INTRODUCTION

  The Board of the Defence Medical Welfare Service is pleased to be asked by the Defence Committee to submit evidence to the inquiry into Medical Care for the Armed Forces. Members of the Board have significant experience in the Armed Forces and healthcare. In addition, the Chief Executive and Operations Manager have just returned from a visit to the Military Field Hospital in Basra (Op TELIC) and have first hand knowledge and experience of the provision of welfare support in Iraq as well as detailed knowledge of the support provided in Afghanistan (Op HERRICK) and in the Ministry of Defence Hospital Units (MDHU's) in the UK, the designated provider hospitals in Germany (DGP's), and the Princess Mary Hospital in Cyprus.

  The Defence Medical Welfare Service is funded under contract by the Ministry of Defence. The current contract expires in March 2009. It is our understanding that a review of the current Service requirement is to be carried out and a competitive tendering process will determine which Organisation will provide the service, revised or otherwise, from April 2009.

BACKGROUND

  For several decades the Order of St. John and The British Red Cross Society included a joint operational "welfare" component in support of military hospitals. Originally this was delivered by the Service Hospitals Welfare Service, which had its origins in the Second World War and was subsequently taken over by the Joint Committee to become the Service Hospitals Welfare Department (SHWD). This was funded by a combination of the Joint Committee's funds and "grant in aid" support from the War Office/Ministry of Defence.

  A change to these arrangements occurred in 2000 when the MoD indicated that it would no longer be acceptable to continue funding by way of "grant in aid" and that a formal contractual relationship with SHWD was to be established. The imperative to move to a more business-like contractual relationship with the MoD led to the decision to establish SHWD as a separate corporate entity, linked to the Joint Committee, but with distinct company and charitable status. The St. John and Red Cross Defence Medical Welfare Service was incorporated on 22 March 2001 and began its activities on 1 April 2001.

PRESENT POSITION

  DMWS Welfare Officers provide a variety of welfare support ranging from routine day-to-day inputs through to highly complex support and interventions. These are provided in dispersed locations to:

—  members of the Armed Forces of the Crown;

—  dependent relatives; and

—  certain civilians acting in support of the Armed Services.

  Welfare Officers also provide support to Defence Medical Service personnel who work in hospitals in the UK and overseas. They deploy on operations and exercises, where they have a key role in support of Military Field Hospitals.

  DMWS has a small headquarters staff based in London and led by a Chief Executive who is accountable to a Chairman and Board of Directors.

  Operational service delivery is via a peacetime establishment of 17 Senior Welfare Officers and 24 Welfare Officers. They are primarily deployed in 7 Departments in the UK, including Northern Ireland, 5 Designated German Provider Hospitals (DGP's) [managed by Guy's and St Thomas' NHS Foundation Trust in Germany], and 1 Department in Cyprus.

DEPLOYED OPERATIONS

  When deployed with mobilised Field Medical Units in times of tension or war, operational numbers are supplemented by additional recruitment from the static locations. Whilst Welfare Officers work in a military environment in a variety of hospitals in the UK and overseas, they are under DMWS authority and management and have civilian status. If deployed with mobilised Field Medical Units they come under military command.

  The Chief Executive and Operations Manager of DMWS recently spent time in the military Field Hospital in Basra. During their visit the hospital came under regular mortar and rocket attack. As a Registered Nurse with accident and emergency experience, the Chief Executive was able to observe at first hand the high quality skills and commitment of the clinical staff caring for sick and injured servicemen and women and the facilities in which they were cared for. It is a tribute to their professionalism that they continue to work in such a highly charged and unpredictable environment. What is also apparent is the way in which DMWS welfare staff are completely integrated with the clinical staff as part of the whole health care team, working along side them in this high risk environment.

DEVELOPMENT

  The Defence Medical Welfare Service works closely with the Armed Services. The Board and staff of DMWS recognise the importance of adapting to changing needs to ensure the most effective and appropriate responses within the available resources. Because, ideally, any changes in service must be evidence-based DMWS has committed resources from its own reserves to provide robust evidence to support change.

  For example, in 2006 DMWS commissioned and funded the University of Stirling to review the provision of support to those members of the Armed Services and their dependent relatives posted or living in Germany who develop cancer. This work identified a number of issues, which DMWS and the Armed Services needed to address. Further detailed work has recently been commissioned.

