To ask Her Majesty's Government whether there is a manpower target for the Defence Medical Services; and, if so, whether it is being met.

My Lords, I am sure that the whole House would wish to join me in offering sincere condolences to the family and friends of Sergeant Robert Loughran-Dickson of the 4th Regiment Royal Military Police, who was killed on operations in Afghanistan this past week.

The Ministry of Defence announced to Parliament on 27 March 2007 its Defence Medical Services uniformed regular manpower requirement. The requirement to support and sustain operations, provide peacetime healthcare and allow for continued training and the provision of headquarters staff during deployment is 8,251, including a manning and training margin of 676. As of 1 April 2009, the total DMS personnel was 7,468, which can be broken down into 6,525 trained personnel and 943 personnel in training.

We on these Benches join the tribute to Sergeant Loughran-Dickson. Is the Minister aware that the BMA is reporting that an increasing number of health trusts are making life very difficult for their reserve doctors in fulfilling their training obligations and, indeed, are increasingly reluctant to recruit them in the first instance? Will she liaise with her opposite numbers in the Department of Health and make it clear to those health trusts that they have a national obligation at a time of war to release their reserve doctors for their appropriate military service? Those that refuse to do so should be named and shamed.

My Lords, I know that the National Health Service is committed to allowing doctors to serve in the Reserve Forces and that it recognises the skills that staff develop through training and through deployment, which can bring significant benefits to the trust. I am aware of the recent letter from the BMA Armed Forces Committee about time off for training. Ministers and officials liaise on these issues and I assure the noble Lord that we are very hopeful that there will be no undue difficulties. We accept that there are pressures in certain areas, but we hope that everyone can work towards ensuring that our medical services, especially on deployment, are as strong as possible. Thankfully, they are.

My Lords, we on these Benches join the noble Lord, Lord Lee, in sending our condolences to the family and friends of Sergeant Robert Loughran-Dickson of the Royal Military Police. Last year, the BMA survey was very critical. Does the Minister think that the situation has greatly improved since then?

My Lords, we have certain pinch points and we have to use reservists when necessary. Indeed, we also use secondees and contractors. I think that everyone recognises that a great deal of effort has to go into making sure that the Defence Medical Services on operations work as smoothly as possible. The Defence Medical Services have responded fantastically to the pressures on them. The services that we provide, especially in the field hospital in Camp Bastion, are second to none.

My Lords, does the Minister accept that the Defence Medical Services are still grossly understrength in surgeons, anaesthetists and other specialists, have been suffering actual cuts in vital clinical training and professional development and are excessively reliant on the National Health Service and the Reserve Forces for the comprehensive handling of battle casualties? All this is happening at a time when any surge in the numbers in Afghanistan is likely to make even greater demands on them.

My Lords, I do not accept that there is an excessive reliance on the National Health Service; rather, there is a complementary relationship, which is the whole idea behind having reserves. It is true that there are pinch points in terms of some of the skills that are needed. For example, we have had to enter into a contract in order to provide a neurosurgeon. Perhaps that should not be surprising, because it would be difficult to provide every level of expertise in a field hospital without some additional help. No cuts have been made in the Defence Medical Services. The pressures have arisen out of the difficulties of recruiting and retaining the skills that are necessary. Significant steps have been taken to improve remuneration and pensions. Retention rates are improving. We are seeing some benefits and improvements, which should be reassuring, although it is not the end of the problem.

My Lords, I declare an interest as a former commanding officer many years ago of the 1 Northern General Hospital (TA) and its successor unit, the 201. The unit is celebrating its centenary this year. Does the noble Baroness accept that large detachments from that unit have served with great distinction in the Gulf, Iraq and, more recently, Afghanistan, but the problem is a difficult one because in many instances they face repeated deployments overseas to the detriment of some of them in relation to their careers in the National Health Service? What efforts are the Government making to increase the recruitment of regular RAMC officers in the Regular Army, perhaps helped by the recruitment of cadets?

My Lords, I am happy to join in the congratulations offered to those who have served in the distinguished way outlined by the noble Lord. As I said earlier, it is true that there are significant pressure points. We are trying to avoid repeated deployments and the Defence Medical Services have been somewhat imaginative in how they have gone about this. They look to regular members for the first contribution, but if that does not make up the numbers they look to the reserves. If there are still problems, they look for secondees from the National Health Service and, in exceptional circumstances, they have to look at using a contractor under a special contract. This has eased some of the pressure and it is hoped that it will be of long-term benefit. However, I remind the House that the services that we provide are there for our allies, with whom we work. Recently the Danes have been providing a great deal of medical assistance in Camp Bastion as part of an agreement that we have had with our allies.

Virtually all of us have received briefing that states that many members of the Defence Medical Services are thinking of leaving, often because they do not believe that they are being well enough paid. What is being done in practical terms to encourage those who are in the services to stay?

My Lords, as I have said, significant retention items have come up for discussion in quite an imaginative way and I think that the situation is improving. What the House needs to remember is that those who serve on operations often gain significant experience, especially in field trauma, which would not be available elsewhere. That is valuable to them in their work and, indeed, valuable to their trusts when they return. The pinch points that we have had have been addressed. The pay review body tries to ensure that there is comparability with the National Health Service.