Wounded receive quality care but resources at their max

Last Wednesday the National Audit Office published its report on its investigation into "Treating injury and illness arising on military operations".

The main findings were:

• Clinical treatment and rehabilitation of seriously wounded personnel are highly effective and rated by the military.
• The high quality of care for the seriously injured is demonstrated by the number of "unexpected survivors".
• Medical capacity at military hospitals in the UK and in Afghan has been sufficient to deal with casualties to date but it is close to its limit.
• Reported rates of disease and minor injury in Afghanistan have almost doubled from 4% to 7%.
• Personnel at risk of developing mental health conditions on operations receive appropriate support but there are some weaknesses in follow-up procedures.

Some figures published in the report:

• Between October 2001 and October 2009, 522 UK military personnel were seriously injured on operations in Iraq and Afghanistan.
• Since 2006 personnel on operations have attended medical facilities 125,000 times for minor injury and illness, with a further 1,700 times for mental health conditions.
• Some 6,900 people have been evacuated back to the UK from Iraq and Afghanistan since 2003 for serious injuries and a range of other medical conditions.
• The estimated the cost of medical care provided as a result of military operations stood at £71 million in 2008-09.

That the treatment for the seriously wounded is both highly effective and of a high quality is, as the head of the NAO himself said, really good news. The worrying thing is that military hospitals seem now to be full.

The current surge strategy with its large-scale offensives against the Taliban (of which Operation Moshtarak is the first) is regretfully going to lead to higher casualties.

The situation is exacerbated by the intense pressure under which UK troops are fighting. Figures released by the MoD show that 46 per cent of all Army units are now in breach of the "harmony guidelines" (leave between combat tours) with the number of soldiers thought to have been affected by the breach estimated at 10,000. The problem of overstretch is further worsened by troop shortages and soldiers who are unfit for front line duty. Virtually every infantry regiment is under-strength by as much as 10 per cent or 70 soldiers and there are around 10,000, servicemen and women who cannot serve in combat zones for medical reasons.


The prognosis is not good for a medical service already running at capacity.

What is even more worrying is that this comes at a time when the Armed Forces budget is about to be hammered yet again. The government cannot depend on Help For Heroes to bail it out; perhaps the bankers could be encouraged to donate some of their bonuses.

NAO: Ministry of Defence: Treating injury and illness arising on military operations
InThe News: MoD feels strain of Afghan wounded
The Telegraph: Overstretch pushes British troops to the brink

Colchester to host first Personnel Recovery Centre

The first of the new Personnel Recovery Centres for injured servicemen and women is to be built at the Merville Barracks in Colchester, Essex. The building costs of the centre will be funded by Help for Heroes and it will be run jointly by The Royal British Legion and the Army.

The 20 residents and 40 day visitors that the centre will accommodate will benefit from a specialised treatment programme aimed at getting them fit enough to return to active service or alternatively preparing them for life outside the Armed Forces.

The centre will also have two family rooms, each catering for two adults and up to three children.

Marianne West, the Help for Heroes Volunteer County Co-ordinator for Essex, said: “I am overjoyed at hearing the announcement that the Personnel Recovery Centre project has at last been given the go-ahead. It will be just marvellous actually to see the proof of the public's generosity taking shape before our eyes in Colchester.”

The new centre will form part of the Army Recovery Capability (ARC) scheme announced last week. Key components of the ARC will be:

• A Personnel Recovery Branch providing assurance, direction and guidance from within the Army’s 3* Personnel and Support Command;
• Personnel Recovery Units one in each of the 10 regional Brigade areas as well as one in London and Germany, to provide support and guidance;
• Individual recovery plans tailored to meet a soldier’s specific recovery needs; and
• Purpose-built Personnel Recovery Centres (like the one in Colchester).
  

ARC marks a return to the time-honoured practice of treating injured Service personnel in a solely military environment and marks a U-turn in government policy which had up until now been looking to cut costs by merging military and civilian care within shared establishments and on mixed wards. As the MoD admits: "Experience shows that injured personnel find a military environment conducive to the best possible recovery, so we will provide purpose-built Personnel Recovery Centres around the UK".

Other Personnel Recovery Centres are likely to be based in Catterick, Tidworth/Bulford and Edinburgh. The facilities and support provided at the centres will also be open to personnel from the Royal Navy and the Royal Air Force.

