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Improving care for the most severely injured service men and women

Following the launch of the Armed Forces personnel in transition, Integrated Personal Commissioning for Veterans Framework, NHS England’s Director responsible for health care of Armed Forces personnel reflects on the work undertaken to develop a new approach to personalised care:

Over the last few years, I’ve had the honour of meeting with some of our most severely injured Armed Forces personnel, veterans and their families.

We’ve explored how we can improve care and support for those individuals who have complex and enduring physical, neurological and mental health conditions resulting from injury attributable to service.

As a nation, we have a duty under the Armed Forces Covenant to ensure that those injured in service receive priority treatment for conditions relating to their time in the military – subject to clinical need – and are cared for in a way that reflects our moral obligation to them.

However, on hearing about their experiences of the care and support they had received since being injured, this was not always the case and it was clear that things needed to change.

Improvements were needed to make sure these individuals are promptly identified, the right organisations brought together earlier to assess their health and wellbeing needs, health and care arrangements put into place before they leave the military and associated support continuing into civilian life.

At a personal level, individuals want to be able to live their life and focus on the things that are important to them. They also want to be more involved in planning and shaping their care and support and have greater choice and control over these arrangements. This is particularly important as they transition out of the Armed Forces, with fears about the unknown and what the rest of their life holds.

To address these concerns and make much needed improvements, the NHS and Ministry of Defence (MOD) set up a series of multi-agency steering groups to retrospectively review and understand the care planning of a number of these individuals as it had evolved. As part of this, we drew on their opinions and experiences, along with that of their families, carers and those organisations supporting them.

This was invaluable in helping to understand all aspects of their lives, which identified a need for a comprehensive care planning framework with a focus on personalised care and early discharge planning from the military.

As a result, the Armed Forces personnel in transition, Integrated Personal Commissioning for Veterans Framework (IPC4V) was developed.

The involvement of patients and their families has been central to this, demonstrating a true partnership approach with the MOD and Armed Forces charities to ensure the best possible care for serving and ex-serving personnel.

Grounded in the principles of the Armed Forces Covenant and the Comprehensive Model for Personalised Care, IPC4V supports organisations to develop partnerships with military charities to facilitate the seamless coordination of personalised care and support across statutory and voluntary sectors.

Under this new approach, eligible individuals are proactively identified by medical staff while they are on the Defence Recovery Pathway – typically about nine months before they leave the military.

With the individual’s agreement and where appropriate, that of their family, they are then referred for an assessment. As part of this, a multi-disciplinary and multi-agency steering group is set up to oversee the case and ensure the right people, including the individual, are involved. This involves a range of organisations, including the MOD, health and social care and military charities – thus eliminating the need for individuals having to keep retelling their story.

Following an initial holistic assessment around the individual and their health and wellbeing needs, a personalised care and support plan is developed with them. Arrangements are put into place while the individual is still serving, ensuring Armed Forces aware care and support are being provided as they transition to civilian life and beyond.

Unique to IPC4V is the allocation of a dedicated Veterans Welfare Manager (VWM), who is a central point of contact for the individual and all involved organisations. The VWM provides a range of support to help the individual identify goals and actions and explore the management of their health and wellbeing within the context of their whole life and family situation. They also make connections to community resources, including veteran organisations, facilitate referrals into health or social care and arrange an annual review of the individual’s care with them and each involved organisation.

Over the course of this year we will monitor and test the role of the VWM, as well as further develop the IPC4V Framework to help ensure that this new approach to personalised care is providing individuals with the best support possible.

While this demonstrates significant progress in the care of these individuals, it is recognised that there are veterans within our communities who have suffered similar injuries during their time in Service and so require arrangements for ongoing care and support too. As a result, work is underway to develop a second framework of care for ex-forces with life-long health and social care needs, which will launch in June 2019.

Kate Davies, CBE commenced in December 2012 as the Director of Health and Justice, Armed Forces and Sexual Assault Referral Centres (SARCs) for NHS England.

She is a national director of three areas of direct commissioning, working to support the commissioning of healthcare services across England for serving personnel, veterans and their families, Sexual Assault Referral Centres (SARCs) and healthcare services in prisons, secure children’s homes and training centres, as well as immigration removal centres. This national role is to assure high quality, consistent and sustained services with a strong focus on health inequalities and outcomes for patients and their families.

Kate has developed and led the national partnership agreements with the Ministry of Defence for Armed Forces commissioning, the Ministry of Justice for prisons and the children and young people secure estate and the Home Office for immigration removal centres. The cross departmental partnership agreements focus on core objectives and outcomes across government for key patient areas that can only be delivered in partnership with cross government agreements.
Veterans mental health has been a focus for the partnership agreement between the Ministry of Defence and NHS England who have secured commissioning for veterans’ mental health services across England (The Veterans’ Mental Health Transition, Intervention and Liaison Service and the Veterans’ Mental Health Complex Treatment Service).

From a health and justice perspective, the partnership agreement has supported the development of the national Liaison & Diversion Programme and Street Triage. Kate has developed and lead and increased provision for survivors of sexual violence including the partnership publication of a NHS Sexual Assault and Assault Strategy in 2018 (SAAS).
Previously, Kate was the Executive Lead for Prison, Detainee and SARCS Healthcare Commissioning for East Midlands, when she led the healthcare commissioning for prison and offender health.

Kate has also worked as the Strategic Director of the award-winning Nottinghamshire County Drug and Alcohol Action Team from December 1995 to May 2009, co-ordinating and delivering the Government’s National Drug Strategy. From 2003 to 2010, Kate was seconded to the University of Central Lancashire, International School for Communities Rights and Inclusion as Director of Black and Ethnic Minority Community Engagement, focussing on the health and social care of diverse groups who experience discrimination and/or disadvantage and directing the national community engagement programme.

Kate has been a Non-Executive Director on the National Treatment Agency Board in England between 2000 and 2013. She was also a member of the Government’s independent Board for the Prison Drug Treatment Strategy Patel Review, which implemented the Substance Treatment Service and Strategy and delivery across England and currently acts as an Ambassador for Diversity in Public Appointments for the Government Public Appointments Commission. Kate started her career in the Probation service and was a qualified Probation Officer from 1986 to 1995, before joining the NHS.

Kate was awarded an OBE in 2009, for services for disadvantaged communities. In 2018, she was awarded a CBE for her work to improve services for some of the most vulnerable groups and an Honorary Doctor of Staffordshire University in recognition of her commitment to health and social equality.

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