The Scottish Veterans Commissioner, Eric Fraser, Picture: @Alan Rennie Photography
24 April 2018 – SCOTLAND – In his latest report published today (Wednesday April 24), The Scottish Veterans Commissioner has called for a return to the days of more attention, ambition and innovation in meeting the long-term health and social care needs of Scotland’s veterans’ community.
While Eric Fraser acknowledges that there is much to be proud of in the provision of treatment and support to veterans by statutory and charity bodies, he has concluded that there is a need for rekindled national leadership and for consistent, long-term funding to protect specialist services for the lifetime of veterans.
The Scottish Veterans Commissioner, Eric Fraser, commented:
“The impressive work at the start of this decade in establishing ‘specialist’ physical and mental health services for veterans in Scotland has had a significant impact over subsequent years and has rightly attracted considerable attention and praise. We still see the benefits of this today.
“However, there are still a significant number of men and women in our communities who struggle with injuries and conditions caused or exacerbated by their military service. I have concluded that the levels of ambition and innovation which characterised work in support of veterans has waned in recent years. This may be partly understandable given the pressures on the health system, but it is also disappointing that the health of veterans no longer attracts the same level of attention it once did. I am determined to see this trend checked and a renewed investment in long-term planning.”
In his report, Eric Fraser sets out ‘A Distinctive Scottish Approach’ to veterans’ health and wellbeing, with 18 recommendations that he hopes the Scottish Government, NHS and their partners will adopt.
Amongst them he calls for the establishment of a National Clinical Network on veterans’ health to address issues such as funding, access and planning, an Action Plan to secure the long-term delivery of dedicated mental health services, and the identifying of veterans as a distinct group within the healthcare system in order to redress health inequalities that some face as a result of military service. He also calls for the membership and remit of The Armed Forces and Veterans Health Joint Group to be refreshed in order to provide the strategic leadership needed, and reinvigorating senior participation in cross-border networks to improve information sharing and collaborative working across the UK and beyond.
He argues that ‘priority treatment’ for veterans, as laid out in the Armed Forces Covenant is “a largely meaningless concept” as care within the NHS is based on clinical need and not on the background, occupation or category of a patient. He believes focus instead should be on the principles of excellence, accessible and sustainable treatment for all veterans.
The report also acknowledges the need to identify veterans as such within the healthcare system and that their distinct needs are understood and met.
Eric Fraser added:
“The current confusion about what priority treatment means and its impact serves nobody well, especially if it results in unrealistic expectations which cannot be matched. It is clear to me that the time is right for a fresh and bolder vision, which will be especially important for those with the most severe and enduring injuries and conditions.
“Within the report I set out the guiding principles of what I would like to see. Included in this is veterans being confident that support – across the entire health and social care sector – is available whenever required and for the rest of their lives.”
Jay Hare, a former Corporal in 45 Commando Royal Marines, who sustained life-changing injuries from an explosion in Helmand Province in 2008 has concerns about future support. He lost his left leg below the knee, several fingers and had injuries to his right arm, right leg and face which required multiple reconstructive surgeries over a number of years.
Now aged 36, Jay already feels twinges from his prosthetic leg, his other injured knee and back. He questions whether the excellent care and support he has received to date, from both the national specialist services and his local clinic in Aberdeen, will be available in the future. He worries about breaking his prosthetics and having access to replacements and updated models.
Jay Hare, comments:
“The Armed Forces Covenant made a promise to the veterans community that we would be treated fairly. Are enough future resources in place to really deliver on this promise? We were told that we were going to be looked after if injured – that was the deal that was on the table and I hope that is still the case.”
Aidan Stephen, who served in the Army (Royal Armoured Corps) for seventeen years, was medically discharged due to serious mental health issues.
