Defence Medical Services

The uniformed and civilian medical and dental personnel from all 3 services are known collectively as the Defence Medical Services (DMS).

Defence Medical Services in the UK

The uniformed and civilian medical and dental personnel from all 3 services are known collectively as the Defence Medical Services (DMS).

The DMS are grouped under Headquarters Surgeon General (HQ SG), the Director of Medical Policy and Operational Capability, the Director of Healthcare Delivery and Training and the 3 single service medical organisations. Medical, dental and related support services are provided to armed forces personnel by the Ministry of Defence (MOD) and the National Health Service (NHS). Charities and welfare organisations are also involved in the provision of support services where appropriate.

Overview

The primary role of the DMS is to promote, protect and restore the health of service personnel to ensure that they are ready and medically fit to go where they are required in the UK and throughout the world; generally referred to as being ‘fit for task’.

The DMS encompass the entire medical, dental, nursing, allied health professionals, paramedical and support personnel. The organisation is staffed by around 11,000 Service personnel (7,500 Regular and 3,500 Reserve) and 2,200 civilian personnel and provides healthcare to 147,030 UK regular forces personnel (as at 1 Jan 2018: The UK armed forces quarterly service personnel statistics).

Personnel from all 3 services, regulars and reserves, work alongside civil servants and other supporting units providing healthcare to service personnel in the UK, abroad, those at sea, and in some circumstances family dependants of service personnel and entitled civilians. It also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict.

The range of services provided by the DMS includes primary healthcare, dental care, rehabilitation, occupational medicine, community mental healthcare and specialist medical care. It also provides healthcare in a range of facilities, including medical and dental centres, Regional Rehabilitation Units (RRUs) and in Field Hospitals. From April 2013, the DMS has been responsible for providing primary healthcare to all service personnel and entitled civilians through the DPHC organisation.

The DMS has:

  • 14 RRUs across the UK and Germany
  • 4 Ministry of Defence Medical Group Units (DMGUs) embedded within NHS Trusts
  • the Royal Centre for Defence Medicine (RCDM) in Birmingham
  • the Defence Medical Rehabilitation Centre (DMRC) in Surrey
  • Mental Health Services are delivered through a network of 20 permanent locations, comprising 11 Departments of Community Mental Health (DCMHs), 6 Mental Health Teams (MHTs), and 3 locations with a permanent Community Mental Health Nurse

The Surgeon General (SG) is the 3 star military officer and professional head of the DMS and the Defence Authority for end to end Defence healthcare and medical operational capability. He is accountable to the Defence Board, reporting routinely through the Defence Audit Committee and Defence People and Training Board, both of which he attends as required. HQ SG became part of Joint Forces Command on 1 April 2012. SG continues to have responsibility for policy making and the provision of high level medical and strategic advice to ministers, the Defence Board and the Chiefs of the Defence Staff.

The SG is responsible for:

  • defining the boundaries and processes, in consultation with top level budget holders (TLBs), together with the organisational structures and composition of Forces, and the standards and quality needed, to deliver advice on health policy, healthcare and medical operational capability
  • setting the overall direction on all clinical matters relating to the practice of military medicine
  • setting and auditing the professional performance of all military medical personnel
  • setting clinical and medical policies and standards, and auditing compliance by military organisations across defence
  • developing the science of military medicine to develop approaches and treatments that will best counter threats to the health and wellbeing of service personnel
  • providing deployable medical operational capability
  • building and maintaining the medical infrastructure and cadre of people
  • providing a comprehensive healthcare system that achieves the appropriate timely healthcare to service and other entitled personnel
  • ensuring coherence of health plans between defence and the NHS
  • chairing the Defence Medical Services Board, the forum for providing strategic direction and guidance to the DMS

The Surgeon General is Major General Martin Bricknell.

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HQ Surgeon General

HQ SG is the strategic headquarters of the DMS based at DMS Whittington (DMS(W)) near Lichfield in Staffordshire. It is involved in a number of defence medical projects, initiatives, campaigns and policy areas. HQ SG includes the positions of the three-star SG, the Director Medical Policy and Operational Capability, and Director Healthcare Delivery and Training; both of which are two-star military posts.

Director of Medical Policy and Operational Capability

Director of Medical Policy and Operational Capability is responsible for the core outputs of the DMS, including medical research and the development of medical strategy and policy which is then implemented across the armed forces. The Directorate of Medical Policy, Operations and Capability comprises three one-star business areas and is distributed over almost the entire country.

