are, and I hope that as many people as possible outside the Chamber—in the armed forces and beyond—read the report and recognise the progress that has been made.
I start by declaring my interest as a medical officer in the reserve forces.
I pay tribute to the House of Commons Defence Committee for delivering its report on an issue of vital importance to our armed forces, and to the Chairman of the Committee, my right hon. Friend the Member for North-East Hampshire (Mr. Arbuthnot), for the manner in which he delivered the report this afternoon. I also pay tribute to the men and women of our armed forces and, of course, to those who look after them, both within the Defence Medical Services, the NHS and increasingly the charitable or third sector.
Today has been quite a big day for the armed forces. We had the launch of the Command Paper. There are lots of very good points in it, a few of which, I must say to the Minister—if I may pull his leg—are eerily familiar. However, I commend in particular the Government’s attitude towards service families and NHS waiting lists. Furthermore, after my brief reading of the report this afternoon, I also commend the statement that people who are being cared for at Headley Court will be cared for to the same standard in the NHS when they become veterans. The Minister and I have corresponded about that issue over the course of several months, so the statement on it is very welcome.
The Defence Committee rightly asked the Government to be more explicit about the so-called Lichfield-Selly Oak dumb-bell, but the response from the Government at the time seemed to duck the issue. Since then, we have been told that Ministers have assessed the project and are now able to give it the green light. Underpinning the whole project, of course, is the need to allow an Army training regiment to relocate from Lichfield to Pirbright, and I will talk a little more about that issue in a moment.
Before I do so, I think that it would be instructive to refresh our memories about the move to Selly Oak and to consider what lessons it might have for the future of the DMS at Whittington barracks. The closure of Haslar dates from Admiral Timothy Laurence’s committee of 1998, which considered that the MOD should not be in the business of running hospitals. Ministers readily agreed to that and a centre for defence medicine was proposed, to be based ultimately in Birmingham, which would cost £200 million.
At the time, the money did not materialise and the Royal Centre for Defence Medicine landed up in a somewhat undistinguished redbrick Victorian building, where it remains to this day. We really should take our hats off to the DMS for putting such a brave face on conditions that are far less inspiring than the service warrants, particularly in current operations.
If the £200 million was pulled in 1998, I must ask the Minister what hope the DMS has of anything really good at Whittington barracks. The stakes are very high indeed, because if the job is poorly done it is likely to lead to further embarrassment for the Minister or his successors, as trained staff decide to leave the armed forces because they feel dispirited, demoralised and undervalued.
I know that the Minister talks to members of the DMS frequently and members of the Defence Committee have also talked to them. I talk to them too, although sometimes on slightly different terms and I must say that the views that are often expressed by the hierarchy, if I can put it that way, sometimes deviate from those expressed by those lower down the tree. That is only to be expected, but I am particularly concerned by the views expressed by people at the coal face, because those people are the future of Defence Medical Services and they are the people who, on a day-to-day basis, are providing the service, both in the UK and, of course, abroad, which is crucial at the moment.
The Midlands Medical Accommodation project was at initial gate in August 2006. According to the Defence Medical Education and Training Agency, main gate was meant to be achieved at the end of last year. I would be grateful if the Minister could tell us why there has been a hold-up. In the deteriorating climate, we have to be cautious about the project coming to fruition. I have to say, however, that it is a matter beyond even the Minister’s exalted pay grade. Can he reaffirm his predecessor’s commitment to Whittington barracks in the event that DMS does not, in the end, move there?
In 2006, we learned from the right hon. Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram):
“If on the other hand, the transfer does not take place, Army training will continue on the Lichfield site.”
I hope that the Minister is able to repeat that commitment today.
Over the past 25 years, medics have become increasingly integrated in the mainstream of our armed forces. Can the Minister tell us what assessment he has made of the importance to the men and women of the Defence Medical Services of being located as close as possible to front-line units? It would be useful if he could frame his remarks in the light of the inconvenient fact that Keogh barracks and Fort Blockhouse are about as close to the heart of the British Army, Navy and Royal Air Force as we are ever likely to achieve.
One does not need to be Mystic Meg to foresee that, if the Whittington project has its funding pared down through harsh economic circumstances, the DMS would find itself in a very uncomfortable situation. Not only would its quarters be substandard but it would be left isolated from front-line units and, crucially, it would be seen as being out on a limb compared with the mainstream of the armed forces.
