House of Commons Defence Committee The Armed Forces Covenant in Action? Part 1: Military Casualties Seventh Report of Session 2010–12 Volume I: Report, together with formal minutes, oral and written evidence Additional written evidence is contained in Volume II, available on the Committee website at www.parliament.uk/defcom Ordered by the House of Commons to be printed 6 December 2011 HC 762 Published on 15 December 2011 by authority of the House of Commons London: The Stationery Office Limited £23.00 Defence Committee The Defence Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Ministry of Defence and its associated public bodies. Current membership Rt Hon James Arbuthnot MP (Conservative, North East Hampshire) (Chair) Mr Julian Brazier MP (Conservative, Canterbury) Thomas Docherty MP (Labour, Dunfermline and West Fife) Rt Hon Jeffrey M. Donaldson MP (Democratic Unionist, Lagan Valley) John Glen MP (Conservative, Salisbury) Mr Dai Havard MP (Labour, Merthyr Tydfil and Rhymney) Mrs Madeleine Moon MP (Labour, Bridgend) Penny Mordaunt MP (Conservative, Portsmouth North) Sandra Osborne MP (Labour, Ayr, Carrick and Cumnock) Bob Russell (Liberal Democrat, Colchester) Bob Stewart MP (Conservative, Beckenham) Ms Gisela Stuart MP (Labour, Birmingham, Edgbaston) The following were also Members of the Committee during the Parliament: Mr Mike Hancock MP (Liberal Democrat, Portsmouth South) Mr Adam Holloway MP (Conservative, Gravesham) Alison Seabeck MP (Labour, Moor View) John Woodcock MP (Lab/Co-op, Barrow and Furness) Mr David Hamilton MP (Labour, Midlothian) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the internet at www.parliament.uk/parliament.uk/defcom. A list of Reports of the Committee in the present Parliament is at the back of this volume. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in a printed volume. Additional written evidence may be published on the internet only. Committee staff The current staff of the Committee are Alda Barry (Clerk), Judith Boyce (Second Clerk), Karen Jackson (Audit Adviser), Ian Thomson (Inquiry Manager), Christine Randall (Senior Committee Assistant), Miguel Boo Fraga (Committee Assistant) and Sumati Sowamber (Committee Support Assistant). Contacts All correspondence should be addressed to the Clerk of the Defence Committee, House of Commons, London SW1A 0AA. The telephone number for general enquiries is 020 7219 5745; the Committee’s email address is [email protected]. Media inquiries should be addressed to Alex Paterson on 020 7219 1589. The Armed Forces Covenant in Action? Part 1: Military Casualties 1 Contents Report Page Conclusions and Recommendations 3 1 Introduction 9 Scope of the inquiry 9 Other reports 11 2 Medical treatment and rehabilitation 12 Background 12 The stages of medical treatment and rehabilitation 13 The provision of medical treatment 14 Resources 14 Advances in medical care resulting in more personnel surviving injuries 15 Queen Elizabeth Hospital 18 Defence Medical Rehabilitation Centre at Headley Court 19 Transfer of lessons between the MoD and the health services 20 The provision of treatment for mental health problems 20 Incidence of mental health problems 20 Research into the level of mental health problems in the Armed Forces 22 Reservists 23 Research 24 Mental health problems in theatre 25 Alcohol misuse 26 Decompression for those returning from operations 28 Trauma Risk Management 28 Mental health issues for medical staff 28 Support for families 29 3 Return to military service or civilian life 32 Recovery Pathways 32 Redundancies 33 Transition protocol 33 4 Support for former Service personnel 35 Compensation 35 Priority health treatment for those leaving the Armed Forces 36 Long term support for injured Armed Forces personnel 37 Prosthetics 37 Brain injuries 38 Mental health problems 39 5 Relationship with the charitable sector 42 How the MoD works with the charitable sector 42 Increase in charitable funding 42 Organisation of the charitable sector 44 2 The Armed Forces Covenant in Action? Part 1: Military Casualties Conclusion 46 Formal Minutes 47 Witnesses 48 List of printed written evidence 49 List of additional written evidence 49 List of Reports from the Committee during the current Parliament 50 The Armed Forces Covenant in Action? Part 1: Military Casualties 3 Conclusions and recommendations Introduction 1. We wish to pay tribute to all the British personnel, both military and civilian, who are currently serving or have served on operations in Iraq, Afghanistan, Libya and elsewhere but, in particular, to those who have lost their lives, and the many more who have sustained life-changing injuries as a result of these conflicts. We have witnessed the courage of those severely injured working determinedly to return to active Service. We would also like to express our