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Veterans

Introduction

This sections considers the health and social care needs of the Armed Forces personnel, their families and Veterans. Veterans include anyone who has served for at least one day in the Armed Forces (Regular or Reserve), as well as Merchant Navy seafarers and fishermen who have served in a vessel that was operated to facilitate military operations by the Armed Forces.

The Clinical Commissioning Groups (CCGs) are responsible for commissioning hospital and community health services required by Armed Forces' Families (where registered with NHS GP practices) and services for Veterans and Reservists when not mobilised.

NHS England is responsible for commissioning hospital and community health services for members of the Armed Forces, mobilised Reservists and their families (if registered with military medical centres). NHS England also commissions specialised services, including specialist limb prosthesis and rehabilitation services for Veterans. The Ministry of Defence is responsible for primary medical care for the serving Armed Forces personnel.

Local Authorities have the responsibility for safeguarding and promoting the welfare of the children, including those in service families. The Council also has the responsibility to monitor the wellbeing of care leavers, including those joining the Armed Forces. The Armed Forces provide professional welfare support to augment those provided by local authorities.

Councils also consider the social care needs of anyone over 18, including includes Veterans, Reservists and adult members of Armed Forces families.

What do we know?

The Ministry of Defence release quarterly statistics on the National and International locations of all UK Regular Forces Personnel and MOD civilian personnel. The most recent release relates to figures as at 1st July 2015. The number or personnel located in the UK and overseas has decreased since the same time point in 2014. The largest concentration of personnel are in the South of England. With the South East having the largest concentration of UK Regular Forces: the region has seen an increase of 180 personnel since 1st July 2014. The Ministry of Defence release annual statistics on the location of Armed Forces Pension and Compensation Recipients. The most recent release relates to data as at 31st March 2015 (MDa, 2015).

The UKs ex-service population is elderly and declining in size. Nearly half of the ex-service community are over the age of 75. Large numbers in this age group are experiencing problems with mobility and self-care  (MDa, 2015).

It is difficult to determine the exact number of people who do retire back to each locality. There is no agreed single process that tracks all service leavers.

GP Practices can identify the Armed Forces community through the use of Read codes. These are a standard system used in General Practice to support detailed encoding of patient phenomena, including occupation, social circumstances, ethnicity and religion, clinical signs and a variety of administrative items The use of this Primary Care data is currently limited by:

  • Awareness or willingness of the Armed Forces community to identify themselves as such when first registering with a GP; and
  • Awareness of the existence of relevant Read codes by GPs and other primary care staff

The Services Careers Transition Partnership do track a percentage of their service leavers for up to 2 years, while the Service Personnel Veterans Agency track those veterans who have approached them.

Currently Services Resettlement Officers should identify vulnerable service leavers and track their progress. Additional sources for tracking service leavers include Office for National Statistics and census data for ex-service personnel.

There are no regular forces stationed in Reading. However, Brock Barracks is the headquarters for the Territorial Army unit 7th Battalion the Rifles and for the Berkshire Army Cadet Force. It is also home to the Air Training Corps and Sea Cadet Corps.

Facts Figures and Trends

Numbers of armed forces personnel living in an area were recorded as part of the 2011 Census. This showed the proportion of personnel who were living in a communal establishment or who were living at home. The majority of armed forces personnel in Reading are living in a household, although this is based on very small numbers.

Table 1: Armed forces personnel located in Reading, 2011.

image1

Source: 2011 Census, QS121EW: All usual residents employed in the Armed Forces.

Pension and compensation scheme data can be used as a proxy for the number of veterans in an area (however, not all veterans are in receipt of pension or compensation payments). There are 395 veterans in receipt of a pension/compensation living in Reading.

Table 2: Residents in receipt of a war pension or compensation, 2014.image2

Source: Ministry of Defence, Location of Armed Forces Pension and Compensation Recipients https://www.gov.uk/government/statistics/location-of-armed-forces-pension-and-compensation-recipients

National & Local Strategies (Current best practices)

The National Armed Forces Covenant sets out the relationship between the nation, the government and the Armed Forces. The Covenant's two principles are that:

  • the Armed Forces community should not face disadvantage compared to other citizens in the provision of services in the area where they live; and
  • special consideration is appropriate in some cases, especially for those who have given the most, such as the injured and the bereaved (MDb, 2015).

All NHS organisations are covered by the National Armed Forces Covenant.

Reading Borough Council and its partners have signed a Reading Armed Forces Community Covenant. This is a voluntary statement of mutual support between a civilian community and its local Armed Forces community. It is intended to complement the Armed Forces Covenant, which outlines the moral obligation between the Nation, the Government and the Armed Forces, at the local level.