Medical Operations and Capability comprises:

  • Medical Commitments which advises the Operations Directorate in Main Building and undertakes the early medical planning for overseas deployment
  • Defence Engagement which advises International Policy and Plans in Main Building and undertakes strategic engagement
  • Joint Medical Capability that delivers the Equipment Plan, Doctrine and Capability Development across the DLODs and leads on CBRN Defence

The Joint Medical Training Requirement Authority delivers education and training needs analyses and undertakes the early work on developing education and training opportunities both inside and outside the Defence education and training process; strategic Plans and Policy is closely aligned with HQ SG in developing long term direction and guidance for the DMS.

Medical Policy and Information Systems delivers DMS specific policy and contribute the specialist medical input into other Defence policies. Medical Information Systems lead on the management of day to day Medical Information Issues (Med IS Joint User) as well as setting the requirement for the future Defence Medical IS solution (through Program CORTISONE). It also includes the Defence Preventive Medicine Unit which provides strategic and tactical advice about Public Health issues; the Defence Nursing Advisor and 1 staff officer embedded in the Chief of Defence People’s organisation delivering the specialist medical input to the Defence People Health and Welfare Strategy.

The Medical Directorate is responsible for the delivery of the Surgeon General’s Research Strategy, the Defence Medical Service elements of the Defence Organisational Learning System, Clinical Innovation as well as an element of the Defence Medical Services Defence Engagement process.

Director of Healthcare Delivery and Training (Dir HDT)

The Directorate of Healthcare Delivery and Training was established in December 2014 following the amalgamation of Defence Primary Healthcare and Joint Medical Command. It is responsible for the delivery of all healthcare including primary healthcare which incorporates rehabilitation; mental healthcare; dental; the placement of secondary care personnel in NHS facilities; and medical education and training.

In order to deliver this capability, healthcare delivery and training is divided into 4 pillars: Defence Medical Group; Defence Primary Healthcare; Defence Healthcare Education and Training; and Future Healthcare. The organisation operates from sites across the UK to provide clinical support, academic and military education and training, ranging from new nurse and combat medical technician recruits through to hospital consultants.

The Royal Naval Medical Service (RNMS)

The vision of the RNMS is to use a whole force approach to provide agile, flexible and responsive support to operations. It provides comprehensive healthcare to ships, submarines and Royal Marine personnel at sea and on land. It provides primary care, deployed surgical support and, through the Primary Casualty Receiving Facility on board RFA Argus, deployable hospital care. It provides specialist advice in fields including radiation protection, diving medicine and environmental medicine through the Institute of Naval Medicine.

It is headed by the Medical Director General (Naval), a member of the Second Sea Lord’s Board of Management and the medical adviser to the Admiralty Board.

The RNMS includes the Queen Alexandra’s Royal Naval Nursing Service

The mission of the RNMS, as a critical component of the Naval Service and wider Defence, is to support delivery of maritime effort and contingency operations at maximal effort. We provide suitably qualified, trained and equipped personnel to deliver quality assured, cost effective healthcare. We support the promotion of health and wellbeing, and provide healthcare, policy and advice to maximise fitness for role.

The Army Medical Services (AMS)

The mission of the AMS is to provide army medical and veterinary policy, operational capability, healthcare advice and assurance, in order to enhance and sustain the operational effectiveness of the army.

Army operational healthcare is provided through the following:

  • regular and reserve army medical regiments that provide primary and pre-hospital emergency care
  • regular and reserve field hospitals

Members of the AMS contribute the largest numbers of staff to the DMS and run the majority of Field Hospital deployments, which is a key capability of the DMS. The AMS encompass:

  • Royal Army Medical Corps
  • Royal Army Veterinary Corps
  • Royal Army Dental Corps
  • Queen Alexandra’s Army Nursing Corps

The Royal Air Force Medical Services (RAFMS)

The RAFMS mission is ‘to be a world class medical service in support of air power’. Comprising of regular and reserve personnel, to provide an air-minded approach, the RAFMS specialises in understanding how the unique attributes of the air environment affect both personnel and patients. Moreover, the evacuation of casualties by air remains an RAF led initiative that continues to develop and improve in line with both clinical and technological advances and experience.

The following organisations within the RAFMS are key facilitators in meeting the strategic priorities and objectives:

  • the Health Directorate, at HQ Air Command, supports the Head of the RAFMS through 4 pillars focused towards Medical Personal Capability, Medical Operational Capability, Revalidation and Training and Health
  • the Centre for Aviation Medicine, based at RAF Henlow, is the lead in aviation medicine on behalf of defence
  • Headquarters Tactical Medical Wing (TMW), based at RAF Brize Norton, provides the expertise to prepare and support the wider RAFMS for operational deployments; TMW places significant reliance on RAFMS personnel being drawn from across Defence (including those employed within the NHS) for deployment on operations and exercises worldwide.

