AFC0072
Written evidence submitted by NHS England.
Amanda Pritchard, CEO of NHS England signed the Armed Forces Covenant on behalf of the NHS in September 2024 reaffirming the NHS’s commitment to delivering high quality care for the armed forces community and to meeting the principles set out in the Armed Forces Covenant.
NHS commissioning responsibilities are discharged by NHS England and Integrated Care Boards (ICBs). NHS England acts as the direct commissioner of services for serving personnel and families registered with a Defence Medical Services (DMS) practice. ICBs, are responsible for commissioning services for veterans and families registered with an NHS GP.
This means that NHS England and the ICBs must consciously consider the Armed Forces Covenant when developing and reviewing their policies, commissioning intentions and services, and what impact any changes might have on the Armed Forces community (serving personnel, veterans, reservists, and the families of these groups).
The Armed Forces Covenant is not prescriptive about the actions specified bodies should take to comply with their legal obligations, and it does not mandate specific public service delivery outcomes.
To that end, the single national NHS England Armed Forces healthcare commissioning team is developing and producing a range of resources, including a framework to support NHS England, ICBs and NHS Trusts in discharging their commitment to, and delivery of, the Armed Forces Covenant as effectively as possible as part of their statutory duty.
To further drive cohesion and commitment across the health service, NHS England has developed an NHS Armed Forces Charter which all ICBs are being invited to sign. This is in recognition of the critical role that ICBs, with their wider system partners, can play in supporting the armed forces community in accessing high quality healthcare and leading healthy lives
In recognition of the challenges faced and the importance of ensuring no disadvantage, NHS England has a national Armed Forces commissioning team which is responsible for commissioning secondary and community healthcare services, for serving personnel and families registered with a DMS practice.
These services are delivered across a range of settings including acute hospitals, community services including those delivered locally by GPs with a special interest, and Out of Hours primary care services which are supported by a range of clinical policies to reduce unwarranted variation in access to services by this patient cohort. An example of this is the NHS England Assisted Conception policy which applies to Service Personnel and their partners in England. This ensures that, subject to meeting the national access criteria, regardless of where someone is living in England, they have access to up to three cycles of In-vitro fertilisation
In addition to the services commissioned by NHS Integrated Care Boards (ICBs), NHS England, supported by the national Armed Forces public, patient voice lived experience group, has directly commissioned some specialised services for veterans - Op COURAGE, Op NOVA and Op RESTORE.
Op COURAGE is an integrated health and wellbeing service for veterans with mental health issues, including those related to their time in service. The service is provided by six lead providers in conjunction with ICB commissioned mainstream mental health services. Op COURAGE also work with a range of providers from the military charity sector such as Combat Stress and Walking with the Wounded.
Op COURAGE was originally formed from the three separate services of the Transition, Intervention and Liaison Service (TILS) which began in 2017, the Complex Treatment Service (CTS) which began in 2018 and the High Intensity Service (HIS) which began in 2020. These three separate services which came together under the common name of Op Courage in 2021, received over 30,000 referrals. The fully integrated Op Courage service which began in April 2023 has now received over 11,800 referrals to end November 2024.
Op RESTORE is an integrated health and wellbeing service for veterans with physical healthcare issues attributable to their time in the Armed Forces. The service works with NHS trusts to provide the best pathway and clinician to support individual veterans. Op RESTORE was formed from the Veterans Trauma Network which was established in 2016 after recognising that some severely injured veterans were being seen in mainstream NHS services who were not familiar with war injuries. Op RESTORE is based around the NHS Major Trauma Network and uses a network of clinical teams across 26 specialist and local NHS providers, made up of military and civilian staff, many of whom were involved in providing clinical care to Service Personnel when they were first injured.
Op RESTORE deals with problems related to a veteran’s time in service, with prioritisation based on clinical need. Op RESTORE works with a range of military charities to ensure that a veteran’s wellbeing needs are being met which helps ensure that the veteran is able to access healthcare and achieve the best outcomes.
Since 2016 Op RESTORE has received over 1240 referrals with 262 this year (April – November)
NHS England has operated the Veterans Prosthetics Panel since 2013. The VPP was established in 2012 as part of the Government’s response to A better deal for military amputees by Dr Andrew Murrison MP. The VPP provides support on a named veteran basis to NHS prosthetic services to ensure that veterans with an amputation attributable to their time in service are able to access the latest prosthetic technologies. At the end of December 2024, the VPP has supported over 525 veterans from all conflicts
Op NOVA provides one to one non-clinical support to veterans pre-, during, and post-prison custody. Veterans using the service have access to a range of practical and emotional help together with support from an expert case worker. Op NOVA began in April 2023 and was initially focussed on the pre- and post-custody phases. The service expanded in 2024 to provide in custody support and between April 2023 and September 2024 has received over 1920 referrals.
Healthcare services for families
Anecdotal evidence suggests that service families may sometimes find it difficult to access NHS services; this can be due to the need to re-locate around the country with the Serving person. NHS England worked with eight integrated care systems to run a pathfinder programme, Op COMMUNITY, to understand what the issues were and the steps that the NHS could take to reduce the barriers for service families. The pathfinder programme comes to an end in March 2025 but the learning from the programme is being developed into a guidance that will be rolled out to integrated care systems to assist them in their delivery of Armed Forces community support locally.
NHS England has established a Serving and ex-Serving Women’s Health Improvement Group (SESWHIG) to better understand the physical and mental healthcare needs of serving and ex-serving women to ensure that the services commissioned are appropriate, inclusive and accessible.
NHS England worked with Fighting with Pride, a military charity, to understand how NHS services can address the needs of the LGBT+ community, particularly recognising the impact that historic actions may had have on people’s health.
Working with partners, NHS England commissions two accreditation schemes and a scheme to support employment of members of the Armed Forces community.
The Veterans Covenant Healthcare Alliance (VCHA) is a group of NHS providers, including acute, mental health, community, and ambulance trusts that have agreed to be exemplars of the best care for, and support to, the Armed Forces community. This is undertaken through the Veteran Aware accreditation model, which encourages providers to identify those patients with an Armed Forces background. The scheme is hosted by the Royal National Orthopaedic Hospital NHS Trust. Over 98% of NHS Trusts and Foundation Trusts have been accredited under the veteran aware model.
Veteran Friendly GP Accreditation scheme by the Royal College of GPs and NHS England is a quick-to-implement, free support programme for GP practices in England that enables them to easily identify, understand and support veterans and, where appropriate, refer them to specialist healthcare services designed especially for them. Over 99% of Primary Care Networks have at least one GP practice accredited as Veteran Friendly.
Step into Health is a programme to support employment transition of former service personnel into roles across the NHS, and reservists and families of those who serve who work in the NHS. Following the signing of the Armed Forces Covenant in September, NHS England has signed the Step into Health pledge to support candidates from the Armed Forces Community.
Contracts - NHS England is bound by the Armed Forces Covenant Statutory Guidance and has highlighted the Covenant and the statutory guidance to providers of NHS services under the NHS Standard Contract with a requirement for healthcare providers to pay due regard to the Covenant when performing their obligations under the Contract. For example, this might mean that a hospital considers time already spent on a waiting list when a patient from the Armed Forces community transfers between hospitals. NHS England has also highlighted this requirement in the GP GMS/PMS contract.
5th February 2025