Better care is coming out of the trauma of war

NHS England has recently launched the Veterans Trauma Network, the first such initiative to help deliver comprehensive medical care to veterans. The clinical lead for the network, explains how it came about and what it will do.

We are all aware that recent conflicts have generated some severely injured young men and women.

These veterans will need ongoing care for rest of their lives and, until recently, the NHS did not have a joined up way of doing this. The newly launched Veterans Trauma Network (VTN) is intended to meet this challenge.

The VTN is based around the NHS Major Trauma Network that was set up in 2012 to provide better management of civilian trauma.

The Major Trauma Network comprises 22 major trauma centres that act as hubs for trauma; ten of which have been designated as veterans trauma centres (VTCs) to co-ordinate veteran trauma care. These centres, which are located in Plymouth, Oxford, London (three centres), Birmingham, Nottingham, Liverpool, Leeds and Middlesbrough, are regionalised so that there is care and treatment provided across England.

There are a number of reasons why the VTN is needed. Veterans may have complex problems that cannot be addressed by most NHS hospitals. Before the launch of the network, a severely injured veteran would have been seen by teams in a standard NHS hospital who were not familiar with war injuries. This led to inappropriate or inadequate treatment of a veteran’s medical problems, which was not right for the patient and wasted NHS resources.

The NHS has a reputation for providing world-class expertise in trauma care. It may not be appreciated, however, that military doctors, nurses and therapists, all work in the NHS when not in uniform. It was these clinicians who kept our veterans alive when they were injured on the battlefield and helped them recover when they got back to the UK. It is these clinicians, together with other NHS experts, who are able to provide the long-term care our veterans need.  The VTCs have within them both military and civilian trauma experts who are able to deal with the full range of a veteran’s health problems.

The VTN will only deal with problems related to a veteran’s time in service. There will be no ‘fast-track’ treatment of veterans over other NHS patients. A veteran will be prioritised on clinical basis only, just as any other NHS patient. This is in line with the NHS constitution and the Armed Forces Covenant, which sets out that veterans should face no disadvantage in accessing care and bespoke services for combat related conditions.  This new system should allow more efficient and effective veteran care which is better for all.

Developed with veterans, military charities – BLESMA, Style for Soldiers, Blind Veterans UK – and the Ministry of Defence, the VTN has been informed by feedback from veterans, their families and GPs, who have requested both clinical assurance on the advice and excellence of care and a supportive ‘safety net’ to meet the ongoing needs of injured military personnel transitioning out of the armed forces and veterans.

The network is linked in with Defence Medical Services, national centres of expertise, veterans mental health services and key military charities to provide holistic care for patients.

The referral process is simple. The veteran’s GP can email a referral to a central email address ( We do the rest from there and will organise a patient review at the most convenient VTC.  Following this, a personalised treatment plan is developed and provided by a specialist team of military and civilian experts in trauma.  It is recognised that major trauma has a significant impact on families and carers, which is also considered in the package of care offered.

The network currently only covers England as the devolved nations of Scotland, Wales and Northern Ireland have not commissioned major trauma networks yet. However, it is anticipated that similar VTNs will be set up when major trauma networks are established.

The VTN is a clear example of the close collaborative working between the NHS and Defence Medical Services. This partnership was forged on the battlefields of Iraq and Afghanistan, where it led to rapid advances in trauma care. Many of these lessons have been translated back to improving the treatment of civilian trauma patients. I hope the VTN, by extending this partnership to provide long-term veteran care, can also deliver benefits to other NHS patients recovering from trauma.

I believe that as a society we have a moral obligation to provide for our veterans. The VTN uses existing NHS expertise and resources more effectively to deliver better healthcare for our veterans. This will benefit all – the public, the NHS and most importantly, our veterans.

Shehan Hettiaratchy

Shehan Hettiaratchy is the clinical lead for the Veterans Trauma Network.

He is the Lead Surgeon and Major Trauma Director at Imperial College Healthcare NHS Trust in London.

He has developed the VTN together with Richard Swarbrick, National Lead Armed Forces and Families & MOD Health Transition, NHS England.

Shehan has served in the British Army since he left school and is currently a reservist serving with Airborne Forces. He was deployed to Afghanistan twice.