Tax Credits (Income Thresholds and Determination of Rates) (Amendment) Regulations 2015
Lord Kakkar Excerpts(8 years, 6 months ago)
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Lord Tebbit
The noble Lord has set out an alternative policy which the Government might have followed, but they did not. We are not dealing with the alternative policy but with what actually happened. He is saying that the Government have seen a way of doing things that he does not like. It does not alter the fact that this is a money matter and he wants this House to overturn a majority decision in the Commons on a money matter.
Lord Kakkar (CB)
My Lords, can I ask the noble Lord how your Lordships’ House should interpret the point of order made by Sir Edward Leigh on 21 October in the other place? He said:
“On a point of order, Mr Speaker. Generations of your predecessors defended the privileges of this House, and the greatest privilege of all is the principle of no taxation without representation …We had a lively debate yesterday on tax credits, and many of us would like to see some movement from the Government, but surely it is the elected representatives of the people who decide on tax and spending”.
The Speaker responded:
“I understand entirely what the hon. Gentleman is saying. My own feeling from the Chair is that the other place can look after itself; but we also can and will look after ourselves. I think it would be much more dignified for the Chair not to become drawn into what might be a public spat between the two Houses. In the final analysis, each House knows what the factual constitutional position is, and that position is what it is of long standing”.—[Official Report, Commons, 21/10/15; col. 959.]
Lord Richard
My Lords, I am bound to say to the noble Lord that I am not sufficiently qualified medically, politically or personally to know what is in the mind of Mr Leigh when he gets up in the House of Commons. To expect me to be able to do that is, frankly, unrealistic.
The answer to the noble Lord, Lord Tebbit, again is very simple. Of course the Government chose to do it. Why? Because it cut off discussion. It meant that they were not accountable on the Floor of the House of Commons. They knew when they did it that there was a convention here that we did not vote against statutory instruments; we did not turn them down. By doing it that way the Government thought they were impregnable in their approach. I do not think they are.
Armed Forces
Lord Kakkar Excerpts(9 years, 10 months ago)
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Lord Kakkar (CB)
My Lords, I join other noble Lords in thanking the Minister for his thoughtful introduction to this debate and in congratulating the noble and gallant Lord, Lord Richards, on his magnificent maiden speech.
I will focus on an issue that the Minister raised in his introduction with regard to the longer-term approach to the provision of healthcare services and the management of veterans with complex wounds. It is well recognised that Defence Medical Services has, through the provision of quite remarkable services in theatre, transformed the outlook for our service personnel who sustain injury. These services are considered second to none in the world and ensure that the immediate care provided to wounded service personnel has improved the rates of survival from some of the most horrific and complex injuries that very recently would not have been survivable.
Coupled with that, the provision of care in such institutions as the facilities at Selly Oak in Birmingham have ensured that the intermediate care provided after that immediate recovery and rescue phase is also of the very highest standard. What has been learnt as a result of the development and provision of these services to our Armed Forces has transformed the way that we have started to look at the management of civilian trauma.
Beyond that, rehabilitation provided at institutions such as Headley Court has also had a transformational impact. The quality of those services, the thoughtful way in which they are delivered and the holistic approach to the management of those brave service personnel who have sustained the most horrific injuries is again recognised throughout the world to be of the very highest standard. It is also recognised by those service personnel who have to avail themselves of those facilities.
However, there have been substantial concerns raised on repeated occasions about what will happen to those complex-wounded personnel once they have left the services and returned to civilian life. It is well recognised that care under those circumstances must return to the National Health Service, ultimately supervised by a general practitioner. In his opening remarks to this debate, the Minister spoke about some of the changes that have recently been provided for the longer-term management of these particular veterans. These are warmly welcomed.
I would like to explore a little further the actual disposition of those services. The report published by Dr Andrew Murrison from the other place laid out a framework for the provision of these services, specifically focusing on two important areas. The first was the provision of disablement services centres so that veterans injured as a result of their service could depend on the provision of services for the management of their amputation and prosthetics in the way that they would have expected to receive while serving in the Armed Forces.
The Minister mentioned 24 centres of excellence. How do those equate to the nine centres originally described by Dr Murrison in his report? How are both the quality of care and the outcomes achieved by those centres currently being assessed? What ongoing assessment will there be to ensure that these centres deliver what was expected of them—the provision of services equivalent to those that personnel had a right to and were receiving as part of their active service while members of the Armed Forces?
