45. Another main element of the work of the DMS is rehabilitation and aftercare. The MoD's Defence Rehabilitation Plan operates a tiered approach to the delivery of services. The first point of contact is one of 70 Primary Casualty Receiving Facilities, which treat around 80% of problems. The PCRFs, in turn, can refer patients to one of 15 Regional Rehabilitation Units (RRUs), staffed by multi-disciplinary teams including doctors, physiotherapists and rehabilitation instructors, which concentrate on the assessment of musculo-skeletal injuries and sports medicine. The MoD's memorandum claimed that the benefits brought by the use of RRUs included successfully treating more than four-fifths of patients through physiotherapy and rehabilitation alone, with no surgical intervention, and discharging the "vast majority" of patients fully fit for task.[28] We visited an RRU in Edinburgh in October 2007.

46. The principle underlying the DMS's approach to the treatment of musculo-skeletal injuries is that, wherever possible, care should be provided at a local level, and should make the best possible use of physiotherapy and rehabilitation rather than surgical intervention. This has the additional benefit of avoiding patients spending long periods on waiting lists for assessment and treatment.

47. We were very impressed by the services at the Regional Rehabilitation Unit we visited in Edinburgh and commend the staff for their excellent work. The MoD's approach to musculo-skeletal injuries is forward-looking and sensible, and we are persuaded that it has been of significant benefit to Service personnel as patients, and to the efficiency and effectiveness of their units.

48. The final link in the rehabilitation chain is the Defence Medical Rehabilitation Centre at Headley Court in Surrey, which we visited in June 2007. The Centre, which was opened in 2004, deals principally with patients suffering from polytrauma and brain injuries. It has 220 staff, half military and half civilian, with 156 patient beds, 36 of which are ward-based. It provides physiotherapy and rehabilitation for complex musculo-skeletal injuries and specialised neuro-rehabilitation for patients with brain injuries. Since June 2006, it has also been home to the Complex Rehabilitation and Amputee Unit, and has a contract with a private company for the production of prosthetics. These are manufactured on site and individually tailored to the patients' needs.

49. The principle underlying the work of the Centre is to return patients to functional independence, and, where possible, to active military duties. Historically, around 95% of patients have returned to military duties, but this has fallen to 85-90% in the recent past, given the increasingly serious injuries with which patients are presenting. Only around half of those patients with serious brain injuries tend to return to military duties.[29]

50. The facility had been requisitioned from Lord Cunliffe by HQ Canadian Forces during the Second World War, after which it was bought by the Estate Agents and Auctioneers Institute (now the Royal Institute of Chartered Surveyors) to endow as a rehabilitation unit for aircrew in memory of the deeds of RAF aircrew during the War. It remains governed by a trust, the deeds of which include the rehabilitation of all Armed Forces personnel.

51. The MoD told us that there was an ongoing review of Headley Court, to look at future anticipated needs and development of the site, and that Mole Valley Council had been involved in discussions about the process.[30] The Minister maintained that Headley Court was currently "very fit for purpose", but added that the MoD "want[ed] to look at the longer, short to medium term future in terms of any developments that need[ed] to take place".[31]

52. There had been some press comment suggesting that some of the facilities available at Headley Court were insufficient to meet the demand placed upon them. Specifically, it had been alleged that the lack of availability of the hydrotherapy pool had forced the Centre to take patients by bus to Leatherhead public swimming pool. It was further alleged that there had been an incident in which members of the public had expressed dissatisfaction with this arrangement on the grounds that the presence of obviously injured personnel might distress other users of the pool, especially children.

53. We put this allegation to the Minister in November 2007. He explained that it was in part founded on a misapprehension of the purpose of different types of pool. The hydrotherapy pool at Headley Court was heated to a relatively high temperature, and was not suitable for those with cardiovascular issues. For those patients, a standard swimming pool was more suitable. Therefore, it was not the case that the hydrotherapy pool was unable to deliver the required capacity, but rather that some patients had different requirements.[32] The Surgeon-General added that the administration at Headley Court had at no point suggested that the arrangements to use the public swimming pool in Leatherhead were ineffective, inadequate or inappropriate, complaints to which the DMS would have responded.[33]

54. We readily acknowledge the extraordinary work which is carried out at Headley Court and have nothing but praise for the staff, who have had to cope with an increased tempo of operations and treat patients with injuries which, only a few years ago, would have been fatal. We regard this as a good example of the Government and charities cooperating to provide those services which they can most appropriately deliver. We were astonished by the ability of some gravely-injured Service personnel to be successfully treated, and to return to active military duty. However, we are concerned by reports of problems with the local community in terms both of developing the facilities at Headley Court and of using local authority amenities. If it is true that some local residents objected to the presence of Service personnel, we find that attitude disgraceful. The Government should make the outcome of the current review into the facilities at Headley Court fully available, and should explain what planning it has done to account for the increased operational tempo and its implications for Headley Court.

29   Ev 92, information from visit Back

30   Q 417 Back

31   ibid. Back

32   Q 419 Back

33   Q 420 (Lieutenant-General Lillywhite) Back