Defence Committee
Oral evidence: The Armed Forces Covenant in Action? Part 5: Military Casualties, HC 940
Tuesday 29 April 2014
Ordered by the House of Commons to be published on 29 April 2014.
Written evidence from witnesses:
– Ministry of Defence and the Department for Health
Members present: Mr Dai Havard (Chair); Mr Julian Brazier; Mr Jeffrey M. Donaldson; Mr James Gray; Mrs Madeleine Moon; Sir Bob Russell
Mr Havard was called to the Chair.
Questions 199-323
Witnesses: Anna Soubry MP, Minister for Defence Personnel, Welfare and Veterans, Ministry of Defence, and Dr Dan Poulter MP, Parliamentary Under-Secretary of State for Health, gave evidence.
Q199 Chair: I am sorry that we are a few minutes late. We are trying to deal with the situation as we go at the minute—we are between Chairs. We will let people settle down for a second and remind them all to turn off their telephones, and other gizmos and gadgets that make a noise, please.
We are taking evidence from you today on the military casualties part of our continuing look at various elements of the covenant, just so that people understand what we are trying to do this afternoon. We have obviously taken a lot of evidence prior to this, as you know, and you have written to us and so on. This is our chance to put any final questions to you before we make any further observations that we want to make on the issue. I am chairing the meeting because, as you know, James Arbuthnot has finished as the Chair of Committee, and we are in the process of electing a new Chair on 14 May. I will deal with today’s proceedings.
I will start with a list of questions. We have asked a number of questions previously about particular elements, but one thing that we have not asked about before, and which has become a bit of a concern to us recently—because we have had some representations, as well as looking at the information you have sent us—is the current compensation scheme. The suggestion is that the speed at which compensation claims are being made is a difficulty. Individuals have certainly experienced what they report as difficulties, and in your submissions to us, you say yourselves that there were initially problems with the process. We need to know if there is a systemic problem, whether there are sufficient people deployed to it and what is happening with that compensation scheme. Clearly it is important to people to get the payment as soon as they possibly can. If there anything you could help us with on that, it would be helpful.
Anna Soubry: I must say that while I am sure that there must be cases that have taken far too long, it is almost inevitable in any system. When I went up to Norcross, I actually sat with those very caseworkers who, effectively, deal with all claims, whether they are under the compensation system or war pension schemes and so on. I have to say that I was actually very impressed. I shouldn’t say that as though I am surprised that people working up at Norcross are good, but I think it was the degree and level of care that they exercised when they looked at any claim.
As I am sure some Committee members understand, there are different types of claims. Some of them have history to them, and I saw examples of that where somebody was making a claim in 2013, or perhaps at the beginning of this year, in relation to an injury that they said had occurred during their service 10 or 20 years before, or perhaps even many more years before. So there is a huge variety of claims, some of which will require more paperwork to be attracted to them, because more inquiries need to be made.
Equally, I have to say—forgive me if this sounds like I am a Minister who went into something with more ignorance than she should have had—that I think the systems are very generous. The presumption is that the claim is met, almost. Whereas in other areas you, as the claimant, would have to produce the evidence and then substantiate it and so on, I think we operate a system that is very fair, because there is almost a presumption that you are entitled to something. It is almost a case of saying, “Now, let’s work out what the percentage is.”
I am very concerned on other levels about the delay that sometimes occurs, whether it is a service complaints delay or this sort of delay. Perhaps I may write to the Committee with any facts and figures we have about how quickly we turn around compensation claims, and with any detail there is on the age of the claim, when it was made and, most importantly, where it pre-dates and so on. May I undertake to do that?
Q200 Chair: That would be very helpful. In fact, your Department has previously written to us to provide that sort of information, which was around the time that Lord Boyce did a review of 12,000 cases. You gave us the figures, but they were from 2005 to March 2013, and we are trying to understand the circumstances since then. Perhaps you could supplement this information and give us an idea of whether or not there are delays. We understand that additional staff and temporary staff were put in, and that a whole series of measures was taken to try to address the situation, but we are concerned that we are still getting some suggestion that delays and difficulties remain. So, if you could write to us, that would be very helpful—thank you very much.
Anna Soubry: It might also be useful for me to check with some of our charities to see whether in their experience there is an inordinate amount of delay. As you and other Committee members know, there is nothing better than talking to people who are, frankly, on the front line. They are dealing with this almost on a daily basis, so they can say, “You know what? I don’t care what your stats tell you. I am working for the Royal British Legion and helping people with these claims, so I know that on average they are taking at least”—whatever time it might be. I will drill down into that as well.
Q201 Chair: Thank you very much; that’s very helpful. In fact, you did say previously that you were keeping the charities appraised—I think that was the phrase that was used—and I am sure that you were appraised by them as well.
Could I ask you a question about amputees and prosthetics? We know that, after the Murrison review, there was a discussion about what should be done. From that, a discussion took place between the MOD and the NHS about the possibility of an equivalent scheme being developed, and there was a discussion about possible joint procurement. However, regarding the sustainability of that, there was a suggestion that the funding for wheelchairs and, in particular, for what I might describe as high-end prosthetic limbs and so on, was due to run out in March 2015. We understood where we were, and we think we understand where we are and where we are going, so our question is about what is going to happen in March 2015. What has happened to the two other elements of possible equivalence and a procurement process?
Anna Soubry: Dr Dan can help us with that, especially given the work that he has done on this over a considerable period of time. Is that all right with you, Dan?
Dr Poulter: Yes, of course. It is absolutely right that, since the publication of the Murrison report, we have put aside up to £15 million of funding specifically for prosthetics. I understand that veterans’ health is now centrally commissioned by NHS England, rather than through the local clinical commissioning groups. I understand that NHS England has committed to maintaining funding for many veterans’ services going forward. I believe that it will consider this to be part of its core budgets, and that it has responsibility to veterans. I think this is a big step forward. We are all very aware that, once our troops return from Afghanistan, while the immediate public awareness of our troops being in a combat zone may not be there, we have a moral obligation and a duty to continue to look after those many brave servicemen and women who have been injured in the service of their country. That was why we set up the initial scheme and the initial funding to support prosthetics. It is also why NHS England is taking this forward with considerable vigour and is showing commitment to veterans.
You may be aware that the Murrison report also set out the need for a number of specialist prosthetic centres to be set up. There are now nine centres that have been set up and identified at Birmingham, Bristol, Cambridge, Carlisle, Leicester, Portsmouth, Preston, Sheffield and Stanmore. They provide, in addition to more localised hubs that have been there for some time, greater community-based support for veterans. In fact, those specialist prosthetic centres also provide care in a secondary care setting, which is really helping to concentrate the centres of excellence that we envisage will provide the equivalent quality of care that Headley Court provides to serving personnel in the months and years ahead.
Chair: That is interesting.
Q202 Sir Bob Russell: May I come in, Dr Poulter, on the subject of cosmetic coverings of prosthetics? If the soldier has lost his leg or arm and is given a cosmetic covering while serving with the Ministry of Defence, and he then becomes a civilian, can you guarantee that the NHS will provide replacement prosthetic cosmetic coverings to match the living limb, as it were?
Dr Poulter: Each individual person’s case is looked at on their merits.
Q203 Sir Bob Russell: If the Ministry of Defence thinks the merits are there for that serving soldier, why would the national health service decide that the merits no longer apply when that person is a civilian?
Dr Poulter: That is very much why we set up the prosthetics fund: to make sure that we improved the quality of care for veterans and that we did have specialist care and resources available for when they left the armed services; and there is the advantage of having our nine specialist centres of excellence. When we look at one of the big challenges that we face with servicemen and women who have lost legs and who have amputations, one of the issues is that sometimes there is a challenge with the fit between the limb and the prosthesis. One of the concerns that there was historically in the NHS was that there was not always the funding, the resource or the care available that there was in a setting like Headley Court to make sure that those servicemen and women were properly looked after and supported to make sure that that fit was correct, and that the ongoing fit was monitored and the ongoing support provided. I am confident that now we have them under specialist prosthetic centres, those more individualised needs of servicemen and women will be better addressed, and properly addressed, in future.
Sir Bob Russell: Chair, I will read the transcript in due course, but we may need to return to this at a later date.
Chair: Fine.
Anna Soubry: May I add something? I think what you are trying to get at, Bob, is that the same standard should be applied when you move over to the NHS, and that is absolutely what we are determined should happen. Obviously Dan is a doctor, so he understands more than I do the medical side of things, but there is one thing that I did not know and that I think should be very much in the public domain, especially as we withdraw from Afghanistan. The idea that that is suddenly the end of the need for people to be returning to places like the Queen Elizabeth could not be further from reality; there will be a long-standing continual need.
When I went to the QE, I met a young man who had lost both his legs above the knee—as a Reservist, by the way—in Afghanistan. He has been set back many years because he needs further surgery on his stumps. One of the things that I did not know until I got this job was that one of the side effects of blast injuries is that muscle turns to bone, which means your stumps need further surgery, and then effectively you start all over again. So there will be a continual need for this work for many years to come.
Q204 Mr Gray: I do not think you have answered Sir Bob’s question at all. His question was very specific. The Army provides a prosthetic covering of the same colour as the rest of the man’s skin. The question was: will the national health service undertake to do precisely the same thing after the person leaves the Army? That is a very specific and detailed question. We do not want to know about all the brave soldiers; what we want to know is: will the NHS provide a covering for the prosthetic that is the same colour as the man’s skin?
Dr Poulter: That was exactly the reason why we set up the prosthetic centres. We wanted to have the equivalence of care that the Army provides replicated in the NHS. That was not the case before.
Q205 Mr Gray: So that is a yes, is it?
Dr Poulter: So, yes, we envisage and would like to see the same quality of care in the NHS, and that is why—
Q206 Mr Gray: No, hang on, this is a very specific question: will the NHS provide a prosthetic with precisely the same skin colouring, as the military does? I do not want the stuff about your funds and everything else. The question is: yes or no, will you do the same as the MOD does?
Dr Poulter: I have said yes. That is what the prosthetic centres are there to do.
Sir Bob Russell: That was why I said I wanted to look at the transcript.
Dr Poulter: To provide that equivalent of care that is available—
Q207 Mr Gray: So the answer is yes.
