Who cares wins

13 June 2008

The position of chief executive to the leading Armed Forces charity prior to the release of a major cross-government strategy for Service personnel approximates that of a bridegroom-in-waiting – initial excitement has yielded to anxiety as the all important date approaches.

What if the promised strategy, once unveiled, falls short of expectations? What are supporters of the Royal British Legion – not to mention Service personnel – to do, should the Command Paper fail to deliver expected improvements to Armed Forces' welfare, housing, care, and compensation?

As a member of the External Reference Group for the Service Personnel Command Paper, I am all too aware of the enormous breadth of the terms of reference the cross-government strategy has undertaken to review.

They include accommodation, education, and medical care; families, veterans' and widows' welfare; inquests and boards of inquiry; pay and allowances; recruitment, retention, and training; and the plight of Commonwealth soldiers and the Gurkhas.

It is, to judge by what it says on the tin, the most extensive review of the human side of defence administration since the 1995 Bett Report on 'Managing People in Tomorrow's Armed Forces: Review of the Armed Forces' Manpower, Career and Remuneration Structures'. Expectations were further raised when the principal authors of that report – Sir Michael Bett, Sir Anthony Vineall, Admiral Sir John Kerr and Ed Miller – were invited to lend independent advice to the Command Paper.

Service personnel, their families, and veterans have also been asked to submit their views to the Command Paper. On the basis of the many shortcomings in the referenced areas highlighted by the Legion's Honour the Covenant campaign alone, one would expect the MOD letterbox to be overflowing.

Then again, perhaps not.

Since the Command Paper was announced a few days prior to Remembrance Sunday by the Minister of State for the Armed Forces Bob Ainsworth, it has quietly moved to the background of public proceedings. Its companion document, the Armed Forces Recognition Study chaired by Quentin Davies MP, has replaced it in the foreground of media attention and political comment, and is expected to be released first.

This is quite literally an example of style taking precedence over substance, as the Recognition Study deals with those matters that are more symbolic than practical, such as homecoming parades, national days, and wearing of Service uniforms in public.

These issues are important in their own right. Public recognition is the basis of understanding and engaging with the Armed Forces' role in society, which is the foundation of political support for the Military Covenant. They are not, however, the hard questions we have been asked to consider, nor do they involve the (more often than not) expenditures required to address them adequately.

No, these questions are legion, and they are also the Legion's. Should the bereaved families of Service personnel be provided with free legal counsel at inquest? Who is responsible for providing accommodation for the families of injured Service personnel being treated at Headley Court? And what do we do with the Gurkhas?

In more than five months that have passed since the Command Paper was announced, there has been little evidence of the flurry of secretariat and departmental activity one would expect for a review of this magnitude, especially one that must necessarily include the participation of other ministries, such as the Department of Health and Justice.

I may be proved wrong – indeed, I would be delighted to be proved wrong. But, the concern exists that expectations have been raised beyond the Government's willingness or the MOD's budget to deliver.

As for the Legion's expectations, we have made them very clear: in our 'Honour the Covenant' campaign; in personal representations to the Prime Minister, his key officials and other major stakeholders; and in the formal recommendations we presented to the Command Paper working party in April.

In short, we said:
On Service accommodation¹:
• The Government should bring all single and family quarters up to the highest standard by 2013;
• Funds from the disposal of Defence Estate assets should be ring-fenced for Service accommodation. Income from the sale of Chelsea Barracks should be brought forward and invested in Service housing;
• The Government should place priority on worst condition housing regardless of location. Families occupying these homes should be given the opportunity to move to alternative – including privately rented – accommodation, while work takes place;
• The Government must improve the 35,000 single bed spaces that are currently expected to be substandard in 2012/13 and immediately upgrade the worst accommodation;
• The Government should assess the relationship between quality of accommodation and retention rates to judge whether extra investment might result in savings in recruitment and training;
• Receipts from the sale of surplus property by Annington Homes must be re-invested in maintenance, not retained by HM Treasury;
• Base commanders and estate offices should have the powers to resolve maintenance issues;
• The Government must guarantee that no further deferrals in planned maintenance are made as a result of budget cuts.

On families:
• The MOD must work co-operatively with the NHS to find a solution to the problem of Service family mobility and healthcare registration;
• The MOD must ensure that the standard of overseas medical care matches that provided by the NHS;
• The impact of mobility on the employment opportunities for spouses, partners and civil partners needs to be assessed.