The second element was specialised commissioning, for example through the National Health Service in England. I understand that that specialist commissioning function is provided by a Veterans’ Prosthetics Panel, which receives applications from veterans who have been complex-wounded and discharged from the services, so that they can apply for the necessary funding for advanced prosthetics, which are made with remarkable technology—bionics and robotics with complex software—and can have a transformational impact on their quality of life.
I understand that the funding for the Veterans’ Prosthetics Panel for 2012-14 was set at about £11 million and was guaranteed for that two-year period. What arrangements have been made to continue the funding beyond 2014? What assessment has been made of whether that funding level is sufficient for the needs of those veterans who may have to avail themselves of the services of the panel? If, after analysis, the funding level is considered not to be of sufficient magnitude, what arrangements will be made to increase the funding, bearing in mind that the NHS itself is facing substantial financial constraint?
Beyond the provision of those important facilities, on which Her Majesty’s Government should be congratulated, there is ongoing concern about whether there is sufficient research effort to inform the longer-term healthcare needs of those veterans—who, as I said, have been wounded in horrific ways that would previously not have been survivable. Little is known about their holistic healthcare needs over the long term—not only years but decades hence—because previously such individuals would not have survived.
All good medical practice is informed by a strong research base. What if any funding from the National Institute for Health Research is directed towards that group of individuals? How is that research organised? To repeat a question that has been asked on previous occasions, are active efforts made at the time of discharge from the services—for instance, using the NHS number—to ensure that that cohort of complex-wounded individuals continues to be followed as a group, so that their clinical outcomes can be used to inform their own ongoing healthcare needs?
Beyond all that Defence Medical Services is able to provide, including the excellent facilities at Headley Court, there has been recent debate about whether further facilities can be created for rehabilitation. We heard from the noble Lord, Lord Holmes of Richmond, about the important work with regard to rehabilitation centres across the country. Another proposal has been to bring together a defence and national rehabilitation centre at Stanford Hall. Where do those proposals stand and what progress has been made? The proposals would bring together a defence and a national rehabilitation facility, the two informing each other and therefore driving up standards of practice and clinical outcomes not only for those discharged from the armed services who require further rehabilitation but for civilians injured in civilian life.
We have heard in this debate about the important obligation that our nation has to its Armed Forces, the covenant and therefore the ongoing responsibility we have to veterans. The provision of healthcare not only while in service but beyond for those who have sacrificed so much is a vital responsibility of government.
In case I did not do so at the beginning, I should remind noble Lords of my interest in this area as a commissioner of the Royal Hospital in Chelsea and a trustee and governor of the King Edward VII Hospital.
Armed Forces Bill
Lord Kakkar Excerpts(12 years, 7 months ago)
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Lord Kakkar
My Lords, I rise to move Amendment 8, which is in my name and that of the noble Lord, Lord Patel. This amendment deals with the question of the covenant but it relates to the covenant report, which will be the obligation of the Secretary of State for Defence with regard to matters of health and healthcare. First, as I think all noble Lords do, I very much welcome the fact that the covenant is to be included in this Bill because it provides so many important opportunities—none more so than when considering the important question of the consequences of current or former membership of the Armed Forces on an individual's health. Equally well, it provides the important opportunity for us as a society to understand the ongoing requirements for access to specific and specialist healthcare facilities for those who have served our nation.
In Committee, I moved two amendments and I was very grateful for the response of Her Majesty's Government to them. They relate to the same issues: the need to enshrine in the legislation an obligation for the Secretary of State for Defence to commission prospective research to inform that part of the covenant report relating to questions of healthcare, health and the utilisation of health resources. If I understood it correctly, the response recognised the importance of this prospective research in providing authoritative evidence to answer specific questions around healthcare and the future need to dedicate specific healthcare resources, particularly to those who have served our country and who have been discharged from the services. The simple reason for this is that once a veteran has been discharged from the services, responsibility for their healthcare is transferred from Defence Medical Services to their own general practitioner. Under those circumstances, it is difficult to track health outcomes or the utilisation of and appropriate access to healthcare resources, because those individuals are no longer under the direct supervision of the service in which they served for matters of their health.