Help For Heroes and the Royal British Legion have each put in £20million to the ARC scheme which will meet the bulk of the costs. Without their funding and their principles such a dedicated military care centre would not have got off the ground.

"There is a long history of charitable organisations contributing to the welfare of serving military personnel, veterans and their families; this relationship will be strengthened further through the introduction of the ARC, for the continued benefit of Armed Forces personnel."

A true ARC of the Covenant then.

EADT24: New centre to help injured soldiers
MoD: New plans to support sick and injured soldiers

Supporting the Armed Forces Community: consultation results

The MoD has today published findings from the public consultation it undertook last year into how best to provide consistent and enduring support to the Armed Forces Community (AFC) , i.e. serving personnel, their families and veterans.

The consultation sprang out of the 2008 Service Command Paper which looked at ways in which the state's commitments in the Nation's Covenant with the Armed Forces could be repaired following years of neglect (NB. the Armed Forces' commitment to the Covenant has never weakened).

To re-establish the Nation's responsibilities - and indirectly to draw a veil over its own earlier failings - the government is seeking to engage the wider civil community in its endeavours. Local councils, the Third Sector (see *** below), the NHS, the Police and charities & voluntary organisations are all to play a role in supporting the AFC in future.

In terms of the number of responses it elicited, the consultation was not a success; indeed you could say that the response was pretty shameful. Of the 468 local councils in the UK, responses were received from just 16; only 3 government departments responded; Service charities and federations sent in 5 replies; 25 responses were received from the AFC itself; and one came in from the business community (Right Management UK). Not only that but "around a quarter of respondents did not answer the consultation questionnaire but took the opportunity to comment on wider Service Personnel issues".

Anyway, the findings of the consultation were summarised as:-

• there was marginal support for an Armed Forces Charter (a kind of new Covenant);
• existing problems would be resolved through increased awareness of Service issues and improved communication between the AFC and service providers;
• the AFC should not be singled out as a minority/disadvantaged group;
• for some reason local councils thought it was difficult to identify the AFC;
• while the AFC thought legal obligations a good thing, local councils, as you would expect, didn't agree saying that additional resources would be needed to meet strict legal obligations;
• again unsurprisingly, councils came out strongly in favour of local autonomy when it came to providing support to the AFC.

Although the 'single point of contact' approach for dealing with AFC issues was not generally popular with respondents, the government has already started to roll out its Armed Forces Welfare Pathway project involving the establishment of local service access points or "gateways". Pilot Pathways have been launched in Kent, Hampshire and in Wigan.

The MoD has also recently set up a National Point of Contact super-helpline for directing calls from Service personnel to the appropriate service-specific helpline.

Other recent developments include the Affordable Houses Scheme, improvements in the way school places are allocated for Service children and, of course, the Army Recovery Capability Scheme.

My experience with public consultations is that, more often than not, they're an expensive waste of time, serving only to line the pockets of the consultants themselves and providing little in terms of tangible benefit. However, this particular consultation exercise does seem genuine .... despite the poor response. A coherent (I hesitate to say 'holistic') approach for dealing with AFC issues is clearly required and it's good to see some joined-up thinking for a change.

MoD: Summary of responses to consultation on supporting Armed Forces Community published

MoD: The Consultation Paper (The Nation’s Commitment to the
A rmed Forces Community: Consistent and Enduring Support - A Consultation Paper)

MoD: A Summary of Consultation Responses - February 2010

MoD: Service Personnel Command Paper. The Nation's Commitment: Cross-Government Support to our Armed Forces, their Families and Veterans.



*** The Third Sector as described on the government's "Communities" website: "The Government defines the third sector as non-governmental organisations that are value driven and which principally reinvest their surpluses to further social, environmental or cultural objectives. It includes voluntary and community organisations, charities, social enterprises, cooperatives and mutuals. We also include housing associations within the third sector. The Government recognises the value of the diversity of organisations in the sector providing voice for under represented groups, in campaigning for change, in creating strong, active and connected communities, in promoting enterprising solutions to social and environmental challenges and in transforming the design and delivery of public services." - ummm, well there you have it.