Dr Poulter: Yes. As with everything else, there has been a historical disconnect between the quality of care that was historically available for serving personnel and what was available when they became veterans and turned to the NHS. As the Murrison report highlighted, the quality of care was not as good as it needed to be. That was why we set up the nine specialist centres, and NHS England is leading—
Q208 Mr Gray: So the answer to the question on the colour of the prosthetic is: yes, the NHS will provide that. Is that correct? Never mind all the rest of it.
Chair: All right, James; I think you have got the answer to your question.
Dr Poulter: What I will endeavour to do for the Committee, to be absolutely clear on this, is to ask Sir Bruce Keogh, the medical director of NHS England, to write to the Committee and confirm that that is how things will be delivered in the specialist prosthetic centres. It is how things were envisaged when they were set up.
Chair: That is very helpful and that is why I asked the question about equivalent schemes. If you could do that for us, that would be useful. We will come back a little later to consistency and sustainability of provision.
Q209 Mrs Moon: On wheelchairs, do you expect people to travel to the nine centres or will wheelchairs be a local provision? Where will wheelchairs be provided from?
Dr Poulter: There are not just nine specialist centres. There are other centres that help veterans with prosthetic needs. There is something of a hub and spoke model with the specialist centres. There are centres of excellence, just as there are in other areas of medicine, such as for cardiac surgery or the like, but that does not mean that someone will not receive slightly more localised care where appropriate.
There are some serving personnel who become veterans who are in wheelchairs. We have made very good progress on prosthetics and we are beginning to see the equivalence that was there with the armed forces coming across into the NHS in England. We have also made good progress on IVF. There are men who lose their testicles as a result of combat and are now receiving IVF treatment, which was not the case before. We are also, with wheelchairs—building on the prosthetics treatment—looking at ways of ensuring the equivalence of service for serving personnel with wheelchairs and finding ways to deliver that. In the short term, we envisage that LIBOR funding will become available for that. NHS England is looking into ensuring that that is as sustainable as the prosthetic services are.
Q210 Mrs Moon: The last time we looked at this issue and asked for evidence, we made the point that we do not want to know about just NHS England; we need to know what the provision is across the UK. Can I take you back—never mind artificial insemination—just to wheelchairs? We have veterans who are now in wheelchairs and we have people—possibly those who are currently able to use prosthetics— who will eventually have to move into wheelchairs because, for example, of weight gain or deterioration. It can take months to get a wheelchair. You have to be properly measured and fitted. Even when the wheelchair is ordered, it has to be specially made and you have to be fitted into the wheelchair once it arrives. Trust me, I have been there and I know about this. How are we going to ensure that people are not having to travel long distances to get access to quality wheelchair services and that they will get them quickly? Once you need to move into a wheelchair, and your condition deteriorates and you need a change in your wheelchair, it needs to happen fast if your mobility capability is not to deteriorate, as you will know. So what are we going to do to speed up wheelchair services and make them directly accessible across the UK?
Dr Poulter: Unfortunately I cannot speak for the devolved Administrations—I am the English Health Minister—but I we now have the offer through the nine specialist prosthetic centres, which will of course also involve supporting people whose condition deteriorates and who require other ways of mobilising, through a wheelchair or otherwise. Those centres are putting us in a very strong place to ensure that we better look after veterans and have that specialist centre of excellent support in all aspects of care, be it general mobilisation, physiotherapy, occupational therapy or orthopaedic input—all of that being in one place in a holistic way at a centre of excellence. That is a good model of delivering health care and it is one that works well at Headley Court. We are now going to see nine of those around the country, with some supportive centres to supplement those.
It is a duty of all parts of the health service—to a veteran or anyone else—once a person has been given a diagnosis and a package of care and support, to look after and support that person in their own home as well. One of the problems in the past was that we did not always have enough emphasis at what was primary care trust level or at a local health care level without the CCGs. We did not always have properly trained personnel in the medical work force who were able to specialise and understand the needs of veterans.
This Thursday, we will be publishing the refreshed mandate to Health Education England. In that, for the first time, there will be a requirement to ensure that there is a trained veterans’ specialist in every clinical commissioning group, who will be there specifically to understand and support veterans in local health care areas in England. That is a big step forward to provide continuity of care for veterans with more specialist mental or physical needs.
Anna Soubry: I think you also need to know that both our Departments are—I know this sounds awful—working on a strategy in relation to wheelchair procurement. As part of that, because, as Dan quite properly said, health is a devolved matter, as you—
Mrs Moon: We certainly do know.
Anna Soubry: Exactly. Working with devolved Administrations is part of that to ensure that we have the same service right across the UK, and not just in England because of the Department of Health.
Q211 Chair: My question at the start was partly about whether the procurement is going to go ahead.
Dr Poulter indicated assent.
Q212 Chair: So the answer is, “Yes, it is.” Perhaps you could give us some update on what progress is on that.
Anna Soubry: At the moment, our Departments are working together on a joint strategy. What we have undertaken to do is to ensure that we work together—all of us, with the devolved Administrations as well as, if you like, the two leads on it, which are bound to be the MOD and the Department of Health. Obviously, I, as the Veterans Minister, don’t just have a duty to the English vets, but to veterans throughout the UK. While it is wonderful that I can go and beat on Dan’s door, it is a bit more difficult for me to do that with the devolved Administrations. But in this instance, for example, I think it is fair to say that we are all on the same page to make sure that that is happening.
Q213 Chair: Can I be clear then? Basically, the devolved Administrations, as well as NHS England and the MOD, are all part of that discussion about the joint procurement process, are they?
Anna Soubry: Yes. The wheelchair strategy, yes.[1]
Q214 Chair: So it is taking out the competition in that sense.
Anna Soubry: Yes.
Q215 Chair: If you could update us on where that is getting to, that would be very helpful to us.
Anna Soubry: No problem.
Chair: We have a lot to cover. I suggest that we move on to the next area. Madeleine, you were going to ask about mental health?
Q216 Mrs Moon: Yes. I would like to know, Minister Soubry, whether you think we have sufficient capacity in the defence community mental health teams to deal with personnel quickly and thoroughly. The longer you leave someone who is developing a mental health problem, the worse they are likely to become, and the more difficult they are to work with. Do we have capacity to deal with them quickly?
Anna Soubry: Serving personnel?
Mrs Moon: Yes.
Anna Soubry: Yes. I am confident. We have to put it in context. Take PTSD, which is one of many mental health issues that can arise with anybody. Obviously if you have experienced a traumatic incident, or witnessed one, it is a disorder that you can develop. But if you look at the figures, in our personnel, it is about 4%.[2] So we have to set it in context. That does not mean to say that that 4% is not extremely important, but this is how I see it, having come into this job after six months.
I came in perhaps with a few preconceptions that it was a huge problem within our armed forces. When I get the figures I can put it into the right context. I perhaps came in with a few preconceptions about our armed forces, the British stiff upper lip and all that, and that it wasn’t taken seriously. As you know, I speak frankly. I have to say that I am impressed, certainly at the level that I deal with within the Department and the senior officers and officials. But even when I go out and I speak to ordinary serving personnel and maybe a rank or two higher, I think that our armed forces are in a much better place than they were. There are things like the campaign, “Don’t Bottle It Up”. Actually, I think throughout the whole of society, the stigma that was undoubtedly attached to mental health has begun to be removed. I am not saying that we are in the right place yet, but we have made huge progress.
Some of us remember that fabulous debate in Parliament about two years ago. To have Members of Parliament stand up and say, “I’ve got a mental illness” was an enormous breakthrough in this stigmatism which has held us back in the past. You asked me the question: forgive me. I think it is something like 200. I am not always great with figures and that is my fault, I accept. When I look at the various medics in place, the availability, the quick access to treatments and just the greater understanding about mental health issues, I think we are in a good place. I think increasingly our statistics are beginning to show this. There are more people reporting incidences, certainly of post-traumatic stress disorder. I know you could say that that means that more people are going through terrible, traumatic episodes. The other way of looking at it is that, yes, there is a delay—sometimes 10 or 15 years has traditionally been thought to be the case. I think there is a higher percentage now of people reporting it in a way that they would not have done 10 or 15 years ago.
Recently I went to America for a conference with other veterans Ministers. There were people from the United States, Canada, New Zealand and Australia and they, too, are seeing a similar increase where the stigma goes and campaigns like “Don’t Bottle It Up”. The Australians have done a marvellous campaign. I saw the video. They use real life stories—veterans or serving personnel explain what happened to them, then what happened to them in their illness and then how they went on to get treatment. That is making a huge difference. You asked me whether I thought the capacity to help is there. My answer is yes, I think it is there.
Q217 Mrs Moon: Following up on the issue of post-traumatic stress disorder, if you went to the States you would be aware that in the specialist centre in Washington they feel that there is a direct link between post-traumatic stress disorder and mild traumatic brain injury.
Anna Soubry: Yes, I do. I am very much aware of that.
Q218 Mrs Moon: Are we taking that same view? Are we treating them as one, as the US do? Are we treating them separately? Do we have the same capacity to treat not just the individual but the family? The US thought it was particularly important to deal with the person within the context of their family?
Anna Soubry: There are two questions there, both very important. As part of this very, very direct conference that I went to—there were not many of us—so, no disrespect to any officials, but it wasn’t one of those huge conferences. It was very one on one, or rather four on four, but anyway. Dan may know because of his medical experience, but this is a new field of work. It may be that what you have seen in Washington was a bit ahead of the others. Effectively, it was a lecture from the man who is leading much of the research in America, a lot of it mirrored by the great research that Simon Wessely is doing, as you will be familiar with. Yes, this link is in many ways a new field of work, but it was not new to my team. It was something we are aware of. What I hope is that we will increasingly work with our colleagues across the world who have many shared experiences. That was what we agreed. We have much to learn from each other.
In relation to the treatment of the family, yes, we know that this is important. I would never pull away from that. I do not know what Dan thinks on this, but I do not think we should—I was going to say “put too much on the family”. I do not mean it like that. Obviously, a family can help and support somebody who has mental illness, wherever it may fall, and that is important, but we have still to look at the individual and not overly rely on the family. I don’t know whether that makes sense. They are part of the recovery, but I do not think we should in any way abdicate to the family our responsibility to make sure that the individual gets everything that he or she needs in the form of treatment.