Aidan explains:
“I was sent to a civilian mental health unit which treats people with addictions and eating disorders. This was one of the worst decisions made in the duration of my treatment. None of the staff were trained to deal with patients from a military background and none of my fellow clients shared my experiences. When Veterans F1rst Point launched in Edinburgh in 2009, for the first time I had the opportunity to access peer-to-peer talking therapy. It was the first time I had really spoken to anyone about my experiences.
“I think ensuring that peer-to-peer support is made available at the earliest stage possible would significantly improve the outcomes for Service leavers with mental health issues. I was diagnosed with PTSD which I got support for from Combat Stress, and accessed a range of other services through veterans charities.
“All veterans have completely different experiences and needs, and have different ways of adjusting to the civilian world. However, being able to talk with someone openly and honestly provides the basis for developing a suitable treatment plan which can effectively address these. Although I have come a long way since my lowest point, I still have bad days which are unlikely to ever go away completely. Most veterans agree that continuity is essential – PTSD can’t be cured, only controlled, and long-term support for this is vital.”
Eric Fraser concludes:
“With healthcare reform underway in Scotland there is a need and an opportunity to embed veterans’ health requirements into existing and new frameworks and guidance.
“My hope in writing this report is to re-focus and re-energise Scotland’s approach to looking after its ex-Service men and women – particularly the mercifully small group of veterans who have serious and life-changing conditions and who have made the greatest sacrifices – and to faithfully represent the views of as many of them as possible,” he added.
It is estimated that there are around a quarter of a million veterans currently living in Scotland.
The report ‘Veterans’ Health & Wellbeing – A Distinctive Scottish Approach’ can be found here: http://bit.ly/SVCHealthFilm.
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FOR FURTHER INFORMATION
Lesley Alexander/Nicola McArthur/Hannah Fisher – Smarts Communicate
Tel: 0141 222 2040 Email: scottishveteranscommissioner@smartscommunicate.com
The Guiding Principles of a Scottish Approach to Veterans’ Health and Wellbeing
Recommendations and Findings
- Recommendation 1 – A Distinctive Scottish Approach to Veterans’ Health
The Scottish Government and NHS(S) should commit to establishing a distinctive Scottish Approach to Veterans’ Health at a strategic level, accept or adapt the guiding principles of this approach and work with their partners to embed it at an operational level. - Recommendation 2 – Improving Collaboration and Partnership
The Scottish Government should reinvigorate senior participation in cross-border networks with a view to improved information sharing and increased involvement in collaborative working and initiatives. - Recommendation 3 Leadership and Governance
The Armed Forces and Veterans Health Joint Group should refresh its membership and remit in order to provide the vital strategic leadership that will deliver the Scottish Approach to Veterans’ Health - Recommendation 4 – National Managed Clinical Network
The Scottish Government and NHS(S) should establish a network on veterans’ health. The network will have oversight of delivering the Scottish Approach to Veterans’ Health, and will consider the key issues raised in this report and others it deems relevant. It should reflect current structures in the health and social care sector in its membership and approach. - Recommendation 5 – Mental Health Action Plan
The Scottish Government and NHS(S), through the network on veterans health (see recommendation 4), should produce a Mental Health Action Plan for the long-term delivery of services and support. This should have a particular focus on those with severe and enduring conditions and consider both mainstream and specialist provision. Issues of funding, collaboration, leadership, planning and governance will be key. - Recommendation 6 – Drugs Misuse
The Scottish Government and NHS(S) should assess the scale and nature of drugs misuse – especially prescription and non-prescription painkillers – amongst the veterans community in Scotland and introduce remedial measures. This should be taken forward by the Joint Group and network, and included as part of the Mental Health Action Plan. - Recommendation 7 – Barriers to Accessing Services
The Scottish Government and NHS(S) should build on existing work aimed at reducing barriers to veterans accessing mental health services. This will include measures to address issues of stigma, seeking help, and improving awareness and understanding within the medical profession. This should be taken forward by the Joint Group and network, and included as part of the Mental Health Action Plan. - Recommendation 8 – Access to Life-long Services