Page 8 of the report deals briefly with the operation of DMS. It has been ruled latterly by a curious bipartite organisation that includes two three-star officers who sit side by side, a little like the Popes of Avignon and Rome. The deputy chief of staff (Health) is a line officer and the surgeon-general, of course, is a doctor. If we are honest, the post of DCOS (Health) was created because, in the past, doctors have proved to possess variable—should we say?—management skills. Sometimes they are truly excellent and sometimes that is not quite the case, so I ask the Minister to consider whether we continue to require both those people. Of course, we should remember in that context that we continue to have the three single service “tribal chiefs”, as medical directors-general at two-star level. For a small medical service, that structure looks increasingly top-heavy.
The Defence Committee heard that we will now have something called the Joint Medical Command, which is currently at Fort Blockhouse, and, eventually, another body called the Strategic Medical HQ. Of course, under current plans both those bodies will be housed at Whittington barracks, once their new offices have been built.
While not wanting in any way to harm the career prospects of my old friends and colleagues in the DMS, I would counsel some caution. Medical personnel have integrated with the command structure as never before, which is exactly as it should be, so I hope that establishing a stand-alone medical command, as it were, and a shift towards the west midlands and away from front-line fighting units will not signal a new era of isolation for the DMS.
Such a situation would be very bad for the credibility of defence medicine and also for the health of the population it serves. Furthermore, it would be a bitter irony if, in their haste to merge with our NHS, our defence medicine personnel found themselves estranged from their patient base, the men and women of our armed forces. Such a development would call into question the whole purpose of the DMS and suggest that perhaps we might even go the whole hog and rely on an extension of sponsored reserves taken up from the NHS. Indeed, that is largely the direction the Americans have taken with their equivalent medical services.
There are a few small points in the Government’s response that need to be picked up briefly. In paragraph 18, the definition of veteran is given as a person
“who has served for at least one day in HM Armed Forces”
or allied services. That may be expedient; I perfectly understand why the definition was chosen. However, I ask the Minister if it is, in fact, wise. We must value our veterans and in doing so we must protect the “brand”. It seems a little odd that a youngster who has turned up at Pirbright or HMS Raleigh, disliked what he saw and taken the next train back home should be given the privileges of a 30-year-old who has deployed half a dozen times and has a chestful of campaign medals. A more realistic definition would be that personnel have at least passed out of basic training, and I ask the Minister to give that suggestion some thought.
I agree with the Government and disagree with the Committee over the flagging of veterans for the purposes of health care. We need to be careful to protect the confidentiality of servicemen and that extends to the Defence Medical Information Capability Programme. Can the Minister confirm that the same opt-outs that apply to civilians and the national programme for IT in the NHS will apply to servicemen and DMICP? DMICP was meant to be available in a deployable form from this year, but I have not seen it. Where is it, and how far behind schedule is the programme? Can we take it that the operational capability envisaged for 2010 will not now be achieved?
If I may express a few gentle words of surprise at the Select Committee’s report, I would have to say that it focused very much on secondary care, both in this country and on deployment. I am afraid that a constant failing of politicians is that we like to think of health care in terms of hospitals, surgeries and so on. We need to understand that in service medicine, as with practice in civilian life, most encounters take place in a non-secondary care setting. There might have been a little more recognition of the importance of public health and preventive medicine.
It is important that we pay close attention to what one might call service-attributable illness and injury. We should ensure that, as far as possible, people are not harmed by virtue of their service, and that such an approach extends well beyond post-traumatic stress disorder and traumatic amputation. Had there been a little more time, the Committee might have considered the excellent research work done in the DMS, in particular by research institutions such as the Institute of Naval Medicine in Gosport and the Institute of Aviation Medicine. They do extremely important work to enhance clinical care and occupational health. We should not overlook the niche capabilities—some of which are found in those institutions—that are not easily available in the NHS and which the armed forces must continue to provide from their own resources, such as hyperbaric medicine, aviation medicine in general, field and survival medicine, and medicine that deals with the health issues relating to human factors and the extreme physical and environmental circumstances encountered by the armed forces.
The Select Committee report did not dwell on pinch points in the DMS other than to say that there is a problem with retention. Again, had there been time, there might have been some exploration of the impact of the shortage of uniformed psychiatrists. I was surprised that in his statement today, the Secretary of State spoke about deploying psychiatrists. What he neglected to say, of course, was that there are not really any to deploy.
Mental health is an area of service health care that requires, more than most disciplines, an in-depth understanding of the occupational situation in which patients exist and to which we hope that, ultimately, they will return, yet the DMS is short of 14 uniformed psychiatrists—at least it was in January. What impact does the Minister think that that has on the quality of health care provision and what is he doing to improve matters?
The Priory Group’s extended contact expires this November. Can the Minister say when the result of the compulsory competitive tendering exercise to find a replacement will be known? Can he update us on the pilot schemes for veterans’ mental health being run by Combat Stress?
