From 1 April 2013, NHS England took up its full duties to ensure that the NHS delivers better outcomes for patients within its available resources and upholds, and promotes the NHS Constitution. As a single national organisation, NHS England is responsible for ensuring that services are commissioned in ways that support consistency not centralisation; consistency in ensuring high standards of quality across the country. NHS England works through its national, regional and area teams to discharge these responsibilities.
Section 15 of the Health and Social Care Act 2012, gives the Secretary of State the power to require NHS England to commission certain services instead of clinical commissioning groups (CCGs). These include services or facilities for members of the Armed Forces or their families.
These regulations define the scope of responsibility as being for any serving member of the Armed Forces stationed in England and any family dependents who are registered with a Ministry of Defence, Defence Medical Services (DMS) Medical Centre. In addition, reservists who require NHS health services while mobilised will be the commissioning responsibility of NHS England. Those stationed overseas who return to England to receive health services is the responsibility of the NHS in England and will depend on what service is needed and where.
NHS England is responsible for ensuring that services are commissioned to support consistently high standards of quality across the country, promote the NHS Constitution, deliver the requirements of the Secretary of State’s Mandate with NHS England and are in line with the commitments made by the Government under the Armed Forces Covenant.
NHS England’s responsibilities are to commission directly:
- all secondary and community health services for members of the Armed Forces, mobilised Reservists and their families if registered with DMS Medical Centres in England;
- specialised services, including specialist limb prosthesis and rehabilitation services for veterans.
CCGs responsibilities are to commission:
- all secondary and community services required by Armed Forces’ families where registered with NHS GP Practices, and services for veterans and reservists when not mobilised. The bespoke services for veterans, such as veterans‟ mental health services, will be commissioned by CCGs either individually or collectively.
- emergency care services on a geographical basis which can be accessed by anyone present in their defined geographical boundary e.g. accident and emergency services, emergency ambulance services and other emergency health services. Serving members of the Armed Forces and their families (where registered with DMS Medical Centres) will have full access to these services.
- health services for these groups stationed overseas who return to England to receive NHS care.
Healthcare for the Armed Forces community: a forward view
Healthcare for the Armed Forces community: a forward view is a companion document to the NHS Long Term Plan, outlining the commitments NHS England and NHS Improvement is making to improve the health and wellbeing of the Armed Forces community (serving personnel (regulars and reservists), veterans and their families). It sets out nine commitments to undertake, which have been informed by the views and experiences of the Armed Forces community. Each commitment provides information on what the NHS will do, in partnership with the MOD, the Office for Veterans’ Affairs, Armed Forces charities and other organisations, to improve the care and support delivered to this population. This is intended to supplement the work already underway in regions and through integrated care systems to meet the goals and ambitions of the NHS Long Term Plan.
Health needs of the Armed Forces
Military personnel put themselves in harm’s way in the service of their country. They risk injury or death in the course of their duty and successive governments have recognised the debt society owes to its Armed Forces, their families and veterans.
Society’s obligations are set out in the Armed Forces Covenant, a framework for the duty of care Britain owes its Armed Forces. In terms of healthcare, the key principle is that they experience no disadvantage in accessing timely, comprehensive and effective healthcare and that they receive bespoke services for their particular needs or combat-related conditions including, for instance, specialist limb prostheses and rehabilitation.
Members of the Armed Forces are typically younger and fitter than the general population. As such, there is relatively low prevalence of long-term conditions, some earlier identified health needs and higher incidence of musculo-skeletal injury. Combat-related injuries aside, Armed Forces healthcare needs can usually be met by standard NHS services. Similarly, the families and dependants of serving Armed Forces members have health needs typical of their age and gender. Maternity services and children’s health services in particular must be planned and commissioned with the needs of military families in mind where they are present in large numbers in a community.
NHS England’s role and responsibilities
NHS England’s responsibility to the Armed Forces serving personnel is set out in the Mandate and this past year has seen new ways of working for the Ministry of Defence (MoD) and the NHS; with both organisations successfully working through these new arrangements for healthcare.