Primary Healthcare

The provision of general practice and specialised occupational health services is the responsibility of Defence Primary Healthcare (DPHC). DPHC’s vision is ‘to sustainably commission and deliver safe and effective healthcare which meets the needs of patients and the chain of command’. It provides primary healthcare in the UK and overseas to service personnel and their dependants, where appropriate, to a common standard as directed by the DMS Regulator. In addition to primary healthcare, DPHC is also responsible for the provision of specialist occupational health services including rehabilitation and mental healthcare. Responsibility for the day-to-day direction of primary healthcare rests with six regional teams in the UK and a separate team embedded in HQ DPHC to manage overseas medical treatment facilities.

Occupational Health Service

The DPHC Occupational Health (OH) service is responsible for the provision of safe, effective and continuously improving OH services to all entitled personnel within the firm base and overseas. The service is delivered through 13 UK and British Forces Germany based Regional Occupational Health Teams or Regional Occupational Medical Departments. The RAF Medical Board and Naval Board of Survey provide OH services, however they have single service specialist functions and therefore remain the responsibilities of single service authorities.

Rehabilitation services

Physical rehabilitation services are provided through a tiered network of rehabilitation facilities including; 152 Primary Care Rehabilitation Facilities (PCRF) and 14 RRUs across the UK and Germany. The PCRFs are Unit/Station based rehabilitation departments offering physiotherapy and exercise therapy on an outpatient basis. Patients with injuries that cannot be resolved at this level are referred to RRUs who provide rapid access to imaging services, podiatry and residential rehabilitation.

The RRUs provide patients with musculoskeletal injuries (MSKI) with an intermediate level of treatment (inpatient and outpatient) between the Primary Care Rehabilitation Facilities at Station and Garrison level and the DMRC.

On operations assessment and treatment for MSKI is provided by specialist multidisciplinary teams consisting of: Rheumatology and Rehabilitation or Sport and Exercise Medicine consultants, Physiotherapists and Exercise Rehabilitation Instructors. Within deployed hospital facilities military physiotherapists also provide advice and treatment across the spectrum of clinical specialities including: critical care, medical and surgical, chests, burns, trauma orthopaedics and MSKI.

In addition to the service provided at the RRUs, consultant opinion, social work, occupational therapy, prosthetics, mental health support and nursing care with intensive, specialist, inpatient rehabilitation is provided at the Defence Medical Rehabilitation Centre (DMRC) at Headley Court. This is a nationally recognised centre of excellence that provides rehabilitation for more complex injuries, including amputee and neurological patients. Patients can be referred to the DMRC from secondary care or directly from primary care. During 2018, DMRC (Headley Court) will transfer patients and services to a new site on the Stanford Hall Estate in the East Midlands.

Mental Healthcare

Military mental healthcare includes clinical, educational and command liaison services, the latter supporting the wide range of command activities to maintain mental wellbeing. Community mental healthcare to service and entitled personnel is provided through a network of 20 permanent locations, comprising 11 Departments of Community Mental Health (DCMHs); 6 Mental Health Teams (MHTs); and 3 locations with a permanent Community Mental Health Nurse. Nearly 250 personnel, both uniformed and civilian, provide community mental healthcare. Members of the reserve forces who have been mobilised for operations since 2003 are able to access mental health support through the Veterans and Reserves Mental Health Programme (VRMHP) for operationally related mental health problems.

In-patient mental healthcare services in the UK are provided under contract by a consortium of 8 NHS Trusts, located to provide assessment, stabilisation and treatment close to either the service person’s unit or home. The consortium is led by South Staffordshire and Shropshire NHS Foundation Trust (SSSFT) and includes:

  • Cambridge and Peterborough NHS Foundation Trust
  • NHS Glasgow
  • NHS Grampian
  • Lincolnshire Partnership NHS Foundation Trusts
  • Somerset NHS Foundation Trust
  • Southern Health NHS Foundation Trust
  • Tees, Esk and Wear Valleys NHS Foundation Trust

Military mental health professionals are also deployed on operations overseas in order to provide assessment and care in theatre.