The hon. Member for North Durham (Mr. Jones) spoke correctly about the impact of the press and much of the unsubstantiated adverse reporting that we find in certain elements of it. May I suggest to him a pamphlet published last week about the misunderstandings surrounding the Muslim community in this country? It was written by a journalist—Mr. Peter Oborne, as it happens—and examined the issue well and in some depth. It is a good piece of work and, in the sense that it was written by a journalist, is by a poacher turned gamekeeper. I found it very instructive indeed.
I will defend any of my colleagues and, indeed, any constituency MP who highlights such matters in the Commons and calls Ministers to task on any area of responsibility at all. Anything that my hon. Friend the Member for Woodspring says is well researched and would not be subject to the kind of scrutiny that Mr. Oborne refers to in his report. Mr. Oborne deals very well with some of the more hysterical reports in the press, and the Opposition, who take a serious view of such things, certainly would not pander to them. I can assure the hon. Gentleman of that.
In concluding my remarks, it is important that I say how much I agree with the hon. Member for Portsmouth, South (Mr. Hancock) and my hon. Friend the Member for Gosport (Sir Peter Viggers) in their defence of the work at Haslar. I served at that hospital, which has provided first-rate medical care for many years, and I pay tribute to all those who have worked there. I very much hope that even at this late stage we can review the site to determine whether there is a military health care use for it that may be helpful to DMS or to some of the other organisations that have been mentioned today. After so many years, it would be a pity to lose it, particularly given the nature of the site, which, as my hon. Friend said, is extremely challenging. It is well set up for health care but may present problems for other usages.
To a great extent, I support and have sympathy with the points that the hon. Gentleman is making. However, on Haslar, does he agree that it was more than mischievous for the Leader of the Opposition, the right hon. Member for Witney (Mr. Cameron), to suggest that if he were to come into office, he would keep Haslar open as a hospital, given that it will close in the middle of next year, and that the transfer from its facilities to Queen Alexandra hospital will be completed by the end of June next year? To give that sort of hope to people who have fought a good campaign was maliciously irresponsible and very unfair.
The hon. Gentleman cannot have it both ways, though it is typical of the party that he represents to try to do so. Nevertheless, I am grateful to him for allowing me the opportunity to put on record my party’s position, which is that, if elected, we would hold a review of the Haslar site and its future in defence health care. That is the position outlined by my right hon. Friend the Member for Witney, (Mr. Cameron) and it remains our position. I am grateful to the hon. Gentleman for allowing me to say precisely that, but I do not think that there were any doubts at all in the minds of anybody associated with Haslar.
I am grateful to my hon. Friend. I look forward very much to visiting Haslar again in the near future, when I will reiterate the same judicious words. I would have thought that the matter was simple and fairly straightforward. I look forward to an opportunity to hold the review in the next few months, and I believe that people in Gosport generally and those in defence medicine look forward to that day.
Since defence cost study 15—DCS15—in 1994, the DMS has had a torrid time, yet it has stepped up to the plate time and again. To be honest, I see little prospect of better times ahead, certainly in the medium term, but we live in hope if not in expectation.
This debate on Defence Medical Services has been fascinating. I pay tribute to our armed forces, who, as I have said on many occasions, are outstanding in terms of their bravery, sacrifice and professionalism. As we are talking about Defence Medical Services, I should like to give special mention to our medical service personnel, whom I have seen in Iraq and Afghanistan and at various places in the United Kingdom and elsewhere: they are truly outstanding. Considering the amount of trauma that they have to deal with, both in Iraq and Afghanistan, at field hospitals and in places such as Selly Oak, it is amazing how they cope with that and get on with being the professionals that they are. We must not forget that we are asking an awful lot of them in that regard, so I pay tribute to those people, many of whom are very young. They are truly outstanding.
I am pleased that the Defence Committee made so many visits; it is a tribute to the Committee that it put so much time and effort into this subject—rightly so, because it is vital to the health and well-being of our armed forces. The Committee went not just to Selly Oak and Headley Court, but to RFA Argus to see a field hospital training exercise. Those hon. Members who witnessed that could not but be impressed by it. I pay tribute to the Committee for the time and effort that it put into the report. I regularly sign off submissions to the many questions that it asks, which shows how thoroughly its members do their job. I am grateful for the feedback provided by the Committee, which said that it was impressed, having made those visits and received the relevant information.
