New clause 24 - Aftercare

Armed Forces (Pensions and Compensation) Bill – in a Public Bill Committee at 10:30 am on 26th February 2004.

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'(1) A member of the Armed Forces may be awarded, in respect of any period during which he receives treatment, a treatment allowance consisting of—

(a) a personal allowance at the rate of retired pay or pension which would be payable if the degree of his disablement were 100 per cent., increased, where appropriate,

(b) an additional allowance for a dependant.

(2) Such allowance shall be subject to such deductions or adjustments as the Secretary of State may think appropriate having regard to all the circumstances of the case.'.—[Mr. Gerald Howarth.]

Brought up, and read the First time.

Photo of Gerald Howarth Gerald Howarth Shadow Minister (Defence)

I beg to move, That the clause be read a Second time.

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

With this it will be convenient to discuss the following:

New clause 25—Medical expenses—

'Any necessary expenses in respect of the medical, surgical or rehabilitative treatment of a member of the Armed Forces and of appropriate aids and adaptations for disabled living may, in so far as not provided under legislation of the United Kingdom, be defrayed by the Secretary of State for Defence under such conditions and up to such amounts as he may determine.'.

Photo of Gerald Howarth Gerald Howarth Shadow Minister (Defence)

The new clauses are probing. They seek to ensure that the provisions of existing statutory instruments are replicated. The Minister may say that such provisions are in place and that there is no need for what I propose. However, I shall take the Committee through my argument.

New clause 24 deals with aftercare. The NHS has a system under which war pensioners are given priority, but it is largely ignored by practitioners. As a result of the closure of military hospitals, the arrangement no longer works, but there is no alternative, which I shall develop in a moment. The Bill contains no provision for treatment allowances as provided under current arrangements. The new clause seeks to replicate the provisions of article 23 of the Naval, Military and Air Forces Etc. (Disablement and Death) Service Pensions Order 1983, S.I. No. 1983/883.

New clause 25 deals with medical expenses. I am indebted to the Royal British Legion for both ideas. Although verbal promises have been made to continue the provisions of article 26 of that order, the Bill makes no mention of it. Those promises need to be substantiated because only then can charities such as Combat Stress, the ex-services mental welfare society, provide care.

It is common ground that the MOD has a clear duty of care for those who have served in the armed forces once their service is completed, particularly for those who have been disabled as a result of that service. It has been said before that the way in which we treat our servicemen and women once they have completed their service is at least as important as how they are treated during that service.

Our servicemen and women need to know that if something should happen to them, they will be properly taken care of and not made to fight the MOD for that to which they are entitled. Simon Weston has done much to highlight the problem. He spread the message that veterans do not want special treatment or to be made to beg for more: they just want what they believe to be their entitlement. The Committee will probably agree that they should not be forced to go cap in hand; on the contrary, we should set down now what they are entitled to, and we must ensure that it reflects the sacrifice that they have made.

Organisations such as Combat Stress and the British Limbless Ex-Servicemen's Association, which rely on Government funding for individual patients as well as charitable donations, do a tremendous job in providing much of that care. I know that the Minister will join me in commending the work of such organisations. He has visited the Combat Stress treatment centre at Tyrwhitt House in Surrey, as have I, and he knows that they play a great role in caring for sections of our ex-service community.

Will the Minister assure the Committee that the Government will continue to support and provide assistance to those thoroughly worthwhile organizations? What plans do the Government have to increase their support to those kinds of organisations properly to reflect the essential role that they play? The NHS is already overburdened with civilian patients, so voluntary charitable organisations such as Combat Stress or St. Dunstan's will be the only ones providing that type of care. Without them there would be no specialist service-orientated provision. I emphasise service-orientated because one of the issues that I have with the Minister on the outsourcing of the mental treatment of service personnel to the Priory group is that it is not service-orientated and takes service personnel out of the service environment.

