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Charities: Veterans Care Sector

Volume 607: debated on Thursday 24 March 2016

Motion made, and Question proposed, That this House do now adjourn.—(Julian Smith.)

Thank you, Mr Speaker, for granting me this debate on a subject on which I know I speak often. I beg patience from those who might understandably become slightly exasperated by my ongoing drive. Let me outline briefly why this subject is so important, why we must start to get this right now and, crucially, how we can get it right. I am not in the Chamber for the last debate before a recess simply to whine away.

I do not profess to be the brains behind the operation when it comes to addressing the role of charities in a sustainable future veterans care model. My thoughts are a coalescence of those of many individuals and teams who have served at the coalface, delivering programmes of care and transition to our servicemen and women, both civilian and serving. This is not about me and my personal experiences, although I clearly cannot disregard them. Furthermore, I am not precious about these proposed reforms. I encourage others to come forward and to challenge and contribute to the debate. That said, since I published the reforms in early January, they have been scrutinised by many in the profession. It has become clear that they are a set of reforms that the service charity community and, crucially, the service charity users, can really coalesce around. I ask the Minister and his Department to consider my remarks in that context.

Charities have for more than a century been the mainstay of the provision and offer to servicemen and women returning from operations. There were just a few to start with, born in the aftermath of the first world war, in response to the sheer number of veterans and service personnel returning from that conflict. Through the decades, these charities have slowly but surely expanded to provide more and more whole-care, wraparound packages for our servicemen and women, who find returning to these shores a struggle.

Let me say now, at the outset, that we must stick to the truth about those whom the sector is set up to benefit. The vast majority of veterans settle and transition from wartime operations perhaps changed by their experiences but able to adapt and cope. Veterans are not victims, they are not dangerous and they seek no advantage or favourable treatment or, in particular, sympathy. In fact, a veteran will usually be the last to complain about their treatment and the last to seek to blame.

Against this burgeoning charitable provision in the last century, the state was happy to take a back seat, content to allow the sector to soak up the problem of veterans care. In some ways, this was understandable. Intense conflict was not a regular occurrence, veterans care needs are complex and long term and, I am afraid, the bald truth is that there are few votes in getting veterans care right. However, I think it would be fair to say that this century has seen a marked change in the scale and complexity of veterans care in the United Kingdom.

In 2003, this House decided to go to war in Iraq. This was swiftly followed by significant expansion of the British effort in Afghanistan to include the now notorious Helmand Province. In Afghanistan, we walked into the most intense ground combat seen by the British Army since Korea in the ’50s. The numbers of troops that those two conflicts required combined with the increasing survivability of soldiers on the battlefield saw an explosion in the demand for the services of veterans care charities.

Against that scene, I decided to try to win a place in this House to be their voice, because I believe we can do it. We can deliver better for our veterans. It is not “us” to allow our veterans to become embittered, desperate or discarded. It is not in keeping with the debt that this nation owes those individuals. It is not British. It is not the British Army’s way of doing things. We look after our people; we do our duty by them, as they have done their duty by us. And crucially, we do not just talk a good game on this; we actually make sure it happens.

I have made it my mission in this place to understand as much as possible about the system as it currently stands. I have spent hundreds of hours, in this first year, meeting and visiting veterans, service providers and armed forces communities. I wanted to layer that knowledge on to my personal experience: I had recently made the transition from military service; I had seen many friends attempt to find help unsuccessfully; and I knew of the dark battles that some of my own men face daily in their minds. For the Government of the day, veterans care, like a lot of things, was not part of the plan for Iraq or Afghanistan.

Set against an increasingly desperate narrative of shocking cases of care, and against a complete vacuum of provision of this type of care by those who had asked our servicemen and women to do their bidding, the great British public stepped up. Help for Heroes and other charities like it were born. They were born out of the gratitude that said simply, “The boys deserve better than this. If the state won’t do it, we will.” Those service charities have been the saviours of many lives—the lives of those whose comrades fought to keep them alive on the battlefield, lives remarkably preserved in Iraq and Afghanistan, but who have found their hardest battles within the relative safety of the United Kingdom.