The purpose of this Community Covenant is to encourage support for the Armed Forces community working and residing in Reading and to recognise and remember the sacrifices made by members of this Armed Forces community, particularly those who have given the most. This includes in-Service and ex-Service personnel, their families and widow(er)s in Reading.

For Reading Borough Council and partner organisations, the Community Covenant presents an opportunity to bring their knowledge, experience and expertise to bear on the provision of help and advice to members of the Armed Forces community. For the Armed Forces community, the Community Covenant encourages the integration of Service life into civilian life and encourages members of the Armed Forces community to help their local community.

The development of an Armed Forces Community Covenant for Reading contributes in particular to the Council's strategic aim to 'promote equality, social inclusion and a safe and healthy environment for all' by working to ensure that both serving and ex-Armed Forces personnel can access appropriate support and are able to integrate well into the community.

This work also relates particularly well to the Sustainable Community Strategy's 'people' theme where 'we look after each other' and the 'prosperity' theme by aiming to ensure that veterans and reservists are not excluded from the economy. Reading's Community Covenant was launched on 7th July 2012 at the Afghanistan Homecoming Parade at Brock Barracks. As stated above Reading does not have a large military 'footprint', with no regular forces stationed in the town. However, Brock Barracks is the headquarters for the Territorial Army unit 7th Battalion the Rifles, and Reading is home to a large ex-Gurkha community. Reading's Community Covenant therefore focuses on Veterans and Reservists and aims to be proportionate in its scope to the size of the Armed Forces community in Reading.

Following discussions with 7th Battalion, The Rifles and key partners, an action plan is now in place. Some of the key actions include:

  • Raise awareness of and signpost to Veteran's Mental Health Service for the South Central region
  • Work with local businesses to encourage employment of service leavers and reservists; for example, working with Tesco Distribution Centre, who are keen to employ ex-forces personnel
  • Promotion of defence discount service/ card amongst town centre businesses
  • Establish and implement domestic violence protocol between Service and Civil Police, agencies and charities
  • Plan and conduct appropriate event(s) in support of the centenary anniversary of the outbreak of the First World War
  • Development of a leaflet on accessing health services to be translated into Nepalese

The new Covenant Fund has recently been set up, with £10 million available every year. This year the priorities for the fund are: community integration projects, the coordination and delivery of support to the armed forces community and projects which address issues facing veterans in the criminal justice system. Under the previous Community Covenant Grant Fund, Reading submitted two successful bids; to run a series of 'health weeks' for veterans (particularly focusing on ex-Gurkhas and their families) and to support Reading Museum's exhibition 'Reading at War' to commemorate the anniversary of World War One in 2014.

What is this telling us?

Research shows that:

  • Nine out of ten of the people surveyed thought that it was common for personnel leaving the Forces to have some kind of physical, emotional or mental health problem, as a result of their time in the Forces. However, there is limited evidence to support the assertions that the post-national service veteran population in England fares any worse than a comparable population of non-veterans.
  • A small minority of veterans do experience difficulties post Service, these tend to manifest themselves on average 10 years post discharge. The presentation of common mental health problems or encounters with the criminal justice system is at a rate less than that in the general population.
  • The longer you serve, the less likely you are to have problems; early Service leavers are more likely to have adverse outcomes (such as suicide and mental health problems) and risk taking behaviours (such as heavy alcohol consumption, suicidal thoughts) than longer serving veterans.
  • Adverse outcomes in veterans are more commonly associated with Pre-Service adversity/vulnerabilities rather than a consequence of Service life or combat experience.

Needs of veterans are similar to any other person or family relocating, with the exception that high levels of housing support need may be expected in a small group with major disabilities. A range of voluntary sector agencies have been brought together locally in Berkshire to support families with basic needs for housing, employment and access to mental health support, as identified in Murrison's report on military amputees (Murrison, 2011). When a veteran leaves, a summary health record is returned to their GP with a read code of 'History Relating to Military Service'. Ensuring this is done will help identify needs in future.

The majority of armed forces families are relatively young women of child bearing age. Spouses often have to cope with being alone by themselves or with the children for quite long periods due to deployment or training. Many families also live away from family support, which can exacerbate this.

For some groups of conditions, Reservists report higher rates of mental health issues than Regulars. Compared with Regular Armed Forces Families, there can be even greater isolation for Reservists' Families.

The younger population make up 6% of the ex-service community. Veterans aged 16 to 64 in particular are more likely than the general population to report a long term illness. This includes depression, mobility issues and sensory impairment. They are also less likely to be in employment, and more likely to suffer from financial difficulties and have caring responsibilities (RBL, 2014).

What are the key inequalities?