Like the rest of us, the veterans look primarily to the NHS for health care. However, the MOD has a significant role to play, first, in the assessment of certain conditions, as that will determine what the veterans are entitled to, and, secondly, in ensuring that they receive any specialist treatment and equipment that they might need. The Government's framework document states:

''As with the present provisions, the assumption is that in-service care will be provided by the Defence Medical Service, while post-service responsibility for service related disablements will fall to the NHS. We will be consulting with the Department of Health about the continuance of current arrangements for priority NHS medical treatment for compensated conditions.''

Will the Minister report on the progress that he is making on those consultations with the Department of Health? The closure of the single-service hospitals makes it increasingly the case—notwithstanding the specialist military district hospital units, such as my local one, Frimley Park—that service personnel required in the front line have to take their place in the NHS queue. So I am interested to hear how confident the Minister is that the arrangements for prioritising service personnel will remain.

We are hopeful that most of the arrangements will stay as they are, but one of the most important parts of the aftercare process that concerns us—it has a direct bearing on the Committee—is the reassessment of care. Many ailments involve progressive deterioration and the care that is provided will need to be readjusted to meet those changed circumstances. A system sensitive to that, and which is flexible to the ever changing needs of individuals, is required.

After speaking to representatives of Combat Stress, I am aware of the need for flexibility when dealing with mental illnesses and psychological conditions. Such illnesses are difficult to diagnose at the outset, and assessing degeneration and how the condition will affect individuals in future years is something that scientists are only beginning to come to terms with. Cases involving mental illness must have that reassessment provision, which allows ex-servicemen to have their entitlements uprated. Even if the initial assessment were correct, it would not be correct subsequently as the condition worsens. I know the Minister shares that concern. Much of the effort and

expense is committed to mending broken bodies—limbs and all the rest. The rehabilitation scheme under way in the services is enormous, but we need to do more to address the problem of broken minds. I think that the Minister is at one with me on that.

Those people face other difficulties, such as unemployment and homelessness, which should not be ignored. Providing help and a safety net is as important in the aftercare process as the treatment. The Department for Work and Pensions document ''Pathways to Work'' says:

''Possible MOD involvement in DWP pilots/projects is also being discussed.''

We welcome such moves, but will the Minister clarify what kind of role the MOD is playing in the process? What is it doing, other than providing medical assistance, to help ex-service personnel who have been forced to leave the service through disability? Does the Minister accept that the MOD has at least some responsibility in facilitating employment for those who have served in the forces, especially those who have had their careers ended through disability? Certain ex-service organisations have suggested to us—I think I mentioned this—that there could be a role for blind and limbless ex-service personnel in other parts of the MOD. Looking favourably on job applications from such people would be a small part in its duty of care when an individual's service has ended for whatever reason.

If the Government stick to their commitments in the framework document to maintain arrangements for aftercare, we will wholeheartedly support them. There is not much in their proposals with which we disagree, but we wanted to use this opportunity to set on record some of the improvements that could easily be made.

Photo of Mr Ivor Caplin Mr Ivor Caplin Parliamentary Under-Secretary, Ministry of Defence 10:45 am, 26th February 2004

I start on the basis of consensus in that we do not have strong disagreements, but perhaps I can clarify matters and answer some of the questions that have been raised.

The hon. Gentleman started by referring to statutory instrument 1983/883, which is the Naval, Military and Air Forces Etc. (Disablement and Death) Service Pensions Order 1983, which governs the war pensions scheme. Article 23 was amended on 6 April 1992 to exclude dependants and again on 12 April 1993 to ensure that the allowance could be paid only when earnings were lost as a result of treatment. I hope that that clarifies the current legislative position.

New clause 24 is not needed for the compensation scheme that we are debating. I understand that the intention is to replicate the treatment allowance that was first introduced under the 1917 war pensions scheme, when there was no social security system or national health service to step in when an individual needed medical treatment and, as a result, people lost their earnings. That is not the case now, as people who are off work sick are eligible for statutory sick pay and may receive full pay from their employer. There can be no justification for an extra allowance to compensate for loss of earnings when the benefits provided under the compensation scheme do that already.

