Written evidence submitted by the Welsh NHS Confederation.

Introduction

1. The Welsh NHS Confederation welcomes the opportunity to respond to the Defence Committee inquiry into the Armed Forces Covenant.
2. The Welsh NHS Confederation represents all the organisations that make up the NHS in Wales, the seven Local Health Boards, three NHS Trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust, and Public Health Wales NHS Trust), and two Special Health Authorities (Digital Health and Care Wales and Health Education and Improvement Wales). The twelve organisations make up our membership. We also host NHS Wales Employers.
3. Our response has been drafted following feedback and information received from several of our members.

Committee Questions

In what areas is the Armed Forces Covenant working well?

4. Our members agree that there are specific areas where the Armed Forces Covenant (AFC) is working well. The AFC has established a baseline of requirements within NHS settings, bringing the management of the armed forces community’s healthcare needs to be at the forefront of NHS strategies and policies. This forms the foundation for what must be achieved moving forward.

5. One of the most significant achievements of the AFC highlighted by our members has been the fostering of partnerships across health boards, local authorities, and third-sector organisations in Wales. This collaboration has created broader opportunities to deliver comprehensive, wraparound care and support services for the armed forces community.

6. Our members have stated that the AFC has also been instrumental in enabling meaningful links between NHS organisations and the armed forces community. Through this initiative, our members have been able to identify applicants from ex-military background more effectively, ensuring they receive appropriate support throughout the recruitment process. Additionally, their policies support reservists, allowing seamless integration with existing frameworks. Our members are committed to offering flexible and part-time working arrangements to reservists, military partners, and spouses. This approach reflects their dedication to fostering a workplace that acknowledges and accommodates the unique circumstances of individuals connected to the armed forces, ensuring they can balance their professional and personal commitments effectively.

7. Our members participation in the AFC has also led to their involvement in Armed Forces Day, further strengthening their engagement with the armed forces community. As a well-recognised initiative, the AFC has helped raise awareness, particularly among recruiting managers. This awareness has been embedded into our members’ recruitment process, to ensure their hiring processes are inclusive and supportive. For example, one of our members, Health Education Inspectorate Wales (HEIW) who lead on strategic workforce issues in Wales, guaranteed interview scheme continues to operate, reinforcing their dedication to providing employment opportunities for ex-service personnel. HEIW fully understand their obligations under the AFC and actively support former members of the armed forces in transitioning to new careers. This includes offering guidance on completing applications, preparing for interviews, and accessing relevant training opportunities.

8. Finally, our members have stated that the creation of the NHS Veterans Mental Health Service has been a positive move forward in supporting the specific needs of veterans, which also incorporates a peer mentor scheme.

Where is the Armed Forces Covenant failing the Armed Forces Community?

9. While our members have stated there has been notable successes as a result of the AFC, there are still areas where the Covenant does not fully meet the needs of the armed forces community. These include:

• Inconsistent awareness across local health services: A key challenge remains the inconsistency in awareness and understanding of the AFC across various NHS services in Wales. Some staff may not be fully aware of the special provisions available for members of the armed forces community, leading to uneven service delivery and occasional difficulties for individuals in accessing timely care.
• Limitations within the public sector: Outdated systems and a lack of interconnectedness impacting all service users, however they disproportionately affect armed forces personnel and veterans due to frequent relocations and the transition out of service. One example is the difficulty in transferring patient records across the England and Wales border, a problem frequently encountered by veterans and their families.
• Access to healthcare for reservists and their families: Reservists and their families often face challenges with continuity of care, particularly when it comes to health services during or after deployment. There is a need to improve their access to care during their years of service and ensure they are not disadvantaged when seeking healthcare once they return to civilian life whilst still signed up as a reservist.
• Knowledge and understanding in primary care: Feedback from our members highlight that some GP Surgeries are not as well informed and committed to the AFC. It is apparent when patients are referred and the question of whether they are a veteran is not asked and/or passed on to the appropriate NHS service.
• Limitation in translating military experience into civilian employment: Despite initiatives such as guaranteed interview schemes, many veterans still encounter barriers in securing roles that match their skill sets. Greater collaboration between employers and the armed forces community is needed to bridge this gap and ensure that veterans are not overlooked due to a lack of understanding of their qualifications, skills and experience.
• Inadequate awareness and engagement with the AFC: While the AFC has raised awareness in some organisations, there is still work to be done to ensure that its principles are embedded across all industries, including public services like the NHS and local authorities.