I shall not spend too much time talking about Selly Oak, because there is not a lot that we need to defend: the work that it has been doing is outstanding. It is unfortunate that things happened in the media and elsewhere that caused a lot of distress to service personnel and their families, because we know that the treatment and care at Selly Oak, both by the NHS and military practitioners, was outstanding. There were issues to do with welfare, support, reception of relatives and accommodation. However, that was not the NHS’s fault. In fact, that is something that we needed to do and improve, and it is being done by the services. Significant improvements have been made, although I will not go into all of those.
On my last visit to Selly Oak, just a few weeks ago, I talked to almost all the patients there at the time. Again, their view, to a person, was that they had superb treatment, care and welfare facilities. That reflects my experience, having visited many times. There were no complaints; I heard only praise. On occasions, things are perceived as going wrong, or do go wrong, as happens in any hospital or similar institution, but it is inexcusable to use that as an example showing that the whole thing is wrong, and then say that there is a problem. The true test is talking to the service personnel and their families and seeing the results of treatment, in saved lives and limbs, not just in field hospitals, but at Selly Oak and elsewhere.
I should like to deal with the concerns about meeting the needs of veterans, service personnel and families. We published a Command Paper today, demonstrating our commitment to the best possible care for our service personnel, their families, and veterans. I will tell hon. Members more about that in a few minutes. Over the past two years, we have worked hard to ensure that our medical care remains world class. I accept, as the hon. Member for Westbury (Dr. Murrison) said, that our defence medical staff are under great pressure: they are doing an awful lot, given the tempo of operations at the moment, and we need more people. Although we have met all our commitments, whether in respect of reservists or using civilians, we are asking a lot of defence medical staff, and we have to do more to maintain recruitment and retention. No one has ever tried to deny that from the Government’s point of view. A lot of work is taking place, and given the arduous nature of operations, the dedicated care that those staff give patients is outstanding.
We are all struck by the commitment and hard work of our people in our field hospitals in Iraq and Afghanistan, which Committee members have visited. Those people have to deal with horrific injuries, but they get on and do the job. The field hospital at Camp Bastion has moved from tented accommodation to purpose-built infrastructure: the building is temperature controlled and includes a fully equipped operating theatre, an intensive treatment unit for the most critically injured individuals and state-of-the-art medical technology, such as the CT scanner, allowing high-quality imaging of complex injuries, which ensures swift and accurate clinical decision-making. The facility brings together the skills of experts in trauma surgery and recovery, intensive care and nursing with state-of-the-art equipment. However, we are not simply concerned with saving lives in operations—of course, that is a key factor—as we must do our best to ensure that our wounded have continuity of high-quality care, including rehabilitation. The work of Defence Medical Services and NHS staff at Selly Oak, Headley Court and other facilities is vital to the care of our wounded. I have already praised the people at those facilities for what they do. We continue to build on that success.
Today, we published the first ever cross-Government strategy for supporting our service personnel, their families and veterans. The Command Paper will reinvigorate the cross-Government delivery of services to our service community, as well as providing us with an opportunity to continue to develop our work with the devolved Administrations. The Committee rightly raised a number of issues with regard to that. However, the situation has changed beyond recognition, given the work that is taking place at both official and ministerial level. I have met my ministerial colleagues in the Scottish Government on a number of occasions—I was up there earlier today—and there is a close degree of co-operation. We must keep focusing on that. The Command Paper is about cross-Government working. Supporting our servicemen and women, their families and veterans is not just the responsibility of the Ministry of Defence, but is a cross-Government responsibility. I can assure hon. Members that that is taking place and that there is a close degree of co-operation.
We owe our service personnel a debt of gratitude, and it is important that we deliver a comprehensive, fair and relevant package of support, which is set out in the Command Paper. The demands of service life affect not only our armed forces personnel, but their families, who support their careers by accompanying them around the UK and overseas and maintain stability while spouses, parents and/or children are deployed. In addition, we must always remember those who have served and those who paid the ultimate price and the families they left behind. We have a duty to ensure that people receive the support that they need in recognition of their service. While we continue to deliver improvements to the package of support we provide to our service community, we in Government know that more is possible. This work underlines our commitment to work relentlessly to continue to improve health care services to service personnel, their families and veterans.
A lot has been said today about Headley Court and, as I said earlier, I share the Defence Committee’s recognition of the achievements of the staff and patients there. As hon. Members will know, I visit the centre regularly. The dedication and hard work of the staff there, and the courage of the patients, never ceases to amaze me. The Government promised in their response to the Committee’s report to make available the outcomes of their review of rehabilitation services as soon as they were ready. I am pleased that we were able to provide the Committee and Parliament with that information in May.
