New clause 24 - Aftercare

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

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Photo of Gerald Howarth Gerald Howarth Shadow Minister (Defence) 10:30 am, 26th February 2004

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.