10. To improve the effectiveness of the AFC, our members have highlighted that there needs to be greater consistency in its application, enhanced employment support for veterans, increased career opportunities for military families, and broader awareness across all sectors. Strengthening these areas will help ensure that the AFC truly delivers on its commitment to supporting the armed forces community.

What are the main causes for these failings?

11. Our members have suggested the main cause for these failings is service delivery being fragmented. The lack of a fully integrated system between the military, NHS services, and local support services can cause gaps in the care and support available to veterans, especially for those who are transitioning.

12. Our members have also highlighted the lack of awareness and consistency across organisations as a cause. While signing the AFC is voluntary, there is no standardised mechanism to ensure that all signatories fully implement their commitments. Some organisations actively support the armed forces community, whilst others may lack the resources, awareness, or motivation to translate their pledge into meaningful action. Furthermore, in relation to the NHS, there is insufficient training for healthcare professionals regarding the specific needs of the armed forces community, as well as a lack of clear communication between service providers and the Ministry of Defence, resulting in inconsistent service delivery. Without a clear system of accountability and awareness of the benefits of the AFC, the level of support varies significantly, leaving many service personnel and their families without adequate assistance.

13. As stated in the previous answer, a major cause for these failings is translating military experience into civilian employment. Many veterans possess valuable skills such as leadership, problem-solving, and teamwork, but these are not always recognised by employers who may not understand military qualifications or experience. This disconnect often results in veterans being overlooked for roles that they are highly capable of performing. The lack of structured pathways between military service and civilian careers exacerbates this issue, making the transition more difficult than it should be.

14. Finally, resource constraints and funding limitations play a role in restricting the effectiveness of the AFC. Many of the initiatives designed to support the armed forces community require investment, whether in training programs, recruitment support, or tailored employment schemes. Without sufficient funding and long-term commitment from both the government and businesses, these initiatives risk being underdeveloped or inconsistently applied.

Are there areas which the Armed Forces Covenant ought to be extended to and why?

15. Our members agree that there are areas where the AFC should be extended to ensure better care and support for the armed forces community.

16. Firstly, our members have suggested that employment support for veterans should be extended. Transitioning from the armed forces to civilian employment remains a challenge for many veterans. The AFC should be extended to provide additional career services and employment support, focusing on the skills translation from military to civilian jobs and supporting veterans through the challenges of job searches and integration into the workforce.

17. Another area our members have suggested is greater support in employment and career development. While the AFC already promotes fair treatment in recruitment, more needs to be done to help service leavers and military spouses access long-term career opportunities. The AFC could be extended to encourage more employers to recognise military qualifications, offer structured career transition programs, and provide mentorship schemes for veterans.

18. Our members have suggested increasing healthcare and mental health support for the armed forces community. While the NHS and other healthcare providers have made progress in addressing the unique medical and mental health needs of veterans, there is still room for improvement. The AFC could be expanded to ensure that all healthcare professionals receive training on military-related health conditions, including PTSD, musculoskeletal injuries, and the psychological impact of service. Additional funding for specialist veterans’ mental health services and faster access to treatment would further strengthen this area.

19. Moreover, our members have suggested that support for families during deployment should be extended. The families of service personnel often bear the emotional and logistical burdens of deployment, including isolation and wellbeing challenges. Extending the AFC to provide more robust support for families during deployment, such as counselling services, childcare, and social support, would help mitigate some of these issues.

If so, which are the priority areas?

20. Our members have highlighted two priority areas where the AFC could be extended.

21. The first priority area is employment and career transition. As previously highlighted, one of the biggest challenges for veterans and military spouses is securing stable and meaningful employment. Many employers still struggle to understand military qualifications, and service leavers often find it difficult to translate their skills into civilian roles. Expanding the AFC to require better employer education, structured career transition programs, and targeted job support for military spouses would have a direct impact on financial stability and well-being.

22. The second priority area is healthcare and mental health support. Ensuring that veterans and their families receive timely and appropriate healthcare, especially for mental health conditions such as PTSD, should be a top priority. The AFC should require all healthcare providers to be trained in military-specific health issues and provide faster access to specialised treatments. Additional funding for veterans' mental health services and physical rehabilitation programs is also essential.