Q219 Mr Brazier: On the team from Oxford who have been pressing for a long time now to do a full study of the last substantial group of people going to Afghanistan, did that ever get the go-ahead? I haven’t heard from them for some time. There was a big effort by an Oxford neurologist to do a study which was blocked for ages and ages by the Army Medical Services. Perhaps I should have given you advance notice of this, but have we done any studies at all on brain injury, specifically getting brain scans before they went, so they could look at them when they got back to see whether or not there were any differences?
Anna Soubry: I cannot help you, Julian—
Q220 Mr Brazier: You will have to write to me.
Anna Soubry: I get the point you are making, which is so important. Dan and I were talking beforehand. We have the mantra “all health includes mental health”. He knows it better than I, and I think it is something that has now begun to be understood throughout the medical world, whether it is looking at service personnel or wherever it may be. As you will understand, when somebody is serving you make sure that they are fit. They all have to pass fitness tests every so often and so on. Part of that might actually be making sure that they are fit mentally. That might indeed involve that sort of work. I will say this: there are all sorts of research works that we should be doing in relation to those who have served most recently in conflict, and there is increasing agreement that this is the sort of work that should be funded. It will take many years for it to come to its full fruition, but it is good, valuable research.
Q221 Chair: So do you have an estimate of the mental health problems that are likely to come from those who have served in Iraq and Afghanistan? Are you saying that you are going to do some particular work on that?
Anna Soubry: No. If you look at Simon Wessely’s work, we are getting a very good picture of the levels of people, certainly with PTSD. It currently sits at about 4%.[3] As you know, it is higher for reservists, which may be a question you will ask today. If we look at Canada, Australia and America, their rates are higher. They are more high in America and not quite as big a percentage—about 6%, I think—in Australia and in Canada. It seems to be at that sort of level, and as we know, that reflects the population at large, which in itself is a very interesting statistic.
Q222 Mrs Moon: May I come back to the issue of the family? This is a big issue for the Americans. One of the things they found was that mental health destroyed families. So they treated the family and literally brought the whole family to the unit, agreed a treatment plan and the family were each part of that treatment plan. The person went back to the unit and the unit also had a component part of that treatment plan. They then found they had greater numbers of successful outcomes. That was the point I was wondering whether you were dealing with.
Anna Soubry: I agree with you, and I am sure that Dan, as a physician, would say that almost anybody, whatever the problem may be, will often need the support of their family when receiving treatment. You will recover better, whatever the problem may be, if your family is part of the treatment. The only caution I give is this: I never want the pressure to be on the family to deliver stuff that should be delivered by the person providing the treatment.
Q223 Mrs Moon: It is the engagement in the treatment, rather than the responsibility for it, that we are talking about; that is the difference.
Anna Soubry: Yes, Madeleine, but I am slightly cautious because what happens if the marriage or relationship breaks up, and unfortunately the family no longer exists for that person? I want to make sure that they are still getting the level of treatment that they need. I do not want to put too much on families. I do not know what Dan thinks.
Q224 Mrs Moon: Perhaps if you had a look at what the Americans are doing, you might be interested.
Anna Soubry: Madeleine, you might be right, but with some stuff from America, just because they found some outcomes, it does not mean that they are doing everything right. You always have to look at the detail of any study. I always apply some caution when looking at one study in one area, as opposed to looking at other studies. I do not think there is any disagreement: families are important.
Chair: Some of the definitions and approaches are slightly different. Obviously, we would like the best practice that we can get.
Anna Soubry: Absolutely.
Q225 Chair: Dr Poulter, did you want to say something about this?
Dr Poulter: Just a couple of thoughts. The first is on the issue of the study in Oxford, which I think is about doing CT head scans, and looking at the ongoing impact of traumatic brain injury, concussion and blast injuries. That potentially has a lot of merit. One of the issues with any medical study is that we have difficult ethical procedures in each country for agreeing how medical research can be done, and of course a CT head scan carries with it a risk in itself—a small background risk, just as when you subject someone to an X-ray or a scan—of exposure to radiation. That is something to consider in the ethical approval processes, but I am sure that it has considerable merit to it, and I am sure we would be happy to go away and look at that on the back of today’s meeting.
We often find in other areas of medicine that we get a lot of very beneficial learning for the NHS, particularly regarding trauma care, from what happens in the armed forces. If we can deliver better care for our services personnel, and find studies and evidence to help us to do that, that has a really good beneficial effect on the NHS. We certainly find that when health care staff have served as reservists or in the forces, their ability to deal with trauma in acute hospitals is often much enhanced when they return to the NHS, as is their ability to deal with high-pressure situations, and often their leadership skills. A lot of benefit can be found, so we will look into that and take that away with us.
Q226 Sir Bob Russell: The Armed Forces Covenant involves families, and I would like to ask the Defence Minister about domestic violence. We have joined-up government here—two Departments—but the Home Office is also keen to pursue issues relating to domestic violence. How is the Ministry of Defence dealing with the concept of cases of domestic violence where a member of the family, whether uniformed or civilian, requires help? Does the Ministry get involved? What are the reporting processes? Do they involve the civilian police, for whom, obviously, the Home Office is the appropriate Department?
Anna Soubry: Do they involve the civilian police? Yes. Is it taken seriously? Yes. Could it be done better? I am sure that somebody would say that there are things that we could always improve. Certainly, the information I have is that incidents of domestic violence are taken extremely seriously, and properly and rightly so. The involvement of the civilian police is also important in making the proper sort of inquiries which you would expect to be taken forward.
Q227 Sir Bob Russell: Is it possible that in due course the Committee could be told how a victim of domestic violence within the military family, as it were, could ensure that his or her concerns are dealt with? I don’t need to tell you that sometimes there is a reluctance within the military family to admit that something is wrong.
Anna Soubry: When you say the military family, you don’t mean the immediate family but the greater military family, is that right?
Q228 Sir Bob Russell: The greater military family, yes.
Anna Soubry: Look, I have no doubt that there have been times when people have really rather swept things under the carpet. This happens everywhere, as we all know.
Q229 Sir Bob Russell: It shouldn’t happen.
Anna Soubry: It shouldn’t happen—I completely agree with you—but our military reflects much of society. People have worked here and elsewhere to say that these sorts of matters should not be swept under the carpet. Certainly, I am told in no uncertain terms by the most senior of officers in all three services that their policy is that this sort of behaviour is no longer tolerated.
Q230 Sir Bob Russell: Could the Committee be provided in due course with information on how this would work in practice, so that we know and can then reconsider the situation of our own troops?
Anna Soubry: Yes, absolutely. If there are practice directions and those sorts of things, that would be no difficulty at all.
Sir Bob Russell: Thank you very much.
Q231 Mrs Moon: I shall very quickly ask another question on domestic violence. If a services member is being investigated by civilian police, how are you able to track instances of domestic violence to ensure that you become aware of whether the problem is increasing? Again, going back to other nations, they have seen very large rises in domestic violence.
Anna Soubry: Sorry, who have?
Q232 Mrs Moon: Other nations. America in particular has seen a tremendous rise in domestic violence among returning services personnel. Are we tracking cases? Are we making sure that domestic violence is reported to civilian police, and that the Ministry of Defence is keeping track? Would you write to us about that?
Anna Soubry: Of course. Just very quickly, once again we always need to treat the American experience with some level of caution. First, the way that American soldiers are recruited is important, certainly during the Iraq war. Secondly, their length of deployment is thought to be one of the reasons why they have higher incidences of PTSD, for example. There may be many other reasons as well. Certainly, the information I have is that the way in which we decompress people, and all the—almost—rehabilitation which takes place after people have been deployed, is often very different to the American experience. I put in that a little caution because I think it is important to remember that, obviously, the vast majority of people in our armed forces do not beat up their spouse or partner. It is a minority. This is not to say that it is not important, but it is a minority. I don’t want any stereotyping.
Q233 Mrs Moon: It is also an issue that lots of people will talk about, but only off the record. This is an increasing problem. I would like to know what you are doing to track that.
Anna Soubry: Okay.
Q234 Mrs Moon: The other thing is alcohol misuse.
Anna Soubry: Well, there are statistics which show that, aren’t there?
Q235 Mrs Moon: Are you working across agencies, both within local communities and across Departments? How are you tracking alcohol problems, within both the veterans community and the serving community? Often the instance of violence may take place during leave, and it goes to civilian police and doesn’t necessarily come back.
Anna Soubry: Mr Havard, do forgive me. I am sorry to be so ignorant, but have you had evidence from Professor Sir Simon Wessely and his team? They have done extensive research on violence and alcohol and all the rest of it.
Q236 Chair: Yes, we have had some background evidence, but what we are looking into is what is happening in terms of the current process and future monitoring.
Anna Soubry: Speaking very, very frankly, I am not convinced that we couldn’t do more about the culture of drinking in our armed forces. I am sorry, but I will say that. Let me roll back to the days when I was a barrister, which were not that long ago. I well remember Bar messes, so I have some familiarity with the mess system. I am not trying to say that being a criminal barrister was ever in the same category of stress.
Q237 Chair: Of course, the legal profession has never had a problem with alcohol.
Anna Soubry: And of course that’s absolute rubbish, as you and I both know.
Chair: Exactly, Your Honour.
Anna Soubry: Let’s be honest about cultures. It was a pretty stressful job—I am not saying that it was as stressful as the front line in a theatre of war, but there were stresses to it—and there was that idea that you let your hair down. I do not have a problem with letting your hair down, and I am not some killjoy—I do not in any way want to be portrayed as that. I am sure that Dan will talk with more authority than I can, because it is similar for his profession as well—there are lots of stresses and strains for front-line doctors and nurses. There was perhaps an attitude in the past that it was acceptable, as part of that de-stressing process, that you could all go out and consume vast amounts of alcohol as part of the camaraderie and the letting down of the hair to get rid of the stresses of the day. There is nothing wrong with some of that, but the levels of drinking, to the point of oblivion and all the rest of it, is a culture that I do not welcome in any work force.
Sir Bob Russell: Does that include the Press Bar?
Anna Soubry: Wherever it may be.
Q238 Mr Gray: Fine. We do not like the boys getting drunk. What are you going to do about it?
Anna Soubry: It is a cultural change—
Q239 Mr Gray: Yes, but what are you going to do about it?
Anna Soubry: Hang on, James. You say, “What are you going to do about it?”, but I cannot say to the Army, the Navy or our great Air Force, “Right, from now on you will do A, B, C or D.” As the Minister, what I can do and continue to do—I have only just recently started this very conversation—is to talk about looking at that culture. As you know, you cannot just put out edicts to change a culture; it begins slowly, sometimes, and sometimes it picks up some sort of momentum.