I cannot speak highly enough of those groups for what they have done. They have stepped up and delivered that duty of care that every commander, at any level in the UK military, feels towards the men and women they command. It is one of life’s deepest privileges to command men in war. Those of us who fought and bled with them will remain forever in the debt of these service charities for the fact that they carried on that duty on our behalf.

I congratulate my hon. Friend on securing this important debate, and I wonder whether he would allow me, as chair of the all-party parliamentary group on eye health and visual impairment, to highlight the brilliant work of Blind Veterans UK, which empowers visually impaired veterans to live independent lives following their selfless service.

I thank my hon. Friend for her intervention. I really mean what I say: these groups really stepped up and delivered what was needed for our armed forces veterans, when there were no other options. It was that very British way of coming together and dealing with that that made some of us so proud.

I really do congratulate my hon. Friend on his impassioned speech, and on his research. I, too, would like to say that we must remember the families of the veterans. I pay tribute to Go Commando, the charity in my constituency, which does so much for veterans. The families left at home have raised money to do such good work for 40 Commando and all the marines and their families, to give them holidays and days out, and to give them children’s centres and help and support.

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

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

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

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

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

I agree with everything my hon. Friend has said, particularly his words about the Help for Heroes charity. I had the privilege of being the president of the Royal British Legion in Leigh-on-Sea. Will my hon. Friend join me in congratulating the army of volunteers who do so much to raise money to make sure that we look after our retired servicewomen and men?

Of course. I cannot highlight enough what those volunteers have done, with no financial or selfish reward, but from a sense of duty to the country and to our servicemen and women. We must look after that. If we do not cultivate and protect it, I fear that over the years it will die out.

Before my hon. and gallant Friend resumes his main narrative, may I thank him for the vigour that he brings to these issues on the Defence Committee and to other issues that we examine as well? What is his view on the sheer numbers of service charities and the difficulties of co-ordinating their efforts? I am thinking of the huge variety, from post-first world war charities such as Veterans Aid in Victoria to very modern ones such as the adventurous Pilgrim Bandits in Hampshire, where special forces take grievously injured service personnel on adventure treks to the mountains and rivers of Canada, for example? How do we bring all this effort together when there are so many actors in the field?

I thank my right hon. Friend for his intervention. I will address precisely that point in about two or three minutes’ time.

Does my hon. Friend agree that local authorities must play a part in co-ordinating local charity work and supporting veteran care so that we ensure that our councils work with the armed forces covenant properly to produce tangible local results?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let me start by congratulating my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) on securing this debate. I shall be honest from the start and say that, in the six minutes I have to reply to the debate, I will not, unfortunately, be able to respond to every point that has been raised. I agree with him: it is absolutely right that he spent his time articulating the case and allowing other hon. Friends to contribute. Perhaps we can pick up some of the detail at another time. Since arriving in the House, he has made it his mission to campaign on behalf of veterans, and he has already forged a strong reputation as a champion of ex-service personnel. That reputation was cemented by the excellent report he presented to the Prime Minister earlier this year. Indeed, we should expect nothing less from a former officer of the Royal Regiment of Artillery.

Today is also an opportunity to pay tribute to veterans. This year, we mark a series of major anniversaries, a century on from Jutland and the Somme and some 25 years on from the first Gulf war. Such momentous occasions remind us of the extraordinary service and sacrifice of our soldiers, sailors and airmen. Those heroes were willing to put their lives on the line to defend our nation. That only underlines our responsibility to all our brave veterans, of whom there are some 2.8 million in this country. We must ensure that their transition to civilian life is as smooth as possible.

The majority of service personnel go on to enjoy a successful second career or, indeed, a well-earned retirement, but, sadly, as we have heard today, there are some who fall on hard times. Although the Ministry of Defence takes its responsibility to address needs arising from service very seriously, charities fill a void. They play a vital role in supporting wider welfare requirements, providing everything from housing to healthcare and helping wounded, injured and sick personnel back on the road to recovery. They prevent vulnerable individuals, some of whom leave service early, from falling through the cracks.