23. Ultimately, these two priority areas for extending the AFC should focus on the most pressing challenges faced by service personnel, veterans, and their families. These areas require immediate attention to ensure that the armed forces community receives the support they need in civilian life.

What legislative changes should be made and why?

24. Our members would support legislative and policy changes in this area. Firstly, our members have suggested making the AFC a legal duty for GP surgeries. They believe that extending the legal duty of the AFC to include contracted GP surgeries would ensure sufficient support across all healthcare settings.

25. Furthermore, our members have stated that making the AFC legally enforceable would be beneficial. The AFC is largely a voluntary commitment, meaning that while many organisations pledge to support the armed forces community, there is no legal obligation for them to follow through. This leads to inconsistencies in implementation. Therefore, to introduce legislation that makes key elements of the AFC legally binding, particularly in areas such as employment protections, and healthcare access. This would ensure that public bodies and large employers adhere to specific standards when supporting veterans, reservists, and military families.

26. Our members have also highlighted the benefit of having stronger safeguards for reservists. Reservists often face a lack of clarity regarding healthcare access, which can lead to delays in treatment or unmet needs. Legislation should be introduced to ensure reservists and their families have clearer entitlements to health services and support during and after deployments.

27. In addition to legislative changes, our members have highlighted some policy and strategic changes that could further support the armed forces community. Our members have emphasised the importance of specialised funding to support health boards and local authorities. Legislation should include provisions for dedicated funding for transition support services for veterans. Ensuring a smoother transition to civilian life, particularly in terms of healthcare this should be a match funded option for armed forces leads within health boards.

28. Additionally, our members have stated the importance of dedicated coordinating roles, such as Armed Forces Liaison Officers and Armed Forces Leads in health boards, to navigate the complex network of organisations supporting the armed forces community. These individuals act as crucial links, and ensuring their positions are secure and consistently funded, rather than relying on ad-hoc or year-to-year arrangements, is vital for effective AFC implementation. Also, Wales should specifically consider the appropriate regional structure and coverage for these key roles.

What impact would the extension of the Armed Forces Covenant legal duty to central government and devolved administrations have?

29. Our members agree that there would be a positive impact to extending the AFC legal duty to central government. For example, there will be an impact on consistency in service provision. A legal duty across both central and devolved governments would ensure uniformity in the delivery of services to the armed forces community across the UK, removing discrepancies in service delivery between different regions and thus avoiding the ‘postcode lottery’. Currently, the Armed Forces Act 2021 places a legal obligation on local authorities and certain public bodies to consider the AFC when making decisions, but central government departments and devolved administrations are not bound by the same duty. Expanding this legal duty would bring key benefits, as well as challenges, in delivering fair and effective support for the armed forces community.

30. Moreover, extending the AFC legal duty to central government and devolved administrations would improve healthcare and employment outcomes while holding government departments accountable for delivering real change. However, careful planning would be required to manage funding, policy coordination, and implementation across devolved administrations. If done correctly, this extension would represent a major step forward in delivering meaningful support for those who have served and their families.

31. Finally, extending the legal is improved coordination and integration. Extending the legal duty would promote better coordination between local health boards, local governments, and service providers, ensuring a holistic and integrated approach to supporting veterans and their families.

Further information

32. NHS Employers, which is hosted by the NHS Confederation, submitted written evidence to the Defence Committee to highlight the benefits of the AFC and encourages organisations across the NHS to sign the Armed Forces Covenant.

33. NHS Employers supports NHS organisations in England and Wales to develop a sustainable workforce, improve staff experience and be the best employers they can be. NHS Employers works in partnership with Walking with the Wounded and The Royal Foundation to support NHS organisations in England and Wales to diversify their workforce and offer guidance on how to be more inclusive recruiters for the armed forces community as part of the Step into Health programme. The programme connects candidates from across the armed forces community with employers and new opportunities in the NHS. 

Conclusion

34. Overall, our members believe the AFC is effective in raising awareness and uniting people to support the armed forces community, particularly for NHS organisations as a large employer and supporting people’s health and wellbeing. However, the current challenges are not with the AFC itself, but with the coordination between organisations which has an impact on service members and veterans and hinders the aims of the AFC's.

20th February 2025