What is happening is that there is a cultural shift in any event in our armed forces. They now completely get the idea about taking a young man or young woman when they first enlist. If you have read—as you will have done—the Ashcroft report, which has been widely welcomed, in effect you are now saying to that young person and often to his or her mother and/or father that, by the time those young people leave the armed forces, they will actually be a better person than the one they already are because that is why we have employed them. So, to use that awful phrase, it is a journey for that individual, and part of that is an increasing understanding of and emphasis on the welfare of that individual. It is an equal concern with whether they have the right kit or had this training or that training—
Q240 Mr Gray: I am sorry. That all sounds very worthy and will no doubt make a good leader in The Daily Telegraph, but the question is that we are concerned about alcohol culture in the military. You said that it was a bad thing and that you were worried about it too. My question was what we can do about it, and you said that there is nothing we can do about it in the Government—it is the journey and the culture and a variety of other things, all of which is very worthy—but there are of course things that you can do about it. Until recently, for example, the armed services had alcohol when they were deployed, but it has been abolished—the rum in the Royal Navy has been abolished. So there are things that can be done. The question is—because it is not the journey and the culture and the “We hope to do something about it”—what are you going to do about it? If we agree that there is too much alcohol in the armed services, what are you going to do about it?
Anna Soubry: I am helpfully advised that there is a guide to alcohol for senior commanders, which will be refreshed on the basis of the outcome of the research into alcohol. That research is due to be reported soon. Forgive me, Mr Gray, but you and I both know that you can write all the most wonderful guides and manuals in the world, but what is most important is the implementation of them. That is something that I am looking at, and I can assure you of that.
I will be frank with you, I read the recent coroner’s report into a very sad suicide case—of a serving person—and there were many things in that report that concerned me. One of them, quite clearly, was the culture of heavy drinking. At the risk of being sexist, we know across society that women have been drinking more alcohol than we have seen before. Equally, we know that the incidence of binge drinking and the quantities of alcohol across society are beginning to diminish. I hope that that would be the same in the armed forces.
Chair: I am going to try and make some progress now. We have a lot of things to get through. Thank you for that on the alcohol. We will obviously continue to see the extent to which it is an accelerant, a catalyst, a contributor or whatever, and what the responses are to mitigate its worst effects, but we now need to move on a little to the question of mental health and reservists.
Q241 Mrs Moon: Very briefly, one thing that could be done about alcohol problems in the armed forces is tackling the high level of subsidy on alcohol in bars in military units. Perhaps if they charged the same price as you would pay in town—I well remember being served a triple gin and tonic for £1 in a military bar and having the fright of my life. However, moving on—
Anna Soubry: I nearly said that would be back in 1950, but that would be exceptionally rude.
Mrs Moon: Actually it was two years ago and it was in the Falklands.
Chair: Right then, on reservists.
Q242 Mrs Moon: How can we ensure that the support is there for reservists? It is acknowledged that there is a high incidence of mental health problems among reservists. How we will make sure that our reservists across the UK have access to timely support for mental health problems?
Anna Soubry: I know Dan is dying to get in and give us even more detail. First of all, the fact that we have recognised that we have a higher incidence among the reserves in itself alerts everybody. Secondly, as you will know, in my constituency, as it happens, at Chilwell we have mental health services that are available for veterans and reservists. I am confident that, by virtue of that recognition and then the provision of services, people understand that there is almost a greater need among our reservists, but the work that Wesley and others are doing is drilling down as to why. We have to understand why our reservists have a higher incidence of mental health problems.
It is thought that all the steps—mobilisation, then coming back from being mobilised and decompression—are exactly the same. The difference is that your regular returns to his or her unit and his or her service family and continues at the unit or base. The reservists return to their non-military family and perhaps without that support when they go back to their civilian lives. That may be one of the reasons why the rates are higher. There is continuing work on that, but there is an absolute acceptance of complete parity of provision of support services and a recognition that there is a difference between the two in terms of the higher rates. By the way, that is the same in Canada, New Zealand, Australia and America.
Dr Poulter: I think there is an opportunity here. We were talking earlier about what benefit the NHS can gain from the armed forces. There may be an opportunity for the armed forces to gain something from the NHS and what happens in civilian life. There are occupational therapists in many workplaces who support people in their roles in work when people run into difficulties with substance misuse, or perhaps have the early signs of depression or mental health problems, or are struggling to cope, perhaps after a deployment. In the NHS, we have a lot of occupational therapists who are very well trained and we are now looking at them to be involved in that process to support reservists when they are back in the UK, or certainly in England from my point of view as an English Health Minister. How the NHS can help to support more in that respect is being discussed at the moment. I think that is something that will bring great benefits.
Rather than waiting for people to get to that point of crisis, when someone has become a full-blown alcoholic when perhaps their life and whole support network have been destroyed by domestic violence—all those problems are exacerbated by alcohol or substance misuse—we need to get that earlier support in. In the reservists there is an opportunity to do that through that work in the NHS and that would bring benefits to those reservists and their families as well. There is a real opportunity here going forward with the 2020 reservists vision to build on that in terms of the links with the NHS and the support networks and the multidisciplinary NHS teams who can help with some of these issues.
Anna Soubry: I am sorry. I don’t think Dan mentioned the pilots. We have eight or 10.[4]
Dr Poulter: A number.
Anna Soubry: We have a number of pilots where mental health workers from the NHS come into the military, then we have mental health workers from the military working in the NHS. They are learning from one another and most importantly helping on that transition point, so they understand when somebody is leaving and coming into the NHS. I think it is a brilliant idea.
Q243 Chair: The Department has told us that from this month there is the implementation of the improved occupational health—
Anna Soubry: Yes, there is that is well.
Chair:—and dental strategy and so on with partners from the health service, the third sector and so on to try to maximise the use of these various activities. I presume that that is part of what you are speaking about.
Q244 Mr Brazier: Could I build on those answers, but take us away from mental health to other wider issues? What additional medical services do you think we need to provide for reservists to ensure that they are fit to deploy?
Anna Soubry: Of course, the criteria are just the same: reservists have to be as fit as regulars. However, as has been identified, because of the new way that we are doing things, they will now effectively get the exact same sort of access to dental, occupational therapy and so on as a regular would. So they are on absolute equal footing in terms of benefit, which means that they are as fit in all respects as your regular.
Q245 Mr Brazier: Could I press you a little further on that? There has been progress on the dental side, which is probably the second biggest area of concern, but the largest is, as you say, physical fitness. It is the reservist’s duty to keep themselves fit, but the bulk of their fitness training is not during military training periods; they have to go out for runs in the evening and so on. At the moment, if a reservist injures themselves while training to get fit, they are not entitled to any kind of free physio. There was a hint of that in the Green Paper, but this has been raised with me repeatedly. If someone is injured in training, they have the same entitlements as a regular, but the reservist when doing the bulk of his physical fitness training has no entitlement. That is, in fact, for most reservists when not on operations the biggest single medical concern. People do have accidents when doing physical training: they fall off pavements, sprain ankles and often do serious things that may need a long period off work.
Anna Soubry: I am told that that is under review—that is sometimes a dreadful expression, because it could be under review for ever. I will undertake to ensure that it is not under review—[Interruption.]. I am getting another note—this is excellent.
Chair: Progress!
Anna Soubry: Yes. I know that this is the NHS’ responsibility, but equally I know the point that Mr Brazier is making. It is under review, but I will undertake to ensure that that review is as short as possible. You make a very powerful case, Mr Brazier; one that I will not hesitate to take up.
Mr Brazier: Thank you very much.
Q246 Chair: One of the things that we have spotted, and that you will have spotted as well, is that as you increase the numbers of reservists, clearly these issues will become more significant to you in terms of deployability of personnel.
Anna Soubry: Absolutely.
Q247 Sir Bob Russell: Chairman, I would like to follow up the point you just made about the increasing numbers of Reservists. I indicated earlier my concerns about how domestic violence is dealt with involving full-time members of Her Majesty’s armed forces. Is there, or should there be, an arrangement that if a Reservist is caught up in domestic violence, that information should be conveyed to the military authorities by the civilian police? Clearly someone who is engaged in domestic violence may have other issues that make them unsuitable for deployment. Will there be a system whereby domestic violence involving Reservists is known to the military command?
Anna Soubry: I do not know, Bob. You could have a Reservist who has gone and bottled someone on a Saturday night. Domestic violence is awful but, equally, going and sticking a knife in someone is awful. I do not know whether there would be a sharing of information in relation to any act of violence. I beg further inquiry. I simply do now not know the answer—Julian might know.
Q248 Mr Brazier: Chairman, may I make a quick intervention on this? The MOD has commissioned a study by Rory Stewart, which is going on at the moment, to look at the whole question of the interaction between uniformed people and the criminal justice system.[5]
Anna Soubry: There is that but, forgive me, I think Bob’s point is that if the civilian police are aware that Bloggins has been involved in assaulting—normally—a wife or a female partner, would you want to bring that to the attention of his Reservist unit? I don’t know the answer to that. But then, with any act of violence, would you not want to bring that to attention in any event?
Sir Bob Russell: The Minister has summarised it exactly.
Q249 Chair: There is an echo of this in the whole business about whether or not GPs or the police know whether someone is a Reservist. There are a number of these sorts of relationship issues, which I think will continue to be around until we find a way of properly understanding them.
Anna Soubry: I have an excellent charity in my own constituency that is already working with the local police. If there is a low level of offending and someone who is a veteran offers up that factor, the police are looking at using alternatives to the normal charge and going through the criminal justice system in the same way.
Chair: These are things that are coming through community covenants for Reservists.
Anna Soubry: Absolutely.
Chair: We will continue to track and decide whether it is being done well enough.
Q250 Mr Brazier: I have one final question which, strictly speaking, is off today’s agenda, but given that we have a Health Minister here, could I ask Dr Poulter this, briefly, just following on slightly from one of his earlier answers?
The actual response of the NHS to people who are medical Reservists—you mentioned the benefit that they bring back to the NHS—is on quite a wide spectrum: from many parts, where it is excellent from employers and individual trusts and so on, through to a minority that are not nearly as good. Is there some sort of thinking going on as to how to formulate best practice in this area?