deep gratitude for the vital contribution made by the families of Armed Forces personnel. We also wish to recognise the dedication and skills of regular and reservist medical personnel, both in theatre and in the UK, in treating and rehabilitating those injured in action, often at some risk to their own lives and mental well-being. (Paragraph 1) Medical treatment and rehabilitation 2. The evidence of Admiral Raffaelli, supported by that of the Families Federations, sets out the extraordinary quality of care given to our Armed Forces almost from the point of wounding. We commend the Armed Forces medical services for the improvement in all aspects of the medical treatment of injured personnel in theatre from emergency treatment by comrades and then the Medical Emergency Response Team followed by staff in the hospital and then evacuation back to the UK. We note, however, that this greater survival rate of very seriously injured personnel has serious implications for the quality of life of these personnel and for the resources required to maximise this quality. (Paragraph 23) 3. We note the significant advances in treatment resulting in a higher proportion of injured personnel surviving than in previous conflicts. We were impressed with what we saw and heard about the medical treatment in the Queen Elizabeth Hospital and rehabilitation services at the Defence Medical Rehabilitation Centre at Headley Court. We commend the MoD for improvements in the medical treatment and rehabilitation given to injured Service personnel and seek assurance that the new arrangements will be adequately resourced so they may be maintained over the longer term. (Paragraph 28) 4. We would encourage the MoD and the Department of Health to continue collaboration between the UK and USA defence medical services. (Paragraph 29) 5. There are significant opportunities for the NHS to learn from the experiences of the MoD in dealing with traumatic injury. In response to this Report, the Department of Health should tell us what mechanisms, other than medical personnel returning to the NHS after operational service and the recently created Centre for Surgical Reconstruction and Microbiology, it uses or intends to use to ensure the transfer of such valuable experience and advances in medical treatment, both in England and in the Devolved Administrations. (Paragraph 32) 6. The number of calls to the recently established helpline demonstrates the high level of need for mental health support for veterans. We welcome the MoD’s increased 4 The Armed Forces Covenant in Action? Part 1: Military Casualties attention to mental health issues. In response to this Report, the MoD should update us on progress on the implementation of the Murrison Report, Fighting Fit. (Paragraph 38) 7. We look forward to hearing the results of the King’s Centre current research on the impact of physical injury on mental wellbeing and the effectiveness of post- operational screening. The MoD should review its practices in response to the results of this research. We also recommend that the MoD continue to fund research into the mental health of those deployed on operations, in particular, the impact of multiple deployments and the stress of being in a combat role. (Paragraph 45) 8. We recommend that the MoD should commission research into the homecoming experiences of reservists and the support and understanding of families and employers. (Paragraph 46) 9. We recommend that the MoD should monitor Armed Forces personnel who have been deployed on operations to determine if PTSD or other mental health problems emerge while personnel are still serving. The MoD should respond to any indication of future problems rapidly and effectively. (Paragraph 47) 10. We recognise the importance of support for the families of deployed personnel, not only because it is right to look after the families but also because Armed Forces personnel are less likely to develop traumatic stress symptoms if their families are supported. We recommend that the MoD review its support for families when personnel are deployed on operations in the light of the results of the King’s Centre Research. (Paragraph 50) 11. It is unclear to us whether the MoD regards the misuse of alcohol and other dangerous risk-taking behaviour as part of a pattern of reprehensible behaviour which requires punishment or discouragement, or a manifestation of stress which requires treatment, or indeed a combination of both. We recognise that the MoD has been trying to tackle the over-consumption of alcohol but there is more that should be done. We recommend that the MoD carry out a study into what is driving the misuse and abuse of alcohol in the Armed Forces and what more could be done to modify behaviour which is significantly at variance with that of the general population.