Working with the Department of Health and UK National Health Services, where necessary, the following mental health services are available to members of the armed forces, and veterans where appropriate:

  • The VRMHP
  • NHS England Transition, Intervention and Liaison Service (TILS) and Complex Treatment Service (CTS)
  • structured mental health assessments at discharge
  • specialist follow on treatment for up to 6 months after discharge
  • Combat Stress 24 hour Mental Health helpline 0800 323 4444
  • Big White Wall, an online intervention service
  • Royal College of General Practitioners online training
  • NHS Veterans’ mental health capability
  • Veterans’ Information Service

The Academic Department of Military Mental Health (ADMMH) is located within the King’s Centre of Military Health Research at King’s College (KCMHR).

Secondary and Tertiary Healthcare

Placement of Defence Consultants in secondary healthcare is the responsibility of DMG. Within the UK, healthcare for service personnel is provided by the NHS, enabling the DMS to take advantage of recent government investment in infrastructure, equipment and staff. Treatment will often be provided in the NHS Trusts that house DMG Units where many DMS staff work to maintain and develop their skills when not on deployment. DMG Unit locations are as follows:

  • RCDM, based at the Queen Elizabeth Hospital Birmingham
  • DMRC Headley Court In Surrey
  • DMG South West: Derriford In Plymouth
  • DMG South East: Frimley Park in Surrey
  • DMG North: Northallerton In Yorkshire
  • DMG South: Portsmouth in Hampshire

Members of the armed forces recovering from orthopaedic and neurological problems are generally treated at one of the RRUs or the flagship DMRC at Headley Court.

Deployed hospital care

Deployed hospital care is delivered on a joint basis, with each Service providing trained and equipped personnel for the deployment. The aim is to return the sick and injured to duty as quickly as possible. The intent is to provide a seamless continuum of Consultant-led (where possible) and specialist care encompassing: preventive medicine; pre-hospital emergency care; primary and secondary care (including dental); imaging and diagnostics; and medical resupply and evacuation.

Patients requiring care beyond the capabilities of deployed medical treatment facilities are evacuated to the UK, usually to the RCDM at the QEHB, Established in 2001, the RCDM’s primary role is the focal point for the military reception of operational casualties, providing the ‘front door’ component of the Role 4 aspect of the operational patient care pathway. Nested within the QEHB [1] the RCDM provides support in its role as the principal acute Role 4 hospital in the UK.

Medical Force Protection (Med FP)

NATO defines Med FP as ‘the conservation of the fighting potential of a force so that it is healthy, fully combat capable, and can be applied at the decisive time and place. It consists of actions taken to counter the debilitating effects of environment, disease, and selected special weapon systems through preventive measures for personnel, systems and operational formations’. Med FP permeates all levels of pre-deployment operational activity. It endures throughout the operation and into the post-deployment period.

While all aspects of medical support to operations might be considered to be a form of Med FP, this activity concentrates on other medical, mainly preventative, contributions to Med FP:

  • the maintenance of a fit and healthy force by promoting behaviour that promotes health, prevents disease and minimises risk; this is a command responsibility, using advice from relevant subject matter experts, as the leadership, conduct and discipline of a deployed force significantly impacts upon the numbers of avoidable accidents and diseases
  • measures taken to counter the debilitating effects of infection, adverse environmental conditions including climatic extremes, environmental industrial hazards and chemical, biological, radiological and nuclear hazards; these measures require input from medical intelligence and may require specific medical countermeasures to be put in place to mitigate the risks generated by the threat
  • input to the operational equipment programme to avoid or mitigate injuries
  • input into the development of collective protection systems for deployed force elements

Programme Cortisone

Programme Cortisone addresses the need to record and archive all medical information generated by the Defence Medical Services (DMS) in producing their mandated outputs. Read more about Programme Cortisone here.

[1] Part of the University Hospitals Birmingham NHS Foundation Trust (UHBFT)

Defence Medical Services training courses

Official list of Defence Medical Services training courses and fellowships, detailing face-2-face course, e-Learning packages and conferences/symposiums for regulars and reservists as of 15 February 2016.

Defence Primary Healthcare overseas

The main objective of DPHC overseas is to bring coherence to governance and assurance of healthcare delivery to be service personnel, dependants and entitled civilians. Read more about Defence Primary Healthcare overseas.

Mefloquine information signposting service for former and serving personnel

The Mefloquine Single Point of Contact launched on 5 September 2016 and is for current and former service personnel who have concerns about their experience of Mefloquine (commercially known as Lariam).

The MOD takes the health and well being of its personnel seriously and acknowledges its duty of care to provide the best possible support to them. This service provides information and signposting to a range of services to address their concerns.

www.healthline.healix.com

Other DMS news