Dr Poulter: Very much so. I know that the Secretary of State has taken a keen interest in supporting this in the past. It is crucially important.
We recognise that there are benefits for both the NHS and the armed forces from symbiotic working. We know that when a member of staff gives up time to work as a nurse or a doctor on the front line, that brings huge benefits back to the NHS in terms of leadership skills, and often on dealing with situations and understanding better how to deal with, for example, a road traffic accident and major trauma in A and E. Those are the sorts of things that someone will be confronted with potentially if they are in service—in Iraq or Afghanistan. To see how the armed forces help to support the training of medics and health care professionals, be they full time or Reservist and part time, is something that brings enormous benefits to the NHS, and it is something that we need to continue to foster and develop further.
One of the challenges in this is that we have some hospitals that have good links with the armed forces. Hospitals that happen to be in relatively cash-rich and affluent areas can often be in a place where they can much more easily afford to do that, because if a member of staff goes off for a few months, there is potentially a vacancy that needs to be filled temporarily. That can bring additional costs to hospitals.
So, at the moment, we are looking at ways of not only how we can encourage more health care professionals to recognise the benefits there are to their own career from being Reservists, but how we can better incentivise and encourage hospitals to recognise that this brings benefits to their trust or organisation, so that even though there may be a small up-front cost, the benefit that that member of staff brings back can be galvanising to how the department is run and how the hospital can learn from those staff and the way they deal with major trauma, as well as in terms of other benefits to patient care.
I picked up a piece of work a few months ago with NHS employers to do exactly that: to encourage the NHS to be much more proactive in supporting the armed forces and encouraging people to be Reservists. It is a piece of work that we are doing collaboratively across both Departments. We are now looking towards the 2020 vision, because it is something that will become increasingly important in the future.
Chair: Good. We now move to a slightly different area: support for those recovering from injury and sickness.
Q251 Mr Gray: Can I bring you on to one of the very good things that has occurred in the past few years: defence recovery centres? Have we got enough capacity?
Anna Soubry: Yes.
Q252 Mr Gray: If that is the case, why is it that of the 1,700 Army people who are injured, disabled or in need of help, only 800 are in recovery centres?
Anna Soubry: Because those are serving personnel.[6]
Q253 Mr Gray: Not entirely.
Anna Soubry: That is what I was going to ask you.
Mr Gray: We ask the questions.
Anna Soubry: Sorry.
Q254 Mr Gray: Of the 1,700 in need of care—some are still serving, but most have left—only 800 are currently in the recovery centres, according to Bryn Parry, who was in that hot seat a month or two ago. The question is: is that because of a lack of capacity in the centres, or is it because they do not want to go?
Anna Soubry: I do not think that there is any debate that the capacity is there in the centres. It is primarily the Army. Has the Army put into those centres as many as it said it would? The short answer to that is no. Has big work been done in recent months to redress that? The short answer is yes.
Q255 Mr Gray: What work has been done?
Anna Soubry: One of the things that happened, as you will know, was that an individual was primarily looked after by his or her—usually his—unit. There is a dispute as to how many people it was ever said were going to go to the recovery centres, placed there by the Army. There is a debate between Help for Heroes and the Army as to the agreed number. What definitely happened was that there were more beds put in than it was ever said there was a need for, based on Army figures across the three services. It is right to say that the Army had not put in as many people—even based on its own figures—as it said it would. That has changed quite dramatically, because they have gone back, looked at it all and are now putting through more people. One of the reasons they give—I am here as the Minister, and I can only tell you what they tell me—is that it was because of how it was organised, how the units operated and the recovery officer that you would have to look after you. Rather than dwelling too much on the past, it is really important to look at the future.
Q256 Mr Gray: Okay, so the answer to the question, as I think I understand it, is that there is plenty of capacity in the PRCs.
Anna Soubry: I answered you straight, yes.
Q257 Mr Gray: But until now they were not being sufficiently used by the armed services.
Anna Soubry: Yes.
Q258 Mr Gray: But that is currently changing and the armed services are making better use of them.
Anna Soubry: Yes.
Q259 Mr Gray: Why is that?
Anna Soubry: Because they are getting on with it. They know that these places are there, and that it is imperative that they are maximised to the full and that they make every single effort to ensure that those men and women who should be in them are there.
Q260 Mr Gray: Do you think that the 900 who Bryn Parry argued ought to be in PRCs but are not will soon be there?
Anna Soubry: Sorry.
Q261 Mr Gray: There are 1,700 that could be there, but only 800 are.
Anna Soubry: Are those 1,700 serving personnel or veterans?
Q262 Mr Gray: They are both. Quite a lot of people who are immediately returned and are injured go into Army recovery centres. There are also quite a number who have since been discharged from Army recovery centres. It is both. The joint venture between the charities and the MOD means that you are responsible for both, I think.
Anna Soubry: But once you have a veteran, you cannot force him or her to go to a recovery centre. Until recently, the recovery centres did not take veterans; they now will take veterans. That is a fact, Mr Gray. I do not know whether you have got into that detail.
Q263 Mr Gray: Very much so. We have been doing this quite a long time.
Anna Soubry: The recovery centres were for serving personnel. That has now changed and they will take in veterans. There has always been a concern about why you would take in veterans, because the recovery centres have a military discipline to them. If you are a veteran, you are rightly no longer subject to military discipline. According to Bryn Parry and others, it is working and there are not any difficulties. The veterans are going in and they are complying with the disciplines that are imposed. I am sorry, but the Ministry of Defence cannot make a veteran go to a recovery centre.
Q264 Mr Gray: There is currently a review being undertaken of the Army recovery capability. When will that report?
Anna Soubry: I don’t know. The officials have not given me a date.
Q265 Mr Gray: We need to know.
Anna Soubry: You will. I am sure someone will give me a date. If they won’t, I will write to you. I don’t know it off the top of my head.
Q266 Mr Gray: Could you give us an advance notice idea of what might be in the report?
Anna Soubry: Somebody has given me a date. It will report next month. I am probably not allowed to divulge what will be in it until such time as it is completed. I hope that is helpful.
Mr Gray: Define “helpful”. Moving in the right direction, perhaps.
Q267 Chair: Before we move on to the transition protocol, may I ask my question about personnel recovery officers? These people were going to help with the process that you were just discussing. Can you say something about how that is being developed and whether there are sufficient of them? As I understood it, they would be the people who would help to direct this traffic and do some of this work.
Anna Soubry: Senior military officials who report to me tell me that those individual recovery officers are doing all that they can to make sure that the wounded and injured receive all the treatment and support that they need, and then there is the onward referral as required to the recovery centres. I think the difference now—one of the reasons why there has been the increase—is that some people are going directly from Headley Court straight into civilian life, whereas most either return to their unit or their home. Their home may not, of course, be near where their unit is, and then you have to pick them up in the system and put them through.
Q268 Chair: So presumably some of that will be descriptively as well as analytically considered in the report to which you referred that comes out next month.
Anna Soubry: I would have thought so.
Q269 Chair: Is that the only evaluation that is going to be done?
Anna Soubry: I don’t know is the truthful answer to that.
Q270 Chair: Can we ask that question and will you let us know?
Anna Soubry: Of course. Anything I don’t know the answer to, you will get it.
Q271 Mr Gray: A particular point on the recovery officers, which was mentioned by either Help for Heroes or the RBL, was that those people are out on the road so much that a large amount of their capability is being wasted. If the people were in the centres, their capability would be better used.
Anna Soubry: That is another debate that I know takes place. Ideally, you want people to be right by the centre and geographically centred on it, but the reality of military life for many is that their home is some distance away from where they are based. If you are wounded, your natural instinct may, especially if you are young, be to return to your home, which is where your parents are, and not necessarily immediately to your base. The debate as to how this is resolved is quite fiery. I can understand why the Royal British Legion and Help for Heroes would prefer people to be in more centralised places with direct access into the recovery centres.
Q272 Mrs Moon: Defence statistics show that one in three personnel in the Military Provost Guard Service are “medically downgraded”, “medically limited deployable” or “medically non-deployable”. Two questions: are you finding that there are units that you are almost having to use as holding units for people who are medically going through treatment for injury or sickness, and is the Provost Guard one of those? Secondly, why is the Provost Guard having such a high incidence of one in three who are medically undeployable?
Anna Soubry: I don’t wish to be rude, but I am assuming everyone knows what the Provost Guards do. I am not trying to decry anybody’s job, because they do a very important job, but they are not deployable. Do you all know what I mean by that? I am not saying they are just the people who stand on the gates and take your details, and check that you are who you say you are, but there is a profound difference in what they are expected to do. Many of them, in any event, are wounded or injured, and by virtue of the nature of this work, it suits the particular problem that they may have.
Q273 Mrs Moon: So you are moving people into there.
Anna Soubry: No, no; it is not moving people in. Good heavens; if we can find somebody who has been in any way injured during their service and, rather than discharge them from military service, we can find them a job, I do not have any problems with that whatsoever. The most important thing is: given the job description, have we got the right people doing that job? I do not have any problem with it whatsoever. They are very different from the Ministry of Defence police who have, for example, to be able to run and do all manner of physical activity by virtue of the establishments that they defend, with often six to eight stones of kit on their back. These guards do not have to do anything like that level of physical activity and, as a result, they do not have to meet the high levels of physical activity that others who are deployable have to. I am more than happy to write to you in greater detail, but I think that when you look at what the Provost Guard actually does, there is not a problem here because they are not deployable.
Q274 Mrs Moon: I am not talking about the problem. I am talking about—because they are medically downgraded, medically limited-deployable or medically non-deployable—whether or not this is, as you have suggested, a case of: they were in the Guard and they were injured, so one in three of the guards are falling over, injuring themselves and making themselves medically non-deployable; or the Guard is somewhere you are finding that you can place people who are medically unfit?
Anna Soubry: I am sorry; I just do not agree with the premise of your question. There is no suggestion, I hope, that we are dumping people in the Provost Guard.
Q275 Mrs Moon: I am not suggesting dumping at all. I am asking how you end up with one in three in the Provost Guard with that high degree of medical unfitness.
Anna Soubry: How we find it is, firstly, because of the nature of them. Surely the biggest question is: is it a problem? No, it is not a problem, because they are not deployable, so we do not have any difficulty with it. Obviously, I would love everybody to be fighting fit, as it were.