The Scottish Government, NHS(S) and local Councils should make a commitment to veterans with the most severe and enduring physical (and mental) conditions that they can access the highest quality health and social care services for life and as their needs change. Health and Social Care Partnerships and Integrated Joint Boards will be instrumental in planning the delivery of these services and the national network recommended in chapter 2 should assume responsibility for oversight of this work as an early priority. - Recommendation 9 – Funding for Multiple Injuries
The Scottish Government and NHS(S) should give consideration to whether the costs of specialist care for veterans who have suffered polytrauma should be funded through the National Services Division (NSD). - Recommendation 10 – The National Trauma Network
NHS(S) should include the specific needs of veterans who have suffered polytrauma as part of its work in setting up a national Trauma Network. - Recommendation 11 – Wheelchairs for Amputees
NHS(S) should adapt current arrangements to ensure an appropriate level of funding is available to guarantee that wheelchairs provided by the MOD for veterans with severe amputations can be serviced, maintained and replaced with the best possible equipment commensurate with that individual’s needs. - Recommendation 12 – Chronic Pain Management
The National Advisory Committee for Chronic Pain (NACCP) should consider veterans specifically as part of their work to improve chronic pain management in Scotland. - Recommendation 13 – Funding Hearing Aids
The Scottish Government and NHS(S) should make funding available so that veterans with the most severe hearing loss as a result of their military service can have access to the best possible hearing aids and support. - Recommendation 14 – The Invictus Games
The Scottish Government should work with partners, charities and others to develop a proposal to host a future Invictus Games in Scotland. - Recommendation 15 – Tackling Health Inequalities
The Scottish Government, NHS(S) and partners should identify veterans as a distinct group in their work to tackle health inequalities. In doing so they should produce proposals for preventing or mitigating inequalities as they apply to this group, with the ultimate aim of improving health outcomes for all. - Recommendation 16 – Identifying Veterans
The Armed Forces and Veterans Joint Health Group should oversee work to increase the number of veterans declaring their previous service to GPs and others in the system. This will likely involve NHS(S), MOD and veterans organisations. - Recommendation 17 – Using Information
The Armed Forces and Veterans Joint Health Group should oversee efforts to improve methods of recording, displaying and sharing information about veterans within the health and social care sector. This will be with a view to providing health professionals with the information needed to better understand and support veterans. - Recommendation 18 – Veterans Champions
The Scottish Government and Veterans Scotland should build on recent work to support the network of NHS and Council champions to develop the role so that it can continue to be effective in supporting the delivery of health and social care to veterans within the new health landscape of Scotland.
- Finding 1 – Specialist physical and mental health services are a vital and valued part of supporting our veterans with the most severe and enduring injuries and conditions. While their exact make-up and models of delivery will inevitably change and adapt over time, it is imperative that the availability of specialist services – and the outcomes they support – are protected for current and future generations.
- Finding 2: Funding for specialist mental and physical health services for veterans is disjointed and in some cases ad hoc. This results in a degree of uncertainty and raised questions about the sustainability of some of these services, which is a worry for those who rely on and value them so much. It is an issue that needs addressed as a priority.
- Finding 3: The integration of health and social care services in Scotland provides a unique opportunity to ensure the longer-term needs of veterans are properly planned and met. The new structure of IJBs and HSCPs is the vehicle for delivering this ambition. They must play a central role in decision-making about veterans’ health and wellbeing and the delivery of both mainstream and specialist services.
- Finding 4: the publication of the Suicide Prevention Action Plan by the Scottish Government later this year is a welcome step in ensuring everything possible is done to help anyone struggling with mental ill health. Vulnerable veterans, and their particular circumstances, will be an important consideration as the plan is developed.
- Finding 5: Rehabilitation services, such as those provided by physio and occupational therapists, can be of huge benefit to those suffering from MSDs. Given the high demand for such services, veterans suffering from severe MSDs as a result of their military service should be given early access as part of their special treatment.