The review concluded that defence medical rehabilitation is a success story, returning service personnel, whenever possible, to full operational fitness faster than in the past. The review confirmed that Headley Court should continue to be the specialist centre for rehabilitation, and it recommended further improvements to allow it to continue to deliver first-class rehabilitation. Indeed, today’s Command Paper underlines the Government’s commitment to ensuring the high level of care provided by Headley Court through to the NHS.
My right hon. Friend the Secretary of State announced on 6 May that we have decided to invest an additional £24 million in the Headley Court site, as hon. Members have mentioned, over the next four years, to maintain and enhance the facilities and capabilities. It is an old, tired building and it needs work, as we must make a number of improvements. The additional money will enable us to replace the new ward annexe, which was designed to be a temporary structure, by extending the Peter Long unit and incorporating into it an extension and an expanded prosthetics facility, treatment areas and imaging facilities. That money will allow us to replace progressively, over the next few years, all the existing 180 non-ward bed patient and staff accommodation.
I pay tribute to the charitable bodies that have contributed to the work at Headley Court and its predecessor organisations since it first opened its doors to RAF patients shortly after the second world war. The estate is owned by a charitable trust, which has contributed generously to the improvement of facilities on the site. The Soldiers, Sailors, Airmen and Families Association has purchased a house in nearby Ashtead, which was opened earlier this year as a home-from-home for families visiting patients at Headley Court, supplementing accommodation that we provided on-site.
Last year, a new charity, Help for Heroes, generously offered to raise funds for a swimming pool and gym, which would together form a new rehabilitation complex, with additional space for rehabilitation and assessment. There are already a number of gyms on the site, and a hydrotherapy pool as well. It is important that we work closely with the service charities and other charities to ensure that we can provide the best possible support for our service personnel and their families. That has always been the case. Nevertheless, I welcome the help given by charities. As I said on 6 May, my right hon. Friend the Secretary of State has decided to invest £24 million, but with current funding for facilities, Headley Court will see investment over the next four years totalling some £28 million, in addition to the funding that Help for Heroes will provide.
Turning to investment and improvement at Birmingham, I was delighted earlier this month to visit the site of the new hospital. It is not yet complete, but I went into a ward that had been provided with some beds showing the form of the cubicles and individual rooms to get an idea of scale, and I was impressed. There will be a military ward at the new Birmingham hospital, and most people accept that Selly Oak hospital is at the leading edge of medical care for the most common sort of injuries sustained by military casualties, such as polytrauma. We have been developing a military-managed ward at Selly Oak hospital, and we want to migrate that concept to the new hospital at Edgbaston.
The new hospital will offer outstanding facilities for military patients. The military ward—the design has now been agreed in outline—will be a designated trauma and orthopaedic ward within the trust’s trauma and orthopaedic division. It will have additional features for the exclusive use of military patients, acknowledging that they have special requirements and are likely to benefit from being together. It will be the ward to which the majority of military patients will, when clinically appropriate, be admitted when their specialist or acute care requirements have been met. The ward will be managed by a senior military nurse—the ward manager—who will be selected and appointed by the MOD in consultation with the trust, and it will be staffed by a combination of military and civilian nurses, the majority of whom will continue to be military.
Military patients will be cared for in single or four-bedded rooms, all of which will have en-suite facilities. The ward will have the capacity, if required, to accommodate about 30 military patients. That number is higher than the number currently accommodated. Civilian patients will occasionally be admitted to the ward, as capacity allows, but unless a major civilian emergency requires all available bed spaces, it will always be possible, because of the configuration of the ward, to care for military patients separately from civilians.
It was interesting to talk to injured service personnel at Selly Oak. When I asked them about being cared for with civilian patients, many of them said that they had no problem with that. Some do, but it is interesting that quite a few do not and find it useful to be with civilian patients. However, because of the nature and format of the new ward, we can care for our military patients separately from civilian patients. We shall incorporate new features in the military ward, and space will be provided exclusively for military use, including a quiet room for briefing relatives, a communal space for military patients to gather, facilities for exercising, and a dedicated military rehabilitation area close to the ward.
The new Birmingham hospital will be Europe’s largest and most modern acute care facility. I am absolutely convinced that it is the right place for the teaching and research work of the Royal Centre for Defence Medicine and the care of our operational casualties. That is why today we have reinforced our pledge to ensure the continuity of the facilities provided by Selly Oak, the enhancement of its ethos, and further improvement of the facilities provided to families.