Q276 Chair: I think the point is that the nature of the community is distorting the information. Clearly they would not be deployable into theatre abroad, but they are useful and productive workers in terms of the job that they have been given. That would distort your figures about their health.
Anna Soubry: Look, these are not Regulars who are moved there. This is a separate organisation that people can apply for from whatever age, background or whatever.[7] Some of them—I will get you the figures if necessary—will be people who have been discharged from service who can apply to be in the Provost Guard without any difficulty whatsoever. We do not move Regulars. They are not Regulars; they are something different, just like the Ministry of Defence police are an entirely separate unit and nothing to do with the Regulars and the three services. They stand alone as a completely separate organisation. That may be not what people appreciate. [8]
Mrs Moon: I think we did appreciate that, actually.
Chair: Thank you. We now need to move on to another area: families of armed forces personnel.
Q277 Mr Gray: We touched on this briefly a short time ago, but I would like to reiterate it. In 2012, the Legion, SSAFA, Combat Stress, the MOD[9] and the NHS jointly produced a report on the consequences of medical problems for families. What were the outcomes of that report?
Anna Soubry: We do not have it yet, because it has not been completed. I think we have been in some discussions with SSAFA as to the sorts of things it is looking at.
Mr Gray: I thought it came out in 2012.
Anna Soubry: I thought this was the latest SSAFA report.
Mr Gray: No, this is the one that was commissioned in 2012 and has raised a number of issues, and the question is—
Q278 Chair: What was done as a consequence of that review?
Mr Gray: We have been told by the Legion as well, so I presume it has been published. The Legion says—
Anna Soubry: No, sorry.
Q279 Mr Gray: Our briefing says that the report that was produced by the Department of Health, Combat Stress and the Legion in 2012 raised a number of issues, including funding for carers, the significant impact on children of the injured veteran and a desire for better recognition of the vital roles played by families and carers. That was the outcome of that report.
Anna Soubry: Sorry. This will probably be my fault, but I think you said it was a SSAFA report.
Q280 Mr Gray: No, I said it was a joint report. I think SSAFA was involved, certainly, but it was produced by the Royal British Legion, the Department of Health and the MOD jointly in 2012 into the consequences of military injuries on the families.
Anna Soubry: I am very sorry, Mr Gray, but I am not going to pretend that I can help you.
Q281 Mr Gray: Okay, you can get that for bedtime reading.
What more can you do—let’s put it a different way, leaving that report on one side—to provide support for families where the serviceman has been severely injured?
Anna Soubry: What more can we do? I know you will tell me otherwise, but I am not aware, for the families of the injured. I know there is a SSAFA report coming out about the better support that could be given to families, but it has yet to report. In the absence of knowing what the problem is—if there is any problem—I would not be able to say what more we can do.
Q282 Mr Gray: Let’s ask this a different way. Do you think that the support currently offered by the MOD to families of those who have been injured is sufficient?
Anna Soubry: By the MOD?
Mr Gray: You are answering for the MOD, aren’t you?
Anna Soubry: Because there is a big difference; forgive me.
Q283 Mr Gray: Do you think the support to families offered by anybody is sufficient?
Anna Soubry: My take on it is yes. I am sure there will be instances when there may be a family who would complain, but I have to say I have yet to come across one. I think it is one of the great features of our military service that—
Q284 Mr Gray: You think that what is currently done for families is sufficient and correct. You are not aware of improvements that could be made.
Anna Soubry: Look, you should never say that you cannot improve on anything, but I have to tell you that what I get back are people who speak in seriously glowing terms about the support that they have received from a unit and the various other organisations. I am minded of the Defence Medical Welfare Services, a remarkable charity that is commissioned by the MOD, that, for example, has sat in the QE and supported families. I hope you are familiar with it.
Mr Gray: Never mind about that.
Anna Soubry: Forgive me. You say, “Never mind about that,” but for many families—
Q285 Mr Gray: No, I’m not saying never mind; I am saying that we are asking you some very specific questions to which we want the answers, not the generality about whether or not something is awfully good. The question is: are you content with the provision currently made for the families of service personnel who are injured in the line of duty?
Anna Soubry: If I may say, I don’t think it’s a great question in this respect. Am I satisfied? I am never satisfied with any service. Every service, I am sure, could be improved, but on the basis of what I have been told, I am not aware of any glaring problems that need solving. In fact, on the contrary, what I get back is that the support for the families of wounded, injured and sick personnel, especially those who have suffered the most traumatic of injuries, is outstanding.
Q286 Mr Gray: Okay. Are you aware of any difference, in that case, between the families of Regular personnel and the families of Reservists?
Anna Soubry: I am not aware of it, but that doesn’t mean to say, Mr Gray, that it doesn’t exist. I am not aware of it.
Q287 Mr Gray: SSAFA has been very up front about saying that the provision made for the families of Reservists, because they are geographically spread, is significantly different to that for Regulars. It is very concerned about it.
Anna Soubry: Did it say at what point? If somebody has been very seriously injured in a theatre of war, the support they will get will be exactly the same, because the first point of contact—
Q288 Mr Gray: Not for the families. I am talking not about the servicemen at all, but the families.
Anna Soubry: No, no. That is what I said. They—do forgive me, I used the plural, “they” being the families—should not find any difference at the initial point of contact. In other words, when that person—that member of their family—is lying injured in a hospital bed, there will be no division between the support.
Q289 Mr Gray: No, that is not what we are talking about at all. That is not even slightly what we are talking about. What we are talking about is long-term care for families of injured personnel. Now, your answer with regard to them, so far as you aware of them, is fine. My question was: does that apply equally to Regulars and Reservists.
Anna Soubry: Exactly, and what I was trying to establish was where was their complaint, because I am not aware of any complaint, and I am trying to help.
Q290 Mr Gray: So as far as you are concerned the provision for Reservists’ families is as good as the provision for Regulars’ families.
Anna Soubry: At the point of, if you like, when they are in a hospital bed, it is identical. What you are talking about—or, rather, SSAFA is talking about—is the long-term support for a Reservist’s family, because of the nature of the Reservists being more dispersed throughout our community. I can understand that there may well be a difficulty there, and I would be very interested to know what SSAFA’s anecdotal evidence is, which is important and valuable, and certainly something to take up.
Mr Gray: SSAFA is very engaged with all this.
Anna Soubry: Forgive me, but now that I know what the problem is—sorry, but you did not explain it, Mr Gray—I will not hesitate—
Q291 Chair: We had the report from 2012. You say there is now another report that deals with the same sort of questions coming out soon. There were issues about how families were affected in terms of the psychological thing, with children, and the whole disturbance. The whole business about the mental health, if I can describe it crudely, of the family, as well as the physical support, were issues that they were raising. Doubtless they have raised them now, again, in terms of this current report. It would be very interesting for us to know what your responses to that will be, as soon as we can see it. Really they had concerns about how, again, with this growing community of dispersed people that Reservists will present, there may need to be organisational changes to support that greater volume of the issue.
Anna Soubry: Absolutely. Of course, it is not something that is going to go away; it is something that will increase. I should say that I am looking at my notes, and I know that, again, at King’s College, there is a body of work that is being done there specifically into families. Whether that will identify a distinction between the Reservists and the Regulars—I suspect it will—that is important work, and it needs to be addressed. I am not minimising it for one moment; I am just trying to identify—
Q292 Chair: Thank you very much; because clearly qualitative work needs to be done on that sort of question, and if it has been done, that is great.
Anna Soubry: Well, I think it is just because it is so different, whereas we have already identified the nature of the Reservists as opposed to the Regulars.
Chair: I would like to move on, please, to the broader questions of sustainability of support and consistency in treatment.
Q293 Mrs Moon: A nice quick one for you. Has the MOD decided whether to establish a defence and national rehabilitation centre?
Anna Soubry: No. If you ask a quick question you will get a short, sharp answer from me. We have not made a decision—absolutely the truth.
Q294 Mrs Moon: Do you have the money to fund it if you decide to do so?
Anna Soubry: Ah—fund in what respect, Mrs Moon? Capital or sustainability long-term?
Q295 Mrs Moon: Are you able to do either or neither?
Anna Soubry: As you know, the plan is that the Duke of Westminster has bought the land and bought the property. As it happens, Dr Poulter and I both, on separate occasions, have been to see Stanford Hall. We are both well familiar with the dream that there is, and the advancement of the plans.
Headley Court is a remarkable place. What makes it remarkable? Yes, they have good facilities. Frankly, you can build new facilities anywhere if you have got the money to do it, and the Duke of Westminster has raised a considerable amount of money. It is going to take an awful lot of money—I think it is £300 million—just to get the defence recovery part of it up and running. What really makes Headley Court sing out is the people who work there.
Some of those people can be moved—you can always move people. Sometimes you cannot move people, for all sorts of reasons which are obvious to anybody. So I think the most critical thing is the sustainability of that project—that means the ongoing commitment to it. In many ways you are grasping at straws. I have seen the plans and we can talk about all of that; but the other thing that is absolutely critical is that there is no diminution in the quality of the care, because of the teams.
I think teams can be moved. They can be rebuilt if you have the time to make sure that you are getting the right quality of people coming through and training. It is important to say that I am a Nottinghamshire MP; Stanford Hall is in Nottinghamshire, so it is in my county. One side of me would welcome the QMC up the road and so on and so forth, but no decision has been made and there are many things to be considered before a final decision is made. For many people, a move from Headley Court, because of what it means to people in the public mind, is an important factor.
Q296 Mrs Moon: How is the transitional protocol working in all parts of the UK? Do you feel it is working effectively, and has the problem of the poor transfer of patient records been resolved?
Anna Soubry: In theory, no problem. Is it working? Dan can give more evidence, but from what I am getting back, it is working. Truthfully, I actually think that for the future it is brilliant and wonderful. I think the real question is: what about all the people who have not had the benefit of it in the past? I will let Dan explain the new system.
Dr Poulter: Clearly, a challenge throughout our health service is how we exchange important information about patient care in an effective way that maintains confidentiality. As we have discussed in the Committee, there has been an historical disconnect between the care given to people when they are serving personnel and that available when they become a veteran. We are taking considerable steps to improve that joined-up approach, and certainly in the NHS in England when a service leaver registers with a GP, their NHS record now encloses a letter informing the GP of their status as a veteran. When a member of the serving personnel is discharged, a more practical approach is now taken by the armed forces to encourage that person to register directly with a GP, whereas in the past they were sometimes left to their own devices. The armed forces now take a much more pastoral approach on discharge to encourage and support people to register with a GP, and the GP is then informed of their veteran status.