The type of payments to be made under the compensation proposals are not comparable to those payable under the war pensions scheme. Disablement will not be assessed on a percentage basis and there will be no such thing as a 100 per cent. war disablement pension. I accept the hon. Gentleman's point that they are probing new clauses, I hope that he accepts my explanation on new clause 24 for those reasons.

On new clause 25 and the health and veterans issues, and priority treatment in particular, we are in an ongoing discussion with the Department of Health to provide for continuation of the provision that currently applies. At the moment, it applies only to those conditions for which compensation is being paid, and we recognise the importance of ensuring that the national health service honours the priority treatment commitment. I am in discussions with the relevant Ministers at the Department of Health and we have a concordat between the two Departments, signed by my predecessor.

New clause 25 would introduce into the new compensation scheme an equivalent to article 26 of the 1983 order. I think we agree on that. The proposed text is based on the outdated version of the service pensions order. The current version stresses that the expenses must arise from disablement due to service.

As with much of the legislation governing war pensions, which remains largely as it was during the 1940s, article 26 is a product of its time. It predates the universal systems of support provided by the welfare state, including the national health service. Article 26 is therefore a generally outdated provision. Since 1948, Ministers in successive Governments have maintained that the national health service should be the principal route for treatment of accepted disablements. War pensioners receive priority in the national health service for treatment of their disablement caused by service, and we are seeking to secure the same approach from the Department of Health for beneficiaries under the new compensation scheme arrangements.

I recognise that there are issues in relation to ex-service organisations such as Combat Stress. My officials and I are in discussion with that group on such issues and I am due to visit its base shortly. We will continue to work with it and I certainly see a continued role for the ex-service charity in the months and years ahead.

Photo of Gerald Howarth Gerald Howarth Shadow Minister (Defence)

What I am getting at is whether there is statutory underpinning of the financial support that the Government, through the Ministry of Defence, give to organisations such as Combat Stress, or is such action discretionary? Will the new arrangements proposed by the Government under the new scheme require any further authority to ensure that the funding support given by the MOD to those worthwhile organisations can continue?

Photo of Mr Ivor Caplin Mr Ivor Caplin Parliamentary Under-Secretary, Ministry of Defence

I understand why the hon. Gentleman wants clarification. Under our new arrangements, there will be no underpinning of charity

arrangements, which is why we are in discussions with Combat Stress, through the veterans secretariat, and officials about how to take the work forward. We recognise entirely the importance of its work and it is the main charity to be affected by the situation. I hope that he will accept that that is how we should progress. I am more than happy to share the conclusion of the discussions with him. They are not meant to be a great secret, but a process of negotiation.

The hon. Gentleman also referred to the homelessness and employment of veterans. That is part of our wider-ranging veterans initiative. It is cross-departmental so we will be working with the Department for Work and Pensions on employment and the Department of Health on mental health issues. We shall continue to work with the Department for Culture, Media and Sport on the veterans and the heroes return initiative and the Department for Education and Skills on skills and employment. The veterans initiative is a cornerstone of our approach to veterans issues when working across the Government. On that basis, and given my explanations, I hope that we do not need to proceed further with new clauses 24 and 25.

Photo of Gerald Howarth Gerald Howarth Shadow Minister (Defence)

I said at the outset that the new clauses were probing. I am grateful to the Minister for his response and for agreeing to keep us posted on his progress on securing agreement with the national health service on the prioritisation of ex-servicemen. It has often been said that the United States Department of Veterans Affairs has a close and comprehensive interest in the well-being of its veterans and that we do not have a similar organisation because we have a national health service, which the United States does not have. However, I think that the Minister has recognised the concerns and I will be grateful if keeps us posted of progress.

I am also grateful to the Minister for keeping me informed about Combat Stress. I have a particularly strong affinity with that organisation; it does such fantastic work. I want to know that its funding from the Ministry of Defence is assured. As for the detail and the extent to which statutory instrument 1983/883 applies, to avoid detaining the Committee I propose to consult further in the light of what the Minister said. We shall have a look through it at leisure and if questions arise from the Royal British Legion or other groups, we can ask them on Report. I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.