I shall refer briefly to the midlands project. I am pleased that a decision has been made on the redevelopment of Whittington barracks, Lichfield, for use by DMS. The project’s assessment phase is complete, and the Government have concluded that the strategic, operational, economic and personnel benefits will fully justify an investment of about £200 million over the next few years. Co-location on the Whittington site of the DMS headquarters and the DMS training centre will provide a critical mass of military medical expertise and assets in the midlands. The area will be reinforced as the central focus for British military medicine, and Lichfield will provide the future military home for DMS, which will work in close partnership with local universities and the NHS. All the related military medical activities benefit, and can benefit further, from relatively close proximity.
Our project assessment confirmed that the Whittington site offers excellent potential for meeting DMS needs. A combination of new build and the upgrading of existing buildings will provide high quality, fit-for-purpose accommodation, training and sports facilities within easy travelling distance of Birmingham, including the RCDM. The site also offers an adjacent military training area, and full planning approval for the redevelopment of the site has been granted. The project will be delivered in three increments. The first will be the relocation to Lichfield of new strategic medical headquarters and headquarters for the recently established joint medical command by 1 April 2010. Increments two and three will be the relocation of the DMS training centre, and the provision of training facilities and accommodation for staff and trainees between 2010 and 2014. By the end of the project, there will be more than 1,100 DMS personnel at Lichfield, including up to 700 trainees. The project will deliver 811 new single living accommodation bed spaces. The decisions announced yesterday on military medical accommodation in the midlands are further evidence of the Government’s commitment to the health care of service personnel.
I want to bring hon. Members up to date on significant and perhaps under-appreciated developments in DMS clinical care, especially the early stages of the care of battlefield casualties. During the past 18 months, DMS has developed and introduced a number of advances to ensure that it has assessed best practice worldwide, including US experience, and it has carefully audited the outcomes using internationally accepted methods.
The recently published Journal of the Royal Army Medical Corps provides the most comprehensive collection of papers yet of UK medical experience on current operations. It shows that the priority that we have placed on maximising survival on the battlefield has proved successful. The underlying message is that more personnel are surviving than would be expected, given the severity of their injuries; that the quality of care for the injured is at least the equal of that usually found in the UK; and that our success coincides with the introduction of a significant number of initiatives.
The Minister cited the Journal of the Royal Army Medical Corps. Does he recall, as I certainly do, a paper that it printed about two years ago by a distinguished orthopaedic surgeon and member of the RAMC, which pointed out that there is a severe airlift shortage for combat evacuation in theatre? If he does, will he assure us that that has now been rectified?
The hon. Gentleman will be aware that we have increased the number of helicopter hours. I make regular checks, and the medical evacuation teams in Afghanistan are doing an amazing job and saving lives today that might not have been saved a few years ago. We are always trying to put more resources in. We have increased the number of helicopter hours, and we are trying to increase them further, but our medical services in Afghanistan are of such a standard that they are saving lives that might not have been saved a few years ago. That is due partly to improvements in civilian medical care and the introduction of CT scanning on deployment, and to our ability rapidly to exploit new technologies and equipment such as the introduction of a bandage that reacts with blood; a bandage that enables local pressure to be better applied to a wound; and a tourniquet that can be applied one-handed, and is issued to every soldier. That has given our soldiers the means to save their own lives. We are sharing those lessons with the NHS and civilian health authorities, not least because reservists are going back into the NHS, so they are benefiting the country as whole.
It is important to make the point that others provide support, including the National Blood Service, through the provision of blood and platelets to deployed theatres. Such services, together with the Medicines and Healthcare products Regulatory Agency, provide support and governance advice in procuring equipment and setting up a process that enables us to take blood from soldiers in theatre, remove the platelets and return the red blood cells to the donor so their performance is not compromised. That represents a technological solution to the medical and logistical challenges posed by the need for platelets to be delivered daily to theatre. The Defence Medical Services are determined to learn constantly, to engage in scientific debate, to stimulate further research and development that will assist us to maximise the survival rates of personnel injured on the battlefield, and to improve the quality of life for the survivors.
On the priority treatment of veterans and associated issues, we all accept that over decades entitlement to priority treatment has not been made well known to veterans and has not always been used as we would have liked or expected. We made an announcement towards the end of last year about extending the priority so that GPs can make referrals if they believe that an injury was caused in service. The reinforcement of that is now taking place for GPs, primary care trusts, hospital trusts and so on, which is a good step forward.
The Committee rightly raised concerns about how we make that process stick and work. It is right to deal with that, which is why the cross co-operation between ourselves, the NHS and the devolved Administrations is important. It is important to get the information out through the ex-charitable organisations, journals, websites, the Veterans Agency and GP surgeries. I accept that if I asked some GPs if they know about the announcement, they might well say, “I’m sorry, I don’t know about that. I get lots of information passed through to me about various issues.” The key is to keep ensuring that we reinforce the message. The way to do that is to keep checking that the message is getting through. However, something that has not happened in decades is not going to happen within a few months. We must maintain the pressure in relation to that and I assure hon. Members that making sure health care workers are aware of that process is one of my priorities.