The need to commission prospective research is therefore to ensure that the objective of reporting on the question of health and healthcare in the covenant is met, because if there is not prospective research we will not be in a position to understand what the consequences of membership of the services are in terms of long-term healthcare needs. What we read is that those consequences may present many years or decades after active service. Often, those individuals are lost in terms of understanding what their healthcare needs are and, as a result, the provision of services is inadequate until they present with very serious illness. If they had been tracked prospectively—in cohorts informing a proper, authoritative report as part of the covenant report made to Parliament annually—then if there were detrimental issues and features associated with former membership of the Armed Forces, those would be picked up early. Appropriate action might then be taken either to assist those individuals prospectively identified or, indeed, to ensure that we designed healthcare services which could meet their needs more appropriately. Without an obligation to commission on a prospective basis this type of evaluation to inform a covenant report, we run the risk that the very purpose of a proper evaluation and reporting of health outcomes, access to healthcare facilities, and the health consequences of current or former membership of the Armed Forces is going to be lost, along with the tremendous benefits that would attend it.
In Committee the noble Lord, Lord Patel, and I proposed two amendments. The first was very similar in nature to Amendment 8, which your Lordships are considering now. The second was more prescriptive, and concerned an obligation to collect the NHS numbers of all those who were being discharged from the armed services so that we would have a database to use for prospective research. I accept that the answer provided in the Committee debate means that that second amendment was unnecessary. However, with regard to the obligation to commission prospective research, my fear is that in the years to come the quality of information that will be provided with specific reference to matters of healthcare and provision of facilities will be eroded. As a result, it will be impossible to use this important opportunity to drive the provision of resources, and so we will be neglecting those who have served our country so well. For the many decades henceforth, when they will potentially be patients suffering the consequences of having served their country, we will not be in a position to use the important opportunities provided by the inclusion of the covenant in this Bill and in the annual reporting mechanisms to Parliament to ensure we achieve the very best for them in healthcare.
Our amendment would ensure that, when directing resources and our national effort to the healthcare of active members of the armed services and veterans, we do so on the basis of appropriate, well-informed prospective research, using the high standards and methodology both of public health research and more specific medical research, to answer questions, identify opportunities and direct our funding accordingly.
The Deputy Speaker (The Countess of Mar)
My Lords, on a procedural matter, I remind noble Lords that with grouped amendments it is only the first speaker who moves his amendment; the remaining Members speak to their amendments and then move them when they are called by the Lord Speaker.
Armed Forces Bill
Lord Kakkar Excerpts(12 years, 8 months ago)
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Lord Kakkar
I speak to Amendment 11 in my name and that of the noble Lord, Lord Patel. The matters I wish to cover in this amendment were dealt with at Second Reading in my own contribution, and relate to the obligation as part of the covenant to make an annual report with regard to matters of healthcare that attend former or current membership of the Armed Forces.
The amendment proposes that that report be properly informed through the collection of objective evidence that will allow us to ensure that the conclusions reached with regard to the impact of service on health status and the requirement to access healthcare facilities are properly recorded, and that conclusions derived from that report can be used to inform the provision of services in the future.
The health consequences of membership of the Armed Forces receive coverage regularly in the media, but much of that is anecdotal reporting. It does not provide the opportunity to constructively understand the implications of service, or how health services should best be provided to ensure that those who have served our country in such an important way have available primary and more acute hospital services that meet their needs. A report to Parliament dealing with the healthcare consequences of membership of the Armed Forces is very welcome. If it is not properly informed by prospective research, however, it will be meaningless and provide little opportunity to report anything other than anecdote.
These two amendments are not onerous. They just ensure, in moving forward a report on the question of healthcare and health status, that questions are posed at the beginning of any reporting cycle; that objective evidence is collected using established public health methods to answer those questions; and that those questions are reported in a systematic fashion to inform future development of policy, and to ensure that we are not in any way denying services or the best possible health outcomes for those who have served our country.
Lord Davies of Stamford
My Lords, I say, first, that the Bill is extremely welcome. It is clear that Clause 2 is very well intended by the Government, but also that there has been a consensus among the contributions in Committee so far this afternoon that it does not go far enough and is inadequate. I congratulate all four supporters and proposers of the amendments who spoke; their contributions were extremely helpful. I will make one or two comments on each, starting with Amendment 11, tabled by the noble Lord, Lord Kakkar.