Veterans needs are similar to any other person or family relocating, with the exception that high levels of housing support need may be expected in a small group with major disabilities

What are the unmet needs / service gaps?

Many veterans find the way health issues are managed in the transition from military to civilian life unsatisfactory:

  • Patients or NHS staff are not always aware of veteran's priority of access to treatment (if a condition relates to their military service);
  • Problems about the transfer of medical records;
  • Difficulties in the continuity of care;
  • Medical personnel do not always know or understand the patient's military background.
  • Access to services is a key issue for Armed Forces Families , including:
  • Time accrued on NHS waiting lists it not always honoured when moving to a new area;
  • Family members receiving care in one area often find that they don't meet the criteria of the new area;
  • Spouses who have been waiting for mental health treatment often get the treatment required just before they move and have to start again;
  • Some families who are carers for a family member with additional needs/disability find it difficult to access short breaks or support when their spouse is deployed or away training.

Provision of health care being regularly switched between military and NHS services can be a problem for Reservists, particularly with respect to the transfer of medical records and continuity of care.

Healthwatch Reading highlighted a number of issues experienced by the ex-Gurkha community in accessing health and social care in the town (HWR, 2014):

GP services

Main findings:

  • 85% of the 70 people in the ex-Gurkha community, who answered the survey, said they found it difficult to fully explain their symptoms to a GP without a registered interpreter assisting them.
  • 89% wanted their GP surgery to offer an independent, registered interpreter for a GP appointment, rather than ask them to use a family member, a friend or an acquaintance
  • 15% said their GP surgery routinely offered to arrange a registered interpreter
  • 5% of respondents knew how to make a complaint about GP services
  • 15% were aware how to transfer to another GP surgery in Reading.

Royal Berkshire Hospital

Main findings:

  • 81% of people attending an outpatients appointment had not been offered an independent, registered interpreter
  • 60% of people admitted as an inpatient had not been offered a registered interpreter during their hospital stay
  • 100% of all people seen at the hospital found it difficult to fully explain symptoms to a doctor because of the lack of an interpreter
  • 83% of people did not know how to make a complaint about hospital services.

Urgent care services

Main findings:

  • All the focus group participants said they were aware of the 999 service
  • Only a very small number were aware of the 111 service
  • None of the focus group participants were aware of Westcall, the out-of-hours GP service in Reading
  • More than three-quarters of those in the focus groups were aware of the Reading NHS Walk-In Centre in Broad Street Mall.
  • All focus group participants were aware of the emergency department at the hospital and one in ten said they had used it since moving to the UK.

Community health services: opticians and dentists

Main findings:

  • 81% of the ex-Gurkha community surveyed said that they wore glasses
  • 26% said they had diabetes
  • 36% had not yet had an eye test in Reading
  • 88% had difficulty explaining their sight problems
  • 95% were not offered a registered interpreter for an eye sight test
  • Only 38% had had an NHS dental check-up
  • Only 25% had had NHS dental treatment

Mental health and dementia services

Main findings:

  • 13% of the focus group participants described themselves, their spouse or friend as having mental health difficulties
  • 3% of focus group participants had used the NHS Talking Therapy service
  • No-one in the focus groups had heard of Mother Tongue, a counselling service in Reading for people from ethnic minority communities
  • 5% of focus group participants were aware of the term, 'dementia'

References

Healthwatch Reading (HWR) (2014). How the ex-Gurkha community access and experience health and social care services in Reading. [Online]. Available at: http://healthwatchreading.org.uk/wp-content/uploads/ExGurkhaFINAL.pdf. Reading: Healthwatch. [Accessed: date].

Ministry of Defence (MDa). (2015). Location of UK regular service and civilian personnel quarterly statistics: 2015. [Online]. London: HMSO. Available at: Location of UK regular service and civilian personnel quarterly statistics: 2015. [Accessed: date].

Ministry of Defence (MDb). (2015). Armed Forces Covenant. London: HMSO. Available at: https://www.gov.uk/government/publications/armed-forces-covenant-2015-to-2020. [Accessed: date].

Murrison, A. (2011). A Better Deal for Military Amputees. London: HMSO, [Online]. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215338/dh_130827.pdf.  [Accessed: date].

Office for National Statistics (ONS), 2011 Census: Table QS121EW. [Online] London: HMSO. Available at: https://www.nomisweb.co.uk/census/2011/qs121ew. [Accessed: date].

Royal British Legion (RBL) (2014). A UK Household Survey of the Ex-Service Community. [Online]. Available at: http://www.britishlegion.org.uk/get-involved/campaign/public-policy-and-research/the-uk-ex-service-community-a-household-survey/. [Accessed: date].

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