With 12,000 to 20,000 individuals leaving the UK armed forces every year and the world becoming a much more dangerous place, as the terrible Brussels attacks this week remind us, we will inevitably demand more from our people. That means that the work of the voluntary sector will become even more important, but charities are under serious pressure, not just from the scrutiny of their governance procedures, but from a decline in charitable giving. That is a direct consequence of the end of our enduring combat campaigns, which acted as a significant recruiting sergeant.

The Government would not ask our great voluntary sector to take on more responsibility without giving more power to its elbow, so we are helping out in three ways. The first is funding. In last week’s Budget, my right hon. Friend the Chancellor announced that £45 million of banking fines would be allocated over the next four years to support military charities. That includes £500,000 for CAIS Wales to fund its Change Step veteran services, which help veterans with post-traumatic stress disorder and a range of psychosocial problems to make positive changes to their lives. There is also £2.7 million for Royal British Legion Industries to help to fund its six care homes, which cater for ex-servicemen and women and their partners.

The second way in which we are helping is leadership. The MOD is providing critical support to the sector. Armed forces charities’ employees, many of whom give their time for free, do an incredible job. However, in tough times charities need to do more to pool effort, minimise duplication and make the most of their resources. There is plenty of scope in that respect. It is worth reminding the House that the military charity sector is as broad as it is complex. We are all familiar with household names such as the Royal British Legion, SSAFA and Help for Heroes. According to the 2014 Directory of Social Change online guide to service charities, however, there are more than 2,200 registered military charities, such as Blind Veterans UK and Go Commando, which were rightly mentioned by my hon. Friends.

We have been supporting organisations such as Cobseo, an umbrella organisation for 250 charities, in their critical cluster work. Cobseo is bringing more coherence to the sector by having members work together, as I saw for myself when I recently attended a housing cluster meeting. It is expanding the evidence base on the big issues that affect veterans at various stages of their lives, from better employment opportunities to residential care homes. We have recently given it almost £500,000 to intensify its efforts. Like my hon. Friend, we believe that common standards will help to focus charities’ activities and ensure a greater consistency of service across the country. We know that some smaller charities exist purely to satisfy a niche requirement in some areas of the country, but for the more established charities, we encourage membership of Cobseo.

The third way in which we are helping is through greater collaboration. My hon. Friend and I agree that there is also a need for the Government to do more. The needs of veterans straddle Whitehall boundaries and national borders. They take in the MOD, the NHS, local authorities and our devolved Administrations. At times, the arrangement is unwieldy and unnecessarily bureaucratic.

Yet, while we agree on the ends, we do not necessarily agree on the means. My hon. Friend believes that we should have a Ministry for veterans, but on balance I do not believe, having considered the idea carefully, that it is the best way forward. That is primarily because it would duplicate what already exists. As Lord Ashcroft has said, a veterans agency would be a cross-Government agency. Yet we already have cross-Government support from the Department of Health, the Department for Work and Pensions and the Department for Communities and Local Government, as well as other Departments. We also already have the DBS—Defence Business Services—Veterans UK, which, while focusing on pensions, compensation, and welfare support, works in the same way.

Above all, we are now using the armed forces covenant, which is designed to stop members of the armed forces family facing disadvantage, as a mechanism to join the dots between services. The covenant is backed not only by a £10 million annual fund, but by a clear governance structure. We have a three-star covenant reference group, chaired by the Cabinet Office, which co-ordinates delivery of the covenant for Her Majesty’s Government. It brings together all relevant Departments and devolved Administrations in a way that a single agency or Ministry could not. We have a ministerial committee on the covenant chaired by the Chancellor of the Duchy of Lancaster, and each year the Defence Secretary ensures that the MOD publishes an annual report to Parliament to communicate the delivery of our covenant commitments.

In my closing seconds, let me say that I find it deeply heartening that so many of my hon. Friends are in the Chamber for the last Adjournment debate before the recess. I hope that that demonstrates the commitment of this Parliament to our veterans.

Question put and agreed to.

House adjourned.