I totally agree with him that it is important that we should have professional analysis of the problems in the medical field before we start reporting on how adequate the medical facilities are, either for those who are serving or for those who have served. Clearly, we need to know what the problem is before we can assess the effectiveness of any solution that is proposed or implemented. However, with great respect to the noble Lord, I say that his amendment has it the wrong way round. It is wrong to wait for the stage after the reviewer has produced the review, at the point where the Secretary of State is going to publish the report, to have that specialist professional work done. We should start with that; it should be the evidential basis on which the reviewer works. He should compare the facilities in place with the professional advice on what the facilities ought to be. That work should be done at the outset, and I hope that if the reviewer is doing his job he will commission such work.
Under the proposals tabled by the right reverend Prelate the Bishop of Wakefield, my noble friend Lord Touhig and the noble Lord, Lord Ramsbotham, as well as in the original draft of the clause, there is provision for the reviewer to receive remuneration. Therefore, I do not see a problem in that. Perhaps we should not tell the reviewer exactly how to do his job, but we should express the hope, here and in other contexts, that he will commission professional work of the kind that has been suggested—or else there should be an obligation on him to commission the work. We should not leave it to the second stage of the Secretary of State.
I find myself entirely in agreement with Amendment 10, tabled by the noble Lord, Lord Palmer of Childs Hill. I do not know why anybody would disagree with it. The issue is one of making sure that the report covers what progress has been made in the provision of housing. This is not in any way a prescriptive obligation placed on anybody; it is purely descriptive and sets out the facts. I do not see why Parliament should resist a proposal, which is not unreasonably costly, that we should be given the facts when we ask the reviewer to review the state of housing. We need to know the facts relating to the portion of housing that is in the hands of housing associations. I am very much drawn to the proposal.
I turn to Amendment 9, put forward by the noble Lords, Lord Lee of Trafford and Lord Glenarthur, the noble Baroness, Lady Taylor, and the noble and gallant Lord, Lord Stirrup. At first sight I thought that it was a splendid proposal, but it is a little ambiguous. It states that the covenant report must include a statement that,
“the provisions of the report are compatible with subsection (2)(a)”.
I am not sure what that is intended to mean. Is it that the statements of fact in the reviewer's report are a correct description of the facts in the respective areas of health, education and local government? Or does it mean that any shortcomings that have been identified, and any recommendations that have been made, have been resolved and implemented by the time that the three Secretaries of State signed the statement? It is slightly unclear what is intended. If it is the latter, that has cost implications of a potentially unlimited kind, so the Treasury may see some difficulty in that. If it is merely a matter of the three Secretaries of State explicitly endorsing a description of the facts that the reviewer has uncovered, I see no objection at all: indeed, that would be extremely helpful.
Amendment 2, the key amendment in this group, is in the names of the right reverend Prelate the Bishop of Wakefield, and the noble Lords, Lord Ramsbotham and Lord Touhig. It is designed to address an obvious inadequacy in Clause 2 as produced by the Government; namely, first, the reviewer has to report only on “healthcare, education and housing” and, secondly,
“such other fields as the Secretary of State may determine”.
We know that “healthcare, education and housing” are not the full picture as far as the covenant is concerned. Several issues have been raised, notably veterans, which is terribly important. But there are also such issues as, for example, coroners’ inquests—this is a big issue which we will need to discuss during these proceedings and has been left out—and many other things.
Another aspect which concerns me is any potential discrimination which may exist against members of the Armed Forces. I am sorry to say that when I chaired the National Recognition of the Armed Forces report some years ago, we uncovered and documented in that report a number of cases of serious discrimination against members of the Armed Forces in this country. Luckily, we have not had incidents of that kind—at least not that I am aware of—in the past few years. But should such a situation arise again, the issue very much should be the target of a report by the reviewer on how the covenant is being implemented. I think that all sides of this Committee are agreed that there are many issues other than those three provided for in Clause 2.
Surely, the idea of the,
“other fields as the Secretary of State may determine”,
is ludicrous. This Bill would be a laughing stock if it went forward in that way. That someone should decide what aspects of fulfilment, responsibilities or behaviour should be reported on would be regarded as ludicrous in any other context and is, indeed, ludicrous in this context. That certainly should not stand.