It is also our intention in developing the new system to encourage greater data sharing in future when there will be an increasing reliance on Reservists. That issue has been touched on a lot in the Committee today, and it is vital that there is much easier data transfer between armed forces medical staff and the NHS in future, particularly as more people will be living in the community for some periods and for other periods will be on active service or under the direct pastoral care of the armed forces. The work we have already done in that respect has put us in a good place to deliver in future.
In terms of the transition, it is worth adding that we have now set up a process whereby when someone leaves the forces, the Veterans Information Service will contact them a year after discharge to signpost health and other services for them. For example, if a veteran fails to register with a GP or moves to another part of the country, the Veterans Information Service can contact them by e-mail or other means, including phone, to remind them that health services and other support is available if they run into difficulties.
Someone with a mental illness or mental health problems may not recognise that, or may not develop them immediately on discharge, but a year later may need that bit of help and signposting of support about where to go. We now have in place a process for delivering that, and Veterans UK and the British Legion are working to do that. There is a much stronger package of support to ensure that service personnel are supported as they transition back into civilian life, be they well or in need of medical care.
Q297 Mrs Moon: Mrs Soubry, what are you doing to ensure that serving personnel, their families, and veterans have equal access to quality care across the UK? How are you working to ensure consistency in capability and access.
Anna Soubry: Apart from all the things that we have already explained, my real concern is the veteran who is disengaged, for whatever reason. Perhaps they have had a falling out with their armed service or they have a mental health problem. It’s how we get them. I am reminded of a colleague of ours who came to see me about a particular case that he had. This person claimed not to have had the treatment and access to mental health services that he should have had, and we made some further inquiry. I’ll put it in this way. One of the things that we know is that when somebody has a mental illness, they often—I’m not being harsh on them—don’t help themselves. They can’t help that, because it is the nature of their illness. Sometimes they can be belligerent. Sometimes it can be because they fall into a dreadful place and end up homeless or they end up in short-term accommodation and move around. They are the ones who trouble me the most, especially when they have injuries that are not just about their mental health. It’s about making sure that we somehow get them in.
That is where I think the role of the charities is so critical. We know that often people will go to the charitable sector, rather than going back to their old regiment or unit if they can still get hold of it. That is the area of work that I think is some of the most important work, and that is where some of our charities—often, they are very small, local charities—are doing really good work. On a bigger scale is some of the work that the Royal British Legion is doing. It now wants to open one-stop shops on high streets. That is to be absolutely welcomed. There is the provision of 24-hour telephone services that people can access, and not just because they may have a mental health problem; they may have some other problem. I think that provision, whether we keep it as it is or perhaps even improve it more, will help us.
The issue is the ones that have fallen through the net. I think the existing net is in a good state. You have heard from Dan about the work that is being done across the two Departments, but it’s the ones from before now, the ones that we don’t know about, who have slipped through the net. We now somehow need to make sure that we bring them back in and make sure that they get everything that they are absolutely entitled to and deserve.
Q298 Mrs Moon: Consistency of service and treatment and access to treatment has been an ongoing issue for this Committee. When the Surgeon General was in front of the Committee, he expressed no concerns related to the devolved Administrations. Subsequently, however, we have been told that there have been problems in Wales, so have you moved personnel from Wales to England to ensure they get speedier treatment and, if so, on what basis? Has a particular form of treatment not been available? Is the problem across the board? Can you clarify that?
Anna Soubry: I have no information as to how many have been—from serving personnel—but I am assured by my officials that if any serving member of our armed forces in Wales is not getting the treatment that they need, they will be moved across the border into England for that treatment.
Q299 Mrs Moon: Can we have details of the numbers? Can we have details of the particular service that was missing—whether it was surgery, obstetrics or whatever? Can we find out what the problem was that would appear to have been highlighted in a freedom of information request?
Anna Soubry: I know that there is a sub-group on access and equity of health care specifically looking at this cross-border issue. I don’t know whether Dan has more—
Dr Poulter: The general issue is this. Because it is very often secondary care services and with the NHS commissioning those services, the responsibility for this is very often with the NHS in Wales. We do know that waiting lists and waiting times are, compared with England, considerably higher in Wales, with a third of patients now waiting more than eight weeks, for example, to access diagnostics.
Q300 Chair: Let us be clear: the way these things are counted is different as well. What we are trying to understand is what the actual issue is.
Dr Poulter: I think the overall issue is that waiting lists are a lot longer in Wales and it is taking a lot longer to get the same treatment in Wales. It is the same secondary care services offered in the NHS—
Mrs Moon: In what specialisms?
Chair: You count it differently in Wales because you count it from the first contact, rather than from another point. Whether or not it is longer, if people are being transferred, why are they having to be transferred? Is it simply a question of their being understood to have been waiting longer, or is there a provision problem? That is the sort of thing that we are trying to understand.
Dr Poulter: My understanding, and I believe that the minutes of the committee’s meetings have been made available to you, is that there is a general issue, because, however you measure it, the waiting times in Wales are considerably longer than in England. If there are concerns about waiting times in any service, but particularly veterans services, which is an issue we are concerned about today, Wales could potentially commission those services from England if there is availability in the English NHS to provide those services. Of course there are cross-border issues that are faced all the time anyway, and some people will routinely access services across the border, but those services are available to veterans. If you are looking at prosthetic services, for example, there is a specialist centre in Birmingham that is available if the Welsh NHS wishes to commission those services, and we stand ready to help.
Q301 Mrs Moon: Are you talking always about specialist services, or are you talking about basic services?
Dr Poulter: In terms of specialist services, particularly secondary care services provided by secondary care providers or those services that we tend to measure such as diagnostics, there are health care providers in England offering those services, which could be commissioned from Wales if there are, as there clearly are, concerns about access and time to treatment. That is part of good cross-border health care, and the population is close together on the England-Wales border. Secondary care services for veterans, particularly prosthetics, are available. If the Welsh NHS wishes to commission those services, the NHS in England is able to provide.
Q302 Mrs Moon: Can we have the figures? How many people have been referred to the English NHS?
Anna Soubry: Serving or veterans?
Mrs Moon: Both.
Anna Soubry: Well, I cannot give you the figures for veterans.
Mrs Moon: Then give us the figures for serving soldiers. Can we also have the reasons for the move into the NHS in England?
Anna Soubry: Yes, we will look into it.
Q303 Chair: Obviously I am a Member of Parliament from Wales, so I have a particular interest, but rising above that for the moment, we are trying to understand how the Ministry of Defence can consistently apply the covenant across the whole United Kingdom. It could conceivably be between Scotland and England, Scotland and Northern Ireland or Northern Ireland and Wales, because as we move to the use of Reservists, people move around more and their communities are extended. This is an issue to which you could give some thought. How will we be able to understand what the processes are for understanding how well the MOD is discharging its broader responsibility to ensure consistency across the piece? This is the first illustration of a series of monitoring processes that will need to be established across the whole United Kingdom, not just the England-Wales issue that is the current illustration. Having said that, I will stop preaching and ask Sir Bob Russell to ask a question on what happens when the money runs out and the charities are not funding things.
Sir Bob Russell: Mr Havard has virtually put the question for me, Dr Poulter. The anticipation is that charitable funding will eventually reduce, so how is the NHS planning to fund health services when that day arrives?
Dr Poulter: My understanding is that NHS England has, as part of its centrally commissioned services—veterans services are centrally commissioned services—committed to recognising the importance of veterans services, and it has put aside, I believe, £27 million a year. I will confirm that figure in writing, and I will ask Sir Bruce Keogh to write to the Committee to confirm the point I made earlier on the prosthetic colourings, which I understand to be the case. That is the only acceptable thing to do.
Q304 Sir Bob Russell: But if donations do fall away, is there a plan B?
Dr Poulter: We have prioritised this as an area of spending and my understanding is that NHS England is going to continue to provide—I think it is £27 million a year—for centrally commissioned veterans care. Commissioning is not only done through the NHS alone; a lot of it is done with joint working. For example, just today we have launched with Big White Wall a mental health app that is available for veterans, so that they can—
Q305 Sir Bob Russell: So there is a plan in anticipation of that decline in charitable funding?
Dr Poulter: In terms of our commitment and the money that we put in to the NHS—£7.2 million for mental health and the £15 million for prosthetics—NHS England is absolutely committed. Some of that is provided by the NHS alone; it is also provided in conjunction with working with charities, as well as funding to support charities to provide the services. That money going forward is something that NHS England has committed—I understand, £27 million, but I will confirm the exact amount. There is an absolute commitment to the sustainability of the funding for veterans health.
Q306 Sir Bob Russell: So yes, there is a plan.
Dr Poulter: Absolutely.
Q307 Sir Bob Russell: Fine. May I ask if the Ministry of Defence has planned to fund those services currently provided by the charitable sector in subsequent years? That is the same root question.
Anna Soubry: Have we planned to fund it, on the basis that all the funds are going to dry up? Your question is, “Have we got a plan?”, because of your assumption about charitable funding—but it will not dry up.
Q308 Sir Bob Russell: No, it will not dry up, but it will decline.
Anna Soubry: There is every reason to believe that after the withdrawal from Afghanistan—this is the fear, isn’t it—there will be a reduction in the amount of giving from the British public.
Sir Bob Russell: That is the anticipation of course, but—
Anna Soubry: That is the anticipation, and it is a perfectly reasonable assumption to make. The £10 million of LIBOR funding in perpetuity is terribly important. I would love to be optimistic and think that in a way, yes, we do not want any more conflict—that is optimistic, isn’t it, that we will never get engaged again in the sort of conflict that we have just experienced in Iraq and Afghanistan?
Q309 Sir Bob Russell: No one can be precise, we accept that, but—
Anna Soubry: That is the problem. I am so sorry for interrupting.
Q310 Sir Bob Russell: I was going to say, is there a bracket of what level of funding will be required in this sphere, that this is the amount of money?
Anna Soubry: I am not aware that that piece of work has been done.