CivvyStreet: helping the transition

Stars of Dragons' Den and The Apprentice have voiced their support to a Royal British Legion website specialising in helping members of the Armed Forces readjust to life on Civvy Street. Dragons' Den Duncan Bannatyne and Lord Sugar's new right hand woman on the Apprentice, Karren Brady, have appeared in a new online video promoting resettlement website civvystreet.org.

Civvy Street is a website for serving and ex-Service personnel and their families. It helps

with a range of issues around resettlement including re-training, employment opportunities and also help around CV building and interview tips. As well as this practical help, in the twelve months from 01 October 2008 Civvy Street had awarded over £600,000 in training and employment grants.

Ken Parkinson, Civvy Street Manager said 'At a time where the resettlement of Service leavers is a key issue, it is great that high profile figures such as Duncan Bannatyne and Karren Brady have helped to highlight the services that Civvy Street can offer.'

Leigh Groombridge, who served with his TA regiment in Afghanistan, is just one of the many who has benefitted from Civvy Street's help. He commented 'After returning from Afghanistan I was having real problems finding work, I came across Civvy Street online and with their help I've retrained as an IT engineer and am doing a job love'.

CivvyStreet.org also works in close collaboration with Poppyscotland, providing resettlement support and training grants for ex-Servicemen and women throughout Scotland


Civvy Street

Armed Forces Community Welfare Pathway

The Armed Forces Community Welfare Pathway is the latest MoD initiative aimed at helping serving personnel, their families and veterans receive the advice and support they need to meet a whole range of health, social and economic issues and to ensure they have consistent, easy and direct access to the services to which they are entitled.

The Welfare Pathway provides a 'one-stop-shop' that brings together the local council, community organisations, Citizen Advice Bureaux, the NHS, Service charities, etc to deliver a complete advice service that is tailored to the needs of the military community - for example:

• advice about access to NHS services;
• information about help for veterans with mental health problems;
• help and advice about education, skills and careers;
• help with affordable and social housing;
• help with transport, including Blue Badges and concessionary transport;
• advice about, and access to, affordable childcare.

The Pathway is a step along the road outlined by Bod Ainsworth in his proposal to introduce an Armed Forces Community Charter. This charter would set out the individual and specific rights of the Armed Forces community and the duty placed on public bodies to fulfil them. It has been suggested that such a charter could actually be made legally binding on public bodies. It al;so fits in with the commitments set out in the Service Personnel Command Paper, 'The Nation's Commitment: Cross-Government Support to our Armed Forces, their Families and Veterans'.

The project was launched last November in Kent and has since been rolled out in Hampshire and today in Wigan and it is expected that local "Gateways" will soon be opening up across the country. A dedicated national helpline (08000 22 33 66) has also been set up.

Despite the tired nulabour jargon which surrounds it, this scheme certainly has the promise of being able to cut through otherwise daunting bureaucracy and bring speedy solutions to the people who really deserve it.

NDS: Armed Forces Community Welfare Pathway for Wigan launches today
MoD: Armed Forces Welfare Pathway launched in Hampshire

MoD: Armed Forces Welfare Pathway launched

Defence Committee report on Recruiting and Retaining Armed Forces personnel

The House of Commons Defence Committee has published its report on Recruiting and Retaining Armed Forces personnel. The report contained few surprises - well-known concerns were re-iterated and in the main the MoD was encouraged to expand on and improve their exisiting initiatives. The Committee found:

• There are serious skill shortages in certain trades and these “pinch points” continue to increase. These trades should be targeted in recruitment campaigns.
• The Armed Forces are overstretched given the resources currently available. The Committee found that the MoD was being complacent and that there is likely to be a “serious weakness in the future capability of the Armed Forces”.
• Failure to meet Harmony Guides is having a negative impact on retention. The current level of operations continues to put Service personnel and their families under considerable strain – need for greater stability and more advance warning of deployments.
• The MoD could do more to raise the general public’s perceptions of the Armed Forces and to counter negative media coverage. The suggestions emanating from the National Recognition Study should be implemented. Engaging with civilian society is “central to ensuring the future success of the Armed Forces”.
• The good work the MoD has been doing working with schools should be expanded particularly with regard to school visits, outreach and promotion of cadet forces. The school recruitment programme needs to be reviewed and further education incentives should be offered to improve recruitment.
• The “recruiting environment” needs to adapt to the changes in the socio-economic environment - the targeting of ethnic minorities, women, older people and EU migrants and the provision of more flexible career structures together with embracing the challenges of diversity (here we go again!) to ensure the “long term credibility and legitimacy” of the Armed Forces.
• More information is wanted on the success or otherwise of the “One Army Recruiting” strategy (integrated Regular and Territorial Army recruiting).
• Initial training programmes need to be reviewed to ensure fewer recruits drop out and that more pass - i.e. standards need to be lowered.
• The improvements the MoD has already made in the operational welfare package need to be expanded. The valuable work carried out by the voluntary sector needs to be better coordinated and given coherence. MoD needs to develop a welfare package that responds to the unique circumstances of Volunteer and Regular Reservists.
• The £5billion (I thought it was £8billion) planned refurbishment and upgrading of service accommodation needs to be pushed forward. The standard of maintenance repairs and level of customer service continues to fall below expectations – a customer-centric approach needed.
• The overall basic pay package does not appear to be a major cause of Armed Forces personnel leaving the Services. Financial Retention Incentives may be expedient in the short-term but may divert investment away from addressing the underlying causes of worsening retention.
• Formalizing the Military Covenant would be counter-productive as it would become a political instrument rather than an instrument to protect the interests of men and women in our Armed Forces. As such, it would divert attention from what is important: ensuring Armed Forces personnel receive what they are entitled to.
• The MoD should consider more constructively the possible benefits which may be gained from an independent Armed Forces Federation.

Interestingly at the top of list of conclusions and recommendations is:
"The use of web fora provide us with an opportunity to hear the experiences of a wide range of current and former Service personnel and their families. We value this interaction. We welcome the Minister’s support for our ability to communicate freely with the Service community. However, this is the second time we have had concerns that the MoD has attempted to undermine a web forum that we have hosted. We look to the MoD to demonstrate its support for our interaction with the Service community by actively promoting web fora we set up for future inquiries." This doesn't sound very politically sensitive of the MoD.

Link> Defence Committee
Link> Defence Committee Report: Recruiting and retaining Armed Forces personnel
Link> The Guardian: Pressure on armed forces unprecedented, say MPs
Link> The Independent: Constant tours of duty leading to exodus of officers
Link> Whitehall Pages: MoD responds to House of Commons Defence Committee

Public Accounts Committee reports on "Leaving the Services"

The House of Commons Public Accounts Committee has recently published its assessment of how the MoD prepares personnel for their discharge from the Services.

As the majority of service personnel leave the Armed Forces at least 25 years before a normal civilian retirement age of 65, many will need or wish to have a second career. The MoD believes that effective support for personnel at the end of their career aids retention and is a reward for long service.

The MoD provides a "resettlement" programme which helps and supports personnel in the transition from military to civilian life. .

The Committee's findings and recommendations:

• Early Service Leavers are most vulnerable to social and economic exclusion. Whilst the MoD provides comprehensive resettlement support to those with long service histories (probably as a reward for service and as an aid to retention), it needs to do more to help those leaving the service early.
• Training improvements needed for first-line resettlement staff. Although the MoD has planned for improvements, these have not yet been implemented. First-line support is crucial for assisting Early Service Leavers.
• The resettlement process needs to be streamlined further. The MoD has already reduced the amount of paperwork and bureacracy associated with resettlement but this can be taken further particularly with regards those who need the most administrative support (i.e. those with lower educational attainment).
• Time must be set aside for resettlement. Commanding Officers should make it easier for Service Leavers to attend the resettlement programme and should give it higher priority to ensure the necessary time is available for all Service Leavers.
• The Career Transition Partnership is not so popular with junior ranks. Although the Career Transition Partnership has been generally successful, attendance and corresponding satisfaction levels are lower amongst junior ranks. The MoD should find out why this is.
• Unemployment is significantly higher among Early Service Leavers. The MoD should monitor how many remain out of work six months after discharge, determine why this is the case and implement appropropriate changes to its support programmes.
• Local authorities are not always meeting their responsibilities with regards to the housing of Service leavers and some Service Leavers have found it difficult to get assistance with housing. Part of the problem relates to the lack of a “local connection” to the area where the Service Leaver had served but, in other cases, local authorities were simply reluctant to assist Service Leavers without them being evicted from Service housing. Such authorities must be identified and instructed not to do this.
• The support provided to those looking to buy their own homes can be extended even further. The MoD provides good support to serving personnel looking to buy their own home, and to single Service Leavers who need accommodation on discharge, but the take up of these services is low. The Department should refer more of its single Service Leavers to the services provided by the Single Persons Accommodation Centre for the Ex-Services (SPACES), especially those whom it has identified as most vulnerable to social exclusion. The Department should do more to encourage home ownership earlier in the careers of serving personnel or prior to discharge.
• The improved mental health support provided to veterans needs to be publicised more. The MoD should do more to raise awareness of the new provision and to remind veterans of the support available. It should also strengthen its screening for potential risk of mental health problems when Service Leavers have their final medical and should use this opportunity to alert Service Leavers to the support available to them following discharge.