Therefore, the proposals put forward by the right reverend Prelate the Bishop of Wakefield are very much to be welcomed. I see no obvious difficulties with any of the text of this provision and no reason why I should not support it if it comes to that point. It is again not a provision that places significant financial obligations on the Government. Of course, the reviewer has to be paid and he is allowed to run up some expenses and to pay his staff, which must be reasonable. We have already gone through one aspect of where he may legitimately incur expenses—for example, on professional medical advice. But these are small sums and very small beer. It could hardly be considered to be a serious financial liability.
I hope that the amendment commends itself to the Government. If they were to accept this, I believe that they would find immediately that there was a qualitative enhancement in the credibility and impact of the Bill as it becomes an Act of Parliament. It would make a real, historic change in the way in which this country regards the covenant, to which we all feel an obligation for the men and women who serve in our armed services.
Armed Forces Bill
Lord Kakkar Excerpts(12 years, 10 months ago)
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Lord Kakkar
My Lords, I shall confine my comments to health. In so doing, I welcome the inclusion of the Armed Forces covenant provision in Clause 2. The provision of healthcare services for those serving actively is well recognised as being of a very high quality. Review of battle and in-theatre services by the Healthcare Commission identified them as delivering excellent clinical outcomes and very high quality care. We recognise that services for those who have been wounded and returned to the United Kingdom are also of the very highest quality, including the rehabilitation services that are vital in ensuring that the best clinical outcomes are achieved.
However, there are important concerns about how information will be gathered to enable the Secretary of State for Defence to meet his obligation to make an annual report to Parliament on the health consequences of membership of the Armed Forces. While personnel are actively participating and continue to serve, it is possible to collect information about their access to health services—be it services provided solely by Defence Medical Services or services that need to be provided by the broader and wider National Health Service. It is equally possible to track the clinical outcomes for these service personnel, in terms of whether they are developing physical or mental health problems associated with their service. It is also possible to determine whether one is achieving good clinical outcomes and whether, indeed, those who have healthcare problems are achieving a good experience in the delivery of the services required.
After discharge from the services, however, there are more important concerns about how we track veterans’ health, and how we track their access to services. The problems relate very much to the fact that many who have served will, fortunately, have no obvious healthcare problems at time of discharge. However, in the years and decades following their service they may start to develop healthcare problems directly related to their period of active service.
If mechanisms are not in place to track these individuals, it will be impossible to understand the health implications of membership of one of the armed services. Therefore, any report that a Secretary of State makes to Parliament would be inaccurate and potentially miss important information. It may have to depend purely on anecdotal reports of the description of mental health problems or physical health problems, and from that draw conclusions that are erroneous with regard to the broad burden of disease associated with a particular period of service or a particular service in a certain environment.
It is therefore important that, if we are to accurately report the consequences of membership of the armed services with regard to health outcomes, we set up prospective research programmes. These programmes should track individuals from the time of discharge from the services back into civilian life, and ask specific health questions with regard to mental health status, physical health status, access to healthcare facilities, clinical outcomes and experience of healthcare services, if we are to have accurate reporting that will inform the Secretary of State’s report and his or her obligation with regard to the armed services covenant, when it deals with the question of health.
A second area where there is considerable concern relates specifically to the commissioning, in the long term, of healthcare services for complex wounded service personnel. As the noble Lord, Lord Empey, said, treatment in theatre is now so successful that many service personnel are surviving injuries and wounding in a way that would not normally have been expected. This is, of course, excellent progress. However, they will be discharged with complex injuries and wounding that will necessitate review of their health status for many decades to come. Under these circumstances, there will inevitably be advances in healthcare and innovation that should be provided to these individuals to ensure that they continue to achieve the best possible healthcare outcomes. It is not reasonable for us to expect that individual general practitioners will be able to do this. I very strongly believe that this group of individuals, the most severely wounded, need to be considered a group worthy of specialist commissioning of their services—either by an NHS commissioning board or by Defence Medical Services—so that the expertise that will inform these clinical decisions can be informed through an appropriate clinical evidence base, searching the world for advances and developments that 20 or 30 years from now could improve the livelihood and the health experience of those who have done so much for our country.