Dr Poulter: Let me absolutely clarify the point. At the moment, there is that funding that has been put into veterans—mental health £7.2 million, for prosthetics £15 million and money coming from the LIBOR fines as well. NHS England has got and is budgeting for continuity of support for veterans, but obviously there is the way in which services are commissioned at the moment. For example, we set up a 24-hour veterans mental health helpline, which the DH commissioned for the first two years. That is provided by Combat Stress and Rethink, the mental health charities, and it is going very well indeed. But obviously, although I am sure that the 24-hour veterans helpline is absolutely the right way to go forward in the long term, we might think in future that there are other and better ways to commission services in mental or physical health. Exactly what is funded today, therefore, may change, but there is absolute commitment to maintain continuity and level of funding. That is absolutely there.
Q311 Sir Bob Russell: Dr Poulter, I want you to confirm this for the record. How do you intend to fund provision of services when the current ring-fenced money for mental health provision for veterans runs out?
Dr Poulter: NHS England—I will confirm the amount—has agreed that it envisages that to be part of its core function. It has ring-fenced £27 million after the current money that goes up to 2015 elapses.
Q312 Sir Bob Russell: In general, though, how will the NHS sustain services, especially to those veterans who have been badly injured in Afghanistan or Iraq and who will have increasingly complex medical needs? How is the NHS going to sustain that?
Dr Poulter: First of all, for physical health we have the specialist prosthetics centres, and they have just been set up. They were identified in the Murrison report, they have been set up, and they have a long and viable future as centres of excellence in their nine locations. For mental health, we have also set up 10—I think—specialist veterans-focused mental health service teams throughout the country, and I think that there will be 40 personnel on the ground in the NHS to support veterans with mental health problems.[10] We have increased the provision of services for veterans with physical and mental health needs. NHS England has now recognised the need for ongoing funding after 2015, and understands the importance of that. There will be continuity of delivery of care for both physical and mental health.
Q313 Chair: Minister, you are desperate to say something—are you waving or drowning?
Anna Soubry: I am desperate to say something. If I may say so, I think that Sir Bob asked one of the most important questions. The truth is that we are all very concerned about the reduction in the amount going to the charitable sector. Secondly, anybody, of whatever political persuasion, is always going to question the long-term sustainability of the NHS and be real, honest and truthful about that.
Thirdly, and perhaps most worryingly, in truth we do not know an awful lot about what is going to happen to our very wounded, injured and sick veterans. Some brilliant work is being done at the blast centre at Imperial college, for example. They want to look at a 20-year cohort of young men—as they normally are—who are usually double amputees, but sometimes they are single or triple amputees, and follow them through. You have already alluded to, and I think that the Surgeon General has told you about, the real concerns about the long-term medical needs of some of our most injured veterans. The simple truth is that we can speculate—brilliant medics, Dan and everybody else, can speculate about the cardiovascular and so on—but we simply do not know.
Sir Bob, one of the big tasks of all politicians and everybody else who is concerned about this issue is to try to look to the future and be pessimistic in terms of the need in order to ensure that, whichever Government is elected in 2015 and so on, we are absolutely true to that long-term continuing commitment to our injured personnel. That might mean that Government is going to have to dig deep, and it might also mean that the British public are going to have to dig even deeper than they have, but it is the right question.
Dr Poulter: It may be helpful if explained something that I know that many members of the Committee will already understand. In NHS England now, the operational response for commissioning is run by NHS England. The NHS England mandate, which has a very strong commitment to the Armed Forces covenant, the Armed Forces and veterans’ care, is set. NHS England’s priorities are of course set by the mandate it is given by the Government of the day, but it recognises that, just as with every other patient group, in future it has a core commissioning responsibility to veterans. That is why, even after the lifetime of this Parliament, NHS England is committing to ensuring that veterans’ care is properly funded. That is not an issue that we have to worry about.
As has just been said, what good health care looks like for people with very serious injuries and how health care evolves as time goes on—we know in health care that we will improve and that the way of treating people will change, and the way that we commission services will similarly evolve. But there is a commitment to funding and commissioning services. I am fairly sure that the amount is £27 million going forward.
Chair: We had some very helpful evidence in the last session on this subject, and what you have just said builds upon that.
Q314 Sir Bob Russell: I have two specific questions for the veterans Minister, but I would like to thank both Ministers for their comments. As we all know and as the Prime Minister says, the Armed Forces covenant is now enshrined in law. Officials here and we, in due course when we revisit this, will be able to see what was said today and what has transpired. I thank both of you for that. I have a question for the veterans Minister. Reference has just been made to the Surgeon General. When will the Surgeon General’s study of the long-term needs of those injured in Afghanistan be finalised and when do you expect the first results?
Anna Soubry: I know the answer is in here, Bob, but I haven’t got it. Somebody will tell me. Hang on. Two to three years after recruitment starts—
Q315 Chair: Could you say that again?
Anna Soubry: It is two to three years—
Q316 Chair: After?
Anna Soubry: The first results will be after two to three years. He will recruit the cohort this summer and then it will report in two to three years—
Q317 Chair: After the cohort has been recruited?
Anna Soubry: Yes, after they have been recruited.
Q318 Sir Bob Russell: Thank you. Again, that is fine. These things take time. I make no criticism.
Anna Soubry: And you will know, because you have had his evidence, that people are more than alert to this.
Q319 Sir Bob Russell: Precisely. I accept that. Finally, is the future of the supportive houses for families near the Queen Elizabeth hospital and Headley Court certain?
Chair: Could I supplement that question—this is the Fisher Houses that were part of the QE development—[11]
Anna Soubry: I didn’t think there was any problem with the QE houses. If that is the case, it is news to me. I thought there was no problem there.
Q320 Sir Bob Russell: I am glad there is no problem there.
Anna Soubry: I am hoping that my information is right.
Q321 Chair: As I understand it, there isn’t a current problem. But the money that was provided for them, because it was partly Fisher and so on, and there is this relationship between state money and—
Anna Soubry: Private money.
Sir Bob Russell: It has been flagged up.
Anna Soubry: Has it? I am not aware of any problem. I went out there and spoke to the chief executive, as you can imagine, at length.
Q322 Sir Bob Russell: That is encouraging.
Anna Soubry: I think the big issue up there is the accommodation of the staff. I am sure this Committee will revisit that subject.
Sir Bob Russell: Thank you.
Chair: Are there any other questions that members wish to ask that we have not covered? We have exhausted our brief. We have run two minutes over time but we were five minutes late starting. Now we are going to abuse the privilege.
Q323 Mrs Moon: I have a particular interest, as you may be aware, in suicide. I accept your caveats in relation to the American situation. The Americans are showing a high degree of suicides—one a day—in veterans who have served in Iraq and Afghanistan. Is the MOD looking at all to fund research to track potential suicides in terms of veterans? I am aware of the work that —
Anna Soubry: You know the work, obviously, that the King’s College Military Health Research is doing.
Mrs Moon: I am aware of the work that Professor Nav Kapur has done from Manchester. There are three specialist units that deal with suicide research and Manchester, where the suicide tsar is based, is one of them.
Anna Soubry: The MOD cannot do an awful lot with veterans, unless we know where they are and all the rest of it. The work that needs to be done—I know it is beginning to be done and I spoke about it before—relates to the duty of care to the welfare of that individual. It starts on the day that they enlist and means that when they leave, because for many it will not be a job for life, they will leave in a better place than when they entered. They entered in a good place because we would not have hired them in the first place. Real work has taken place, alongside the change in attitude and the reduction in the stigma, to make sure that mental health is as big a part of the overall health of any individual. That is the key to ensuring that when that person leaves the armed forces, the chances of them getting mental illness, falling into alcoholism, committing suicide—God forbid—are as limited as we can possibly make them and that if they came in as an individual with difficulties and flaws, they are given the help and support that they need so that they leave in an even better place than when they first entered.
Chair: Any information that you can supply us about work that is happening on that would be gratefully received. As you will understand this is the latest iteration of our continuing inquiry into the various aspects of the covenant. We will take the evidence you have given us and we will make some further observations and recommendations in the near future. Thank you for being frank and open in what you said to us. Doubtless someone has a list of all the things you promised to write to us about. We look forward to receiving them. Thank you very much indeed.
Oral evidence: The Armed Forces Covenant in Action? Part 5: Military Casualties, HC 940 36
[1] Note by witness: MoD, DH, NHS England and the Devolved Administrations are discussing wheelchair provision but this will not be a joint strategy as this will differ across each part of the NHS in the UK.
[2] Note by witness: The 4% figure relates to Service Personnel only, although this is broadly comparable to the rate experienced by the civilian population, of which veterans are a part.
[3] Note by witness: The rate is between 3% and 7%, but higher among Reservist and combat troops. Reports indicate rates in the US of 9–20%, while Australia reports 6–7% and Canada reports 3–6%.
[4] Note by witness: The number of pilots is not yet finished.
[5] Note by witness: This study was commissioned by the Secretary of State for Justic.
[6] Note by witness: Wounded, Injured or Sick (WIS) Personnel who are not in Personnel Recovery Units (around 900) remain in their units, under unit command and with an allocated unit Personnel Recovery Officer. These figures do not relate to Service Personnel in Personnel Recovery Centres—the Centres are utilised by all WIS as part of their Individual Recovery Plans but are not the ‘unit’ of the WIS.
[7] Note by witness: Soldiers enter the MPGS through one of three routes: change of engagement, re-enlistment having been discharged from the Service less than a year ago, or re-enlistment having been discharged from the Service more than a year ago but less than six years ago.
[8] Note by witness: Members of the Military Provost Guard Service are an integral part of the Regular Army. The only difference between them and other Regular personnel is that they are employed on a Local Service Engagement which allows them to serve within a specific geographic area within the UK. The terms of the Local Service Engagement can be found at Para. 7 of Statutory Instrument No. 3382 dated 2007: http://www.afimplementation.dii.r.mil.uk/Legislation_vol3/TheArmyTermsofServiceRegulations2007si2007_3382.pdf
[9] Note by witness: The MoD was not involved in the production of this report.
[10] Note by witness: Dr Murrison recommended an increase in the number of NHS personnel providing services specifically for veterans to 30. The NHS has put in place more than this across the 10 teams in England but the numbers will vary at any given time.
[11] Note by witness: The Ministry of Defence has no involvement in Fisher Houses. Fisher House at the Queen Elizabeth Hospital is funded by the Queen Elizabeth Hospital charity, Help for Heroes and the US Fisher House charity.