In terms of veterans health and tracking, hon. Members will appreciate that although we accept that more can and should be done, the millions of veterans we currently have—three still from the first world war, many from world war two and many from the period of conflict in Northern Ireland—means that it is impossible to track veterans. The records do not exist and people move or there are changes in many other sorts of circumstances. The defence medical records system and the link to the NHS mean there is an opportunity to do more, which we will consider.
It is a fact that once some people leave the services, they do not want anything more to do with the military and that is the end of it—although they might change their mind in 20 or 30 years’ time. It is also a fact that the vast majority of service personnel do not have any issues or problems whatsoever; they get into employment pretty quickly and get on with life. They use their immense skills, training and various professional attitudes to become good citizens who contribute in a variety of ways. We must do more for those who do get into difficulty because it is a great tragedy when that happens. We will, of course, continue to explore how we can do more in that area, as the Committee has requested.
I shall emphasise a number of the initiatives we have launched in relation to mental health. There were also a number of issues that we set out today in the Command Paper. In terms of the mental health pilots, we started first with Camden and Stafford and we are still rolling out the rest. It is early days yet to take a concrete view on the success of the pilots, but they seem to be working well. We are working with Combat Stress and, of course, the NHS to provide veterans with a mental health service. Over the next few years, initiatives are also taking place in the NHS to increase therapists. That is a key part of the process and will take account of the issues around veterans’ health.
The extension to the medical assessment project that I announced across the river at St. Thomas’ hospital means that any veteran from 1982 onwards can go for a mental health assessment. They should primarily be referred to an assessment by a GP, but they could self-refer.
May I remind the Minister of a point made about the funding and Combat Stress? I appreciate that extra funding has gone in, but I believe that the specific problem is about the new NHS model of funding that is being developed, rather than the MOD model. Is the Minister aware of that?
I am not aware that that is a problem. The point is that we are working together with Combat Stress and the NHS to develop the veterans’ mental health service. We have put significant funding into Combat Stress and I see Toby Elliott, its chief executive, on a regular basis. I am not aware of the specific problem that my hon. Friend mentioned, but I am happy to come back to her on that.
It is important to ensure that those who need help go to the right place and therefore commissioning to provide that is the right way to go. That help might be at a Combat Stress facility or it might be part of the NHS. Obviously, by that stage, we hope there will be a service for veterans’ mental health. The key thing is to make sure that the veteran is directed to where they can best get help, and commissioning that process by working together is the correct way forward.
May I return to the issue of giving proper support for veterans and raise the point again about veterans in prison who suffer from psychiatric illness? They will not have organisations such as Combat Stress available to them and will not have some of the dedicated medical care that is available to civilian veterans. Those in prison are particularly vulnerable and need to be given some consideration. The link between the MOD and the prison service needs to be considerably strengthened.
The hon. Gentleman makes an important point and research has taken place on the issue. Dr. Ian Palmer, the psychiatrist who runs the medical assessment programme at St. Thomas’, has offered his services, about which I have written to the Under-Secretary of State for Justice, my hon. Friend the Member for Liverpool, Garston (Maria Eagle). He is willing to go into prison to do assessments. That offer has been made, but the hon. Gentleman is right: we need to consider what more we can do in that area, as it is of concern.
I should have made it clear to the Minister earlier that Combat Stress is concerned that it would have to bid to a variety of NHS trusts throughout the country, rather than just to the Ministry of Defence. That would create a huge bureaucratic burden on Combat Stress and might make its operation quite difficult.
The intention is not to create a huge burden; it is to get it right for the veteran and to establish where they would get the best support. Combat Stress is working with us on that. In any relationship there are always issues when pilots are developed. The whole point of having a pilot is to consider the potential problems that might arise, but we also need to develop a service that fits the model we are looking for. We work closely with Combat Stress and I have listened carefully to its comments. I am sure that that partnership will develop further in terms of how we commission services for veterans. I re-emphasise that the connection with the devolved Administrations is also important in relation to mental health issues and that we are working with them on that.
A point about service personnel was made and, as hon. Members will know, there is the reservist mental health scheme in Chilwell, to which reservists can be referred if they have a mental health problem. They could obviously then be admitted to one of our mental health units if necessary. The way we approach mental health generally is to hold pre and post-deployment briefings for our service personnel, which are increasingly led by commanding officers. There is a big issue about stigma that we have to deal with. Although that problem is improving, we must do more work on that and there has to be leadership from the top.