It is equally important that, in making an annual report to Parliament, the Secretary of State is properly informed about the commissioning arrangements, and the success in commissioning appropriate services and achieving the best clinical outcomes for those veterans. I hope that the Bill provides an opportunity for these issues to be reflected in more detail. I also hope that the forthcoming Health and Social Care Bill might possibly be used as an opportunity to ensure that the commissioning arrangements for this particular group of veterans is more clearly defined, and that, in addition, prospective evaluation and research programmes are established to understand their longer-term healthcare needs and the resources that need to be provided to ensure the best clinical outcomes.
Armed Forces: Post-service Welfare
Lord Kakkar Excerpts(13 years, 3 months ago)
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Lord Kakkar
My Lords, I, too, thank the noble Lord, Lord King of Bridgwater, for having secured this important debate. I reiterate the important points that he made about the success that is currently achieved in the acute management of injured service personnel in the battlefield and their successful early rehabilitation, which has resulted in saving these complex-injured casualties.
I shall focus on two issues. The first is how we should go about commissioning the longer-term care of injured service personnel once they are discharged from the services and the second is how we can organise long-term prospective research cohorts for research studies to allow us to understand the long-term physical and mental health needs of these veterans.
Veterans leaving the services represent a broad spectrum of complexity in their healthcare needs, from the complex-injured multiple amputee, where some of the early needs after discharge are very obvious, to those with more subtle injuries and the very large number of veterans who are apparently healthy at the time that they are discharged from the services but who are at risk of deteriorating health in the years and decades that follow their discharge.
The provision of medical care for veterans after discharge is, at best, haphazard. The majority of NHS civilian personnel have no military experience. As the noble Lord identified, some NHS personnel have military experience, but they are quite few. Therefore, the majority of doctors and clinical staff who will take responsibility for the care of discharged veterans will have little insight into the experience of that patient population. Under those circumstances, they may not always be in the best position to understand these specific patients or to provide the care that is necessary.
There are also important concerns about the transfer of medical information from Defence Medical Services to the NHS. This is a serious problem. At the moment, a final medical examination occurs prior to discharge and an FMed 133 form, which provides, at best, rudimentary medical information, is completed to provide civilian medical practitioners in the NHS with any pertinent medical history during service in the armed services. At best, this information is rudimentary and very frequently it does not reach the NHS general practitioner. In these circumstances, early arrangements for medical care are going to be poor and, importantly, as time progresses, whatever information was available that might be pertinent to the long-term healthcare needs will be lost. Service personnel may not be able to recall all that information, putting themselves at a great disadvantage in their longer-term medical care. Is any work taking place on trying to understand how better the transfer of medical information can occur between Defence Medical Services and the NHS, with particular reference to the establishment of the electronic patient record to transfer as much information as possible to ensure that the medium-term and long-term care of veterans after discharge from the services can be best secured?
There is an important opportunity to improve the training for civilian NHS staff on some of the information skills and knowledge that they will need to deal with quite important numbers of veterans who will present with physical or mental health needs. At the moment, some 24,000 military personnel leave the services every year, and 10,000 of them have recent combat experience. There are about 32,000 GPs, which means that on average a general practitioner will see one new veteran every 16 months. GPs are not going to have a large volume of patients, so the training and experience that they need to develop have to be specifically tailored.
I turn to how we should commission services in future. The Health and Social Care Bill was presented last week and will begin its passage through the other place shortly. It recognises the need to change all commissioning services, with greater emphasis on primary care commissioning of the majority of services by general practitioners. It also recognises that there are certain patient populations with very complex needs, for which there should be more central commissioning of services—so-called specialist commissioning. Does the Minister agree that complex-injured veterans discharged from the services represent a population of patients with complex, long-term, ongoing healthcare needs that could be considered to fall into a specialist commissioning group where either the NHS board commissions services specifically for this population of veterans, based on advice that it receives from Defence Medical Services, or commissioning responsibility is transferred to Defence Medical Services so that the services can be provided in centres that have the opportunity to provide all the specialist requirements in a holistic fashion to achieve the best possible clinical outcomes?