On medical care:
• The Military Managed Ward at Selly Oak should be replicated to at least its current capacity in the new hospital;
• The Government needs to reconsider entitlements for families of injured non-British nationals, who can find themselves stranded in the UK without support before their relative is fully recovered;
• The cost of accommodating the families of injured personnel at Selly Oak and Headley Court should be borne by the UK Government, not charities;
• Training for Headley Court staff in the continuing care assessment should be made a priority;
• Detailed health surveillance should be mandatory for all Service personnel. This should include additional surveillance for personnel who have been on multiple or lengthy operations;
• More effort is needed to tackle the heavy drinking that still occurs among sections of the Armed Forces;
• The Government should introduce comprehensive health surveillance for medically downgraded personnel to quantify the extent of psychological illness among those with physical injuries;
• The MOD and NHS should work together to raise awareness of the Medical Assessment Programme and Reservist Mental Health Programme among GPs, reservists, veterans and their families, to ensure more people benefit from the service;
• The Government should quantify the number of veterans currently eligible for priority treatment for conditions related to service, and should find a more effective way to raise awareness of priority treatment among healthcare professionals and veterans;
• The Government should consider an opt-out tracking system for veterans, to help ensure they are being offered priority treatment where appropriate;
• The MOD should identify a more effective method to transfer medical records from the MOD to the NHS;
• The personal expenses allowance for people in care homes should be at least doubled, to give vulnerable older people in residential care a better standard of living;
• War Pension payments should be disregarded by local authorities when calculating income in order to determine how much an individual has to pay towards their residential social care costs.

On compensation:
• The Government should reverse the burden of proof back upon the Secretary of State for claims under the Armed Forces Compensation Scheme (AFCS);
• The MOD should immediately review the value of all awards in the AFCS, taking into account the cost of continuing care needs and housing adaptations;
• The MOD should remove the time limits for applications and worsening conditions to the AFCS;
• The exclusion of conditions caused by medical treatment administered in Service under the AFCS should be removed;
• There should be a full and independent review of the Armed Forces Pension Scheme;
• A one-off compensation payment should be available for personnel with hearing loss at 35dB - 49dB bilateral hearing loss averaged at 1, 2 and 3 kHz from both .
On inquests:
• The Government should ensure that families have access to an open, transparent and timely inquest service;
• The Government must not suppress the findings of military inquests, and should recognise the public interest in these matters;
• Families of military personnel who have died in-Service and subject to a coroner's investigation should receive advocacy and legal representation at public expense;
• The powers of the Services Complaints Commissioner should be extended to provide investigative powers.

On Commonwealth Soldiers and Gurkhas:
• The Government should grant resettlement in the UK to any member of the Armed Forces medically discharged post-initial training as a result of an injury or medical condition directly attributable to Service;
• Those with a Service background should be exempt from the 'Life in the UK Test' and from any future requirements to prove commitment to the UK, such as those proposed in the 'Path to Citizenship' Green Paper;
• UK Border Agency instructions should be updated to reflect the change in Gurkha terms and conditions;
• The Government should allow simultaneous applications for settlement and UK naturalisation for dependent spouses or civil partners.

On resettlement:
• The new category of 'vulnerable Service leaver' should be introduced;
• The MOD should examine why a high level of early Service leavers are not receiving the appropriate briefing and correct this problem;
• Access to resettlement services should not be disrupted by operational pressures.

On legacy health research:
• The MOD should establish a fund to which applications for research into legacy health issues such as Gulf War illness, Agent Orange, the effects of radiation on nuclear test veterans (including children) and mTBI (mild Traumatic Brain Injury).

On Gulf War veterans:
• The Government should provide Gulf War veterans in receipt of a War Pension (including dependants) with an ex gratia payment for sustained failures to fulfil their duty of care to this group of veterans.

The Legion acknowledges the huge amount of work that has been done by Government to try to ensure that current and former members of the Armed Forces receive the best available care and support. And, we are pleased by the willingness of its agencies to work in partnership with us, and our sister organisations, to take these things forward. But, we are intent on ensuring that this nation acknowledges and addresses those key areas that are still in need of action.

We believe the nation has a life-long duty of care to Service people, past and present, and their families. There is a moral and practical obligation to look after those who enter into a unique contract with the nation and who are willing to make the ultimate sacrifice for it. How could this great nation not act on their behalf?