91% of those entitled to the resettlement package (which is the majority of leavers) are very satisfied with the support provided. Six months after discharge only 5% of Service Leavers looking for work were still unemployed. Those not entitled to the full resettlement package, i.e. Early Leavers, are the ones more likely to suffer from unemployment and to find it more difficult to get suitable accommodation.

On balance it sounds as if the MoD is providing a good resettlement package for the majority of service personnel about to make the transition to civilian life, but ..........

Campaign groups like Parcels43 are saying that significant numbers of soldiers are finding it increasingly difficult to find appropriate accommodation on leaving the Forces.

A recent BBC TV documentary "Ex Forces and Homeless" found that on any given night in London alone there are thought to be over a thousand homeless veterans; in some parts of the country they number 12% of the homeless population. It also found that problems were mainly being experienced by those with long service histories.

Charities dealing with those suffering from post-traumatic stress disorder, like Combat Stress, are not reporting a diminuation in the number veterans seeking their help, rather the reverse.

The Committee and the MoD seem to believe that the MoD's and Government's responsibility for ex-Forces personnel only lasts for six months after discharge. The above research has found that PTSD, homeless and unemployment most often kicks in several years after leaving the Services.
The MoD must take a longer, more responsible view. It must monitor key indicators (health, work, accommodation, family status) at 5, 10 and 15 years after discharge and its resettlement programme must provide help and support to veterans developing psychological problems several years after leaving the Services.

Link> AV: Helping servicemen through their own front door
Link> AV: Ex-Forces and Homeless

PAYD or PAYE?

Pay As You Dine (PAYD) - or "the privatisation of the cookhouse" as it has come to be called - began being introduced in 2005. It requires that soldiers not on active duty must pay for each individual meal rather than having a standard monthly food charge deducted from their salary to cover all their meals (kind of like PAYE). According to the MoD, PAYD is "a feeding model (sic) where Service personnel only pay for what they eat and is replacing an outmoded system where personnel paid in advance. It is therefore a fairer system and, as it does not apply to personnel at sea on exercise or on operations, where feeding is free, it is a decisive step in improving the well-being of personnel." In theory "everyone will have the choice and flexibility to eat what they want, when they want and how they want"

In practice however things have turned out quite differently. PAYD was one the areas that came in for particularly strong criticism in General Sir Richard Dannatt's Briefing Team Report published in November 2007. The report said: "There are real concerns about the new eating habits of some soldiers due to Pay As You Dine. A Pot Noodle and sandwich culture is being created and soldiers are cooking rations over gas burners in their rooms. There are apocryphal stories of soldiers flaking out during PT sessions from a lack of nutrients."

Six months on and the situation has got even worse. A Briefing Team Report in May 2008 has revealed that some soldiers are living in such poverty that by the end of the month they are having to rely on food vouchers under the "Hungry Soldier" scheme to get them enough to eat. As the cost of the vouchers is deducted from their future wages, this adds yet further to the problems of soldiers on low pay. The quality of the food provided under PAYD has also come in for a lot of criticism as have the confusing and bureaucratic procedures that surround it.

General Dannatt may well be "determined that PAYD must be made to work". Far better would be get rid of the whole thing and return to the traditional practice of "three square meals a day for free". A petition to achieve this has been launched by Parcels 43 Supporting Our Troops; to sign it visit:

Link> www.petitions.pm.gov.uk/feedthem43/

Link> The Independent: Soldiers need loans to eat, report reveals
Link> The Sun: Soldiers get grub vouchers