I will when I have made this point. We have deployed medical staff in theatre to provide help if necessary. In fact, I heard about one medic who flies out in a helicopter to a forward operating base if necessary to provide the right sort of counselling or help.
I cannot say that the system is perfect, but I believe it is a good model and we must keep it under scrutiny and assessment. If someone has a particularly difficult problem that needs to be dealt with, they can come back to the UK. There has been a lot of work on the trauma risk management project, which the Royal Marines have used. The Army and others are also going to use that project.
On the decompression period in Cyprus, I was talking to some Scottish soldiers today who believe that it is a good process and that it is the sort of thing that should happen. At the moment, there is no evidence that the process works, but everyone feels that it is a good thing. Again, I have been to see the facilities in Cyprus, which are good—although they need constant attention and improvement. That is something we must do. A number of mental health initiatives are not just for veterans, but our serving personnel.
I thank my hon. Friend for giving way, but in the interim he made reference to what I was going to ask about, which is if he recognises what I refer to as the “buddy” scheme that was developed by some of the Royal Marines based in Plymouth. That is becoming increasingly widely used to deal with some of these issues.
Yes. My hon. Friend makes an important point. The Royal Marines have done a lot of work on the issue. It is important that, in the light of experience, we constantly review what we are doing. We know the type of combat experiences that our armed forces personnel are going through at the moment.
The Priory was mentioned. We are asking for bids for the contract in that respect. We are not in a position to announce a decision on that, but we will do so as soon as possible. We have a liaison officer from one of the mental health units at the Priory centre regularly. I am not aware of any specific problems regarding the treatment and care there, but I am always happy to look into an individual case.
Primary care and governance in clinical care were raised. That is an important point. One of the questions that I asked some time ago was how we know that the DMS provision of medical services is at the level that we expect. We believe that we know it is, and clearly we are seeing the results in trauma care, but we also have to consider services elsewhere, such as in primary care and so on. That is why I asked the Surgeon General to examine the issue and why he has agreed, along with the Healthcare Commission, to do an inspection. The Commission for Healthcare Audit and Inspection (Defence Medical Services) Regulations 2008 were laid before Parliament.
I think that we are of the same mind on the issue. We need to keep a constant watch to ensure that we continue to make improvements. Of course, that does not take away from the amazing care that our service personnel receive. Some of the negative points from the armed forces continuous attitude survey were mentioned in the press last week, but one of the positives was the way in which our service personnel welcomed the medical care that they receive.
With regard to the German issue that the hon. Member for Dunfermline and West Fife (Willie Rennie) mentioned, I am not aware of any particular problem being caused at the moment. However, I will be happy to write to him once I have examined the issue and I will do that as soon as possible.
With the leave of the House, I shall end the debate with a few short remarks. I thank very much those hon. Members who have played such a valuable role in both the inquiry and this debate. I shall wind up the debate with only three points. The first relates to the charities that have received such honourable mention today, such as Combat Stress, Help for Heroes, SSAFA—there are many others. One view that the Committee strongly holds, perhaps in contrast with some members of the public, is that there is nothing intrinsically wrong with medical help for our men and women in the armed forces being provided by charities. There is something very valuable about members of the public being able to express in a tangible way their support for the work that our armed forces do in such dangerous and demanding circumstances, so I pay tribute to the charities that achieve that.
I am pleased to say that my second point has been made already by the Minister. He said in relation to mental health that there is an issue of stigma that we have to overcome. We need to get past that. We need to move on, beyond the stigma attached to mental health, and I am pleased to say that that is gradually beginning to happen in this country. When people go out and do such incredibly dangerous things on our behalf, there is no reason to suppose that they are physically invulnerable, so there is equally no reason to suppose that they should be psychologically invulnerable. In either case, they need the best possible care.
Finally, this debate and our inquiry have shown that often it is the members of the armed forces themselves who are concerned about the medical care that they may receive. When we went to Camp Bastion’s hospital last week, we found that the armed forces were taken round and shown that hospital, which made them realise that it was a proper hospital in the most extraordinary conditions in the desert. As a result, they felt that they would be well looked after if they were wounded, whether seriously or less seriously. They felt that they would receive proper care, so to those members of the armed forces who are listening to this debate—I hope that that is every single one of them, except for those very actively engaged—we can say that they should be reassured and their families left behind at home can also be reassured that their loved ones are in the best possible hands with the Defence Medical Services, to which we all pay tribute.
Question put and agreed to.
Adjourned accordingly at fifteen minutes past Five o’clock.