2011/05/25 - British Medical Association (BMA) Armed Forces Conference

Speech delivered by Minister for Defence Personnel, Welfare and Veterans at BMA House, Tavistock Square, London on Wednesday 25 May 2011.

This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
The Rt Hon Andrew Robathan

Thank you Brendan [Dr. Brendan McKeating, Chairman, BMA Armed Forces Committee] for that kind introduction.

Last week, the Secretary of State was questioned about the potential for abuse of the Covenant by scurrilous members of the legal profession.

He said that he had one sister who is a doctor and one who is a lawyer.

His father used to say he had the best of both worlds: one licensed to kill; one licensed to steal.

Now, Liam Fox is himself a Doctor and of course a politician.

He has therefore the licence not only to kill but to explain why it was the right thing to do.

The work of the Defence Medical Services is a hugely important part of my Ministerial brief.

I’ve made it a priority to meet as many Regular and Reserve DMS members as possible.

On my visits to Afghanistan, I have visited Camp Bastion’s Role 3 medical facility - last time, commanded by Colonel Robin Jackson TA, and now by a RN Commander Carole Betteridge.

As you may well know, on the office wall at Bastion is a map of Task Force Helmand (South West) with the facility in the middle surrounded by concentric circles.

Each circle shows the distance a Medical Emergency Response Team can cover in a set time to reach a casualty.

The first boundary is ten minutes - five minutes out, and five back again.

And every minute matters.

As many of you know personally, the Bastion team are doing quite remarkable work in difficult circumstances.

Indeed, I am always very impressed at the sheer breadth of service which DMS members provide - from emergency life-saving procedures on operations to primary care at home and overseas.

I also pay tribute to the civilian medical staff who support the Services and their families around the world.

So it’s right to take stock at this conference - of achievements and future challenges.

On behalf of the MoD Ministerial team I would like to pay tribute to everyone involved - regular, reserve, civilian - for the magnificent job they, you are doing; thank you.

The challenges of the next 12 months are likely to be no less testing than the past 12 months.

Afghanistan remains our number one priority.

We also have the challenge of operations elsewhere - not least Libya.

And I saw on Saturday an RAF doctor working in Italy with the Typhoon/Tornado deployment on ops.

And we face a major programme of change following the Strategic Defence and Security Review which will transform Defence for 2020 and beyond.

The SDSR sets the vision for the Armed Forces we require.

The implementation of the SDSR will take some time and there are a series of complicated second order consequences including the basing and reserves reviews, as well as the emerging work from the Defence Reform Unit.

We recognise the uncertainty this places on you.

You have jobs that are tough, often dangerous, and always vital.

So it’s important to keep you updated.

Today I would like to talk about four things which I know are of personal interest to you.

First, the vexed issue of pay and allowances.

All of us are tightening our belts, and I won’t pretend it’s pain free, including for the Armed Forces.

In the current financial climate we cannot do as much to honour that obligation, or do it as quickly, as we would like, but where we can act we will.

That’s why we have doubled the operational allowance - over £5000 tax free for a 6 month deployment; changed the Rest and Recuperation arrangements on operations; and maintained the annual increments for eligible military personnel.

And the Armed Forces Pay Review Body will continue to review recruitment and retention levels of specific professions within the DMS, and where necessary introduce measures to improve conditions or recruitment.

The obligation we owe to our service men and women, set against the commitment and sacrifice that they make, is enormous.

The Armed Forces Covenant launched last week recognises that service personnel should face no disadvantage compared to other citizens in the provision of services and therefore require, in some circumstances, special consideration.

There is much still to do.

I have always been clear that the covenant is an evolving issue, not something completed overnight, and I believe that the British people understand that.

This has to be a whole of Government effort, linked to what you are doing, what the NHS is doing, and what local government and the charitable sector is doing.

A great example of that is the work the MOD is doing with the Health Department and charities to support Andrew Murrison’s review into the effectiveness of NHS prosthetic services.

The second thing I want to talk about is the future shape of the DMS.

Admiral Jarvis will say more about this later, but as most of you know we have launched a comprehensive internal review - DMS 20 - to help shape the DMS for the next decade and beyond.

Affordability will be a factor because everything we do has to be anchored in the art of the possible.

But DMS 20 is primarily about the medical capabilities required to support Defence, and how best these can be delivered.

The other significant workstrand for the DMS is the independent Future Reserves 20 study - commissioned by the Prime Minister - which is planning to publish its report later this year.

There’s a limit to what I can say without pre-empting its work, but I will say this.

The continued deployment of significant numbers of DMS Reserves underlines their value to and integration with overall Defence capability.

The Reserves remain integral to the future of Britain’s Defence as part of the “Whole Force.”

Third, mental health - a subject around which I tread very warily.

In the course of their service, the men and women of our Armed Forces see things and experience things that push them to the limit.

Some will have physical injuries.

Some will have mental scars.

Some will have both.

Of course, good training, understanding leadership, the support of family and the comradeship of those who have been through the same thing can help.

But psychological difficulties can be hard to diagnose, and, as you will know better than I, sometimes taking years to surface, often after people have left the forces.

That’s why we made tackling mental health issues such a high priority, and why we are putting extra funding aside for better healthcare.

It’s why we welcomed Andrew Murrison’s independent study of mental health services for both current and former Service personnel.

We’ve already put two of his recommendations into practice: a free, dedicated 24 hour support line for former and serving personnel and their families - and I have phoned it and can confirm that it works; and 30 additional mental health nurses for former personnel.

Looking ahead, there will be an enhanced mental health assessment for serving personnel during medical examinations -in-Service and prior to discharge.

And where our personnel do suffer mental health illness they must receive of course proper compensation.

That’s why we’ve nearly trebled the maximum compensation payment for those suffering the most severe mental health problems under the AFCS, and increased the amounts that they are paid for life on leaving the Armed Forces.

It’s simply the right thing to do.

Fourth, what of the future?

Hippocrates is quoted as saying that ‘war is the only proper school for a surgeon’.

Certainly, the physical and mental toll of war has driven medical practice and innovation forward and refocused research into specific conditions.

Our work benefits not just those on the front line or in the Armed Forces generally, but civilian patients too.

This is not new.

There was the foundation of the Red Cross in the aftermath of the Battle of Solferino in 1859.

There was the pioneering work to develop penicillin in the Second World War.

And the Royal Victoria Hospital in Belfast became the world leader in treatment of gun shot wounds during the Troubles.

This is one of the principles behind the new National Institute of Health Research for Surgical Reconstruction and Microbiology at the Queen Elizabeth Hospital in Birmingham, the opening of which I attended earlier this year.

Around 20,000 people in Britain suffer major trauma each year, and issues like haemorrhage control; resuscitation; and wound management remain challenges for society at large.

The NIHR will help us continue to develop new techniques to treat our forces fighting in Afghanistan, and allow military surgeons to share rapid advances and surgical innovation in managing severe trauma with the NHS.

That’s collaboration in action for the benefit of all.

I hope that puts your Conference in context.

Military service is never without risk.

We have a moral duty to ensure those who suffer in the service of our country are properly cared for.

That is why making sure our people get the right medical support is such a vital component of the Armed Forces Covenant.

There’s much to be resolved, but our intent is clear and with your help we will achieve it.

Published 25 May 2011