I believe that there is also a need to initiate a programme of research to address four important questions with regard to the health of veterans. The first is to look at what the long-term, ongoing physical and mental health needs are. As has been identified in this debate, our ability to provide acute medical care ensures that many more service personnel are surviving horrific injuries, but we have little knowledge about what the long-term needs will be in the years and decades hence. This research needs to be conducted on a prospective basis. Secondly, we need to understand how to provide rehabilitation to achieve the best healthcare outcomes for these personnel. Thirdly, we need to understand how to adopt new technology and innovation that will be available in the years to come to achieve the best quality of life. Fourthly, we need to be certain that we can assess what resources need to be provided over time to ensure that some of the potentially most vulnerable of our citizens, who are those to whom we owe the greatest debt, have healthcare services provided for them that they justifiably have a right to expect.
Strategic Defence and Security Review
Lord Kakkar Excerpts(13 years, 5 months ago)
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Lord Kakkar
My Lords, I very much welcome the opportunity of this important debate on the SDSR, and will confine my comments to paragraphs 2.B.9 to 11, which deal with Defence Medical Services. Much has been made in this debate, rightly, about the military covenant. One of the most important components of that covenant is the appropriate provision of medical care, not only in matters of conflict but back here at home and, of course, for veterans after discharge from the services.
The Defence Medical Services were reviewed and a report was published by the then Healthcare Commission in 2009. Defence Medical Services is quite a remarkable organisation. It provides care for some quarter of a million individuals through some 9,000 dedicated personnel across the three services. That review identified that the management of the injured patient—the entire journey, both in theatre and back here in the United Kingdom—was quite exemplary, that it should be widely publicised, and indeed that the NHS had much to learn from the Defence Medical Services in managing traumatised patients. When we look at the horrific injuries that are being sustained in recent conflicts and the fact that so many loyal and brave servicemen are being salvaged in theatre and are able to survive those injuries, we see how far advanced the services in theatre have become.
In paragraph 2.B.9 of the strategic defence and security review, there is a commitment to a “£20 million per year” increase in funding over that spending period. Can the Minister say whether the same increases by proportion in NHS expenditure over the past 10 years—a doubling in NHS expenditure—have been seen in the provision of finance for the Defence Military Services? What proportion of overall spending on medical services in the military does that £20 million per year increase represent? It is important to understand the baseline, because across this same period we expect to see a 1.4 per cent increase in overall spending by the NHS on the civilian population.
All good clinical practice is informed by a strong evidence base. It is very important that we ensure that funds that are available for research and development on healthcare in this country are in some way also targeted toward understanding the long-term healthcare needs of service personnel who have been severely injured. This is a very special population who would not have been salvaged in previous operations, so their long-term healthcare needs are not well understood. Will the Minister be able to pursue this with Ministers in the Department of Health and try to understand whether there is an opportunity for some of the large NHS budget for research and development to be targeted on understanding the longer-term healthcare needs of these individuals and what resources will be required to provide the very best healthcare, not only in the years but in the decades to come, because there will be very long-term healthcare needs that we do not currently fully appreciate?
It is well recognised that service personnel receive very good healthcare while in the services, but at the time of discharge the responsibility for commissioning their healthcare needs is no longer the responsibility of their individual service. They pass back into the National Health Service, where commissioning is currently through primary care trusts and in the future potentially through practice-based commissioning. This review identifies that there are going to be important and radical changes in the health service in the coming years, and I wonder whether this provides an important opportunity for us to solidify the military covenant with regard to healthcare.
Would the Minister pursue, with his right honourable friend the Secretary of State for Health, a dialogue that might focus on using the proposed new mechanisms for the commissioning of healthcare to provide opportunities for the budget for the long-term needs of the most severely injured veterans to be held by the individual services after their discharge, such that the commissioning of their long-term care needs can be informed by individuals who understand those needs? If so, we could ensure that we move towards a situation in which we are always looking to achieve the very best healthcare outcomes not only immediately, quite rightly, but in the very long-term future that is decades hence.
This is an important opportunity for us to renew the military covenant. It is also a very sensible way to utilise the opportunities that will be provided in the forthcoming health Bill that is to be presented to Parliament to ensure that commissioning for this very important group of our citizens is, once and for all, determined in a way that will help them in the long term and give them and their families the greatest confidence that as their healthcare needs change over time, so our nation will be able to deal with them appropriately.
Winston Churchill said in 1910 that the test of society was the way in which it treated its prisoners. One hundred years later, in 2010, I think it is safe to say that the test of modern British society is how we care for our military personnel and, in particular, how we provide for their long-term healthcare needs.