INTRODUCTION

  1. The Government has given careful consideration to the report on the Defence Medical Services (DMS) by the previous Defence Committee. Its response to the principal points in the report are set out in this memorandum.

  2. The Government notes the conclusion of the Committee that the DMS are not sufficient to provide proper support to the front line in all realistic planning scenarios and that the staff shortages in the DMS are so serious that it is not clear whether it will recover. It recognises that the previous Government's restructuring of the DMS, particularly in the secondary care area, has been very unsettling for many medical personnel, leading to higher than normal rates of voluntary exit during the difficult period of transition. The Government accepts that there are very serious shortages in key specialities, and that action needs to be taken to restore confidence. Given the gravity of the situation, it is clear that it will take time to recover the position. The Government is committed to providing the medical care required to support the Armed Forces in peace and war.

OPERATIONAL CAPABILITY

  3. The proper level of medical support to British troops on operational deployment in Bosnia and elsewhere continues to be provided, although this is proving a heavy load for consultants in the surgical and anaesthetic specialities because, in part, of current significant undermanning. The Government is currently reviewing the capability of the DMS to support operations in the light of evolving strategic Defence planning, to establish whether any changes are required to detailed assumptions for the provision of medical support to the front line. Where there are shortages in particular specialities, we will seek to fill the gaps with reservists under the provisions of the Reserve Forces Act 1996, although reservists in these specialities are also in short supply.

MINISTRY OF DEFENCE HOSPITAL UNITS

  4. The Government welcomes the Committee's support for the concept of Ministry of Defence Hospital Units (MDHUs) in NHS District General Hospitals and its recognition of the advantages which flow from this form of partnership. It agrees that effort should be concentrated on improving the overall effectiveness of the MDHUs, including the preservation of an appropriate military ethos at these units.

  5. The current difficulties are being discussed with the host Trusts. Efforts are being made to involve Service personnel more widely in general management responsibilities at the Trust hospitals and the expertise offered by all ranks and grades is being increasingly recognised and used by the Trusts. Our objective is for Service personnel in the MDHUs to be able to use their technical, professional and management skills to the fullest possible extent.

  6. As regards training opportunities for staff at the MDHUs, the Defence Secondary Care Agency (DSCA) is establishing a training cell at the MDHU Frimley Park to coordinate essential military training and to help develop adventurous training and sport; if successful, the arrangement may be introduced at the other MDHUs. The release of staff for study leave, personal fitness training and sports is encouraged, but cannot easily be achieved until manpower shortages are reduced.

  7. It is not practicable to provide on­site Service mess and accommodation facilities at the MDHUs. MDHU Peterborough has benefited from a close association with, and administrative support from RAF Wittering. The other two MDHUs are developing similar close links with local military units to provide the full range of support services. Staff at MDHU Frimley Park will soon benefit from HQ Aldershot's plan to provide improved living accommodation.

  8. The Government accepts the Committee's recommendation that it should review the operation of the MDHUs before contracts with the host Trusts are renewed. The 5­year Service Level Agreements which govern the operation of the three MDHUs are carefully monitored, controlled and reviewed by the DSCA at the end of each financial year. Morale is a vital component of forces well­being and operational capability and one which the Government takes very seriously indeed.

MORALE/STAFF SHORTAGES

  9. The Government notes the Committee's assessment of the low state of morale in the DMS. It accepts that morale in some areas, particularly among senior clinicians, is fragile; on the other hand, there is evidence that younger medical officers recognise and welcome the value of the improved clinical training and experience offered by the MDHU concept. It is not unusual for major structural changes in an organisation to result in temporary lowering of morale. Low morale is less of a problem in the primary care area and in field units, where there have been fewer changes.

  10. The Government recognises that there are shortages across a range of specialities in the DMS, most notably in general and orthopaedic surgery, medicine and anaesthetics. There are similar shortages in the NHS and the greater stability which the NHS offers, together with professional opportunities and the prospect of significant earnings from private practice, are attractive to many Service consultants. The recommendation in the recent Armed Forces Pay Review Body (AFPRB) report that the salaries of Service Doctors should be aligned more closely with those of the NHS should, over time, be helpful in this respect, particularly when the entitlement to the X factor (which recognises the net disadvantages of Service life) is taken into account. Among non­commissioned personnel, there are significant shortages of nurses and technicians, particularly in the Army. Additional funding has been made available for the recruitment of civilian staff to fill nursing and technician vacancies at the Royal Hospital Haslar. The Surgeon General is giving the highest priority to retention, recruitment and improving morale in the DMS, although even with this new emphasis and effort, it will be some years before manning balance can be fully restored.

PAY, PENSIONS AND TERMS AND CONDITIONS OF SERVICE

  11. The principal problem for the DMS is the retention of trained and experienced personnel. The Government recognises the importance of pay in recruiting and retaining high quality personnel within the DMS. Other factors such as career progression, status, and stability are also recognised as important.

  12. The Government has recently announced its acceptance of the AFPRB's 1997 report which recommended improvements in medical and dental officers' pay and pensions. Separate pay scales have been introduced for the consultant cadre and General Medical and Dental Practitioners and, with effect from 1 April 1997, pensions will be based on medical and dental pay scales rather than combatant pay. The possible future use of special financial retention incentives will be kept under review by the Ministry of Defence, in consultation with the AFPRB.

  13. Work on the terms and conditions of service for DMS personnel is continuing, for example, on the rationalisation of terms of service for nursing personnel across the DMS. Some measures came into effect on 1 April: Lead Service arrangements for certain medical technical branches are being implemented and Royal Navy and Army medical and dental officers are now able to extend their Short Career Commissions in order to undertake higher professional training, in line with the existing policy in the Royal Air Force. At the same time, the Return of Service required for higher professional training has been rationalised to three years for medical and dental officers in the three Services.

  14. The Government is hopeful that improvements in terms and conditions of service will encourage DMS personnel to remain in the Armed Forces, as well as attract more recruits.

GYNAECOLOGY

  15. The Government notes the Committee's recommendation that it should review whether gynaecology should be reinstated as a uniformed medical speciality. It believes that the peacetime needs of Servicewomen are capable of being met by contracts with NHS hospital trusts, but the issue is being further examined against the background of the current range of operational deployments.

RESERVES

  16. Finally, the Government will continue to monitor closely trends in the recruitment and retention of reserve medical staff, and welcomes the Committee's support for the use of additional payments for reserve medical staff deployed in peacetime as provided for under the Reserve Forces Act 1996.

  17. We accept the serious challenge posed by the Select Committee's report which will inform our considerations in the course of our efforts to respond.

15 July 1997