  This work on cancer care will continue during the course of the contract and Welfare staff have identified further areas of welfare provision and areas of concern for which DMWS will seek to fund further research

ISSUES

 (a)   Support in hospital

  DMWS provides a 24 hour 365 day a year welfare service. Patients and dependent relatives in hospital are visited at least every day and, more often, depending on need. In Germany and Cyprus, Welfare Officers are based in a DGP (or The Princess Many Hospital, Cyprus) but operate on a regional basis covering hospitals over a large geographical area.

  In the UK, welfare staff work and are based in an MDHU. They are often completely unaware of patients in other nearby hospitals and therefore these patients cannot access a medical welfare service. A recent example encountered by our staff working at MDHU Portsmouth concerned Patient A. Patient A underwent routine surgery at Queen Alexandra Hospital, part of the Portsmouth NHS Trust, and was discharged but readmitted with an apparent infection. He was subsequently diagnosed with a terminal illness and transferred to Southampton General where DMWS visited him until he was discharged. Patient A continues to be admitted for treatment to Southampton General on a regular basis but, because this is not part of Portsmouth NHS Trust he does not appear on bed-state lists issued to DMWS. We continue to visit and do so because we are notified in advance of his expected admission by Patient A's mother. It should be noted that this lady lives approximately 160 miles from Southampton. Unfortunately this is not an isolated example. A fully comprehensive tri-service notification does not exist or if it does, there is a reluctance to share this information with DMWS. Despite our very best efforts to provide a medical welfare service to this group of people, our attempts have been frustrated.

 (b)   The Royal Centre for Defence Medicine, Birmingham (RCDM)

  We are very concerned about the situation regarding welfare support to patients and dependent relatives at RCDM because roles and relationships lack clarity and definition and they are confused.

  DMWS is contracted to provide the in-patient hospital welfare service, the service is well regarded but despite consistent excellent local feedback about the quality of this service, it was decided by the Chief of the General Staff to increase the number of individuals and organisations providing support. This has caused significant problems and, as a result, patients have been regularly visited by more than seven different people or organisations daily. In our view there is a real danger that if this confusion regarding roles, accountabilities and reporting relationships continues, patients and their relatives will fail to get the targeted and appropriate support they so desperately need and deserve.

  We have no doubt that Ministers and senior military personnel regard welfare support to the Armed Services as a top priority. However, we believe that in an effort to counter the untoward publicity regarding inpatient treatment at RCDM there appears to have been a knee jerk reaction to solving problems but with no strategic overview of how to manage them in the longer term. In our view this is evidenced by the decision to over provide welfare resources in Birmingham which has added to the problems and not solved them. We understand that an Army Colonel has now been tasked to co-ordinate support to patients in RCDM and we look forward to clarity of direction in the near future.

 (c)   The Defence Medical Rehabilitation Centre Headley Court, Surrey

  DMWS does not currently provide medical welfare support to those patients transferred here from RCDM and other hospitals. We believe that this is an environment where patients could benefit from additional medical welfare support put and we are exploring this potential.

 (d)   Support on discharge from hospital

  The present contract with the MoD requires DMWS to provide an in-patient medical welfare service. The service does not extend to those patients attending out-patient follow up.

  When a patient is admitted to or discharged from hospital, or transferred to a non-MDHU hospital it is very unlikely that they will have access to a medical welfare service for the reasons given above. This means that their immediate needs will not necessarily be assessed (something the DMWS welfare officers are trained to do) or solutions found to resolve worries. Sometimes these concerns are fairly routine and can be dealt with easily but often they involve complex liaison and communication with a variety of other individuals and organisations. Under the terms of our current contract DMWS is constrained from providing this much needed after care and would welcome the opportunity to continue supporting these patients following discharge from hospital if appropriate. This would not impact on the role of single Service welfare organisations whose work focuses on community based issues and not in the specialist medical welfare field.

  DMWS believes that these issues represent a major gap in the provision of support and may be one of the reasons why so many people have said that they feel abandoned by the Armed Services particularly if they have served on deployed operations.

CONCLUSION

  DMWS is proud to work closely with the MoD and with other welfare agencies including Army Welfare, SSAFA, WRVS and others to ensure the very best outcomes for members of the Armed Services and their families. We will continue to do our very best to enhance the ethos that prompted the creation of our predecessor, the original Service Hospital Welfare Service, to ensure that every serviceman and woman and their loved ones get the maximum support that DMWS can provide.

10 May 2007