NHS England has a dedicated team of Armed Forces healthcare commissioners. For the first time, a single, national organisation is commissioning the majority of services required by the Armed Forces community, which includes mobilised reservists and some families. This duty is carried out by NHS England’s National Support Centre and its three lead area teams: North Yorkshire and Humber (North); Derbyshire and Nottinghamshire (Midlands and the East); and Bath, Gloucestershire, Swindon and Wiltshire (South, including London).
As well as these teams, NHS England has been working with other partners, including a full range of service supporting charities and the Department of Health (DH) and Local Government Association (LGA), to improve the services available to veterans and raising awareness of veteran’s health and mental health issues within ex-service communities. This is all part of helping to connect other parts of the health system for this population, notably with CCGs, local authorities, providers and health and wellbeing boards.
Further information can be accessed on the NHS website.
Partnership agreement between the Ministry of Defence and NHS England for the commissioning of health services for the Armed Forces
This agreement sets out a partnership approach, which enables the Ministry of Defence (MOD) to work with the NHS to plan and organise the delivery of healthcare for the Armed Forces community and support the best outcomes and experience for patients and their families and carers.
As part of this commitment to working together to ensure safe and effective services, which improve health outcomes for the Armed Forces community, these services must:
- be tailored to the needs of the Armed Forces community, in accordance with the Armed Forces Covenant
- ensure that patients experience a seamless transition between services, minimising any risks associated with accessing care commissioned and provided to the Armed Forces community
- provide as a minimum the same standards and quality of care that can be expected by the civilian community.
The Armed Forces Covenant
To support fair access to treatment, the Armed Forces Covenant sets out a number of health commitments for the Armed Forces community:
- The Armed Forces community should enjoy the same standard of, and access to healthcare as that received by any other UK citizen in the area they live.
- Family members should retain their place on any NHS waiting list, if moved around the UK due to the service person being posted.
- Veterans should receive priority treatment for a condition which relates to their service, subject to clinical need.
- Those injured in service should be cared for in a way which reflects the nation’s moral obligation to them, by healthcare professionals who have an understanding of the Armed Forces culture.
To find out more, visit: www.armedforcescovenant.gov.uk.
Assurance that services are being appropriately commissioned
For both area teams and CCGs, assurance is a major factor when approaching the NHS’s responsibility for the Armed Forces community. It has been agreed by the three lead area teams that they will include assurance questions in all area teams’ quarterly reviews.
Providers role across the wider health economy in relation to the Armed Forces
Whilst this community group is relatively small compared to larger populations it is important to note the following:
- Most secondary acute and mental health care for serving personnel is provided by the NHS
- Ministry of Defence GPs now use e-referral (previously Choose & Book) to refer into NHS services
- There are complex and variable commissioning relationships for serving, families, veterans and reservists
- To ensure accurate patient data transfer and speedy invoicing and payment, data departments will need to be aware of recent changes and useful activity codes
- As stated in the Armed Forces Covenant, Armed Forces personnel must suffer no disadvantage due to their Service
- Veterans have distinct health needs and should receive priority treatment where it relates to a condition which results from their service in the Armed Forces and is subject to the clinical need of others (page 10, Healthcare – Armed Forces Covenant).
Veteran friendly GP practice accreditation
NHS England and NHS Improvement, together with the Royal College of General Practitioners, have launched the veteran friendly GP practice accreditation scheme to help improve the care and treatment of UK Armed Forces veterans. This is an NHS Long Term Plan priority, which commits to rolling out the scheme across England by 2020.
Whilst accreditation is voluntary, it is strongly encouraged as evidence shows that GPs are unsure of how many ex-forces are registered with their practices and want more information and guidance on how to meet their health needs. There is also a need to improve the identification and coding of veterans in GP computer systems, with a linked aim of further increasing awareness and understanding of their health requirements and ensuring appropriate referrals, which in some cases will be to dedicated NHS services for ex-forces.
Being accredited means that a practice can better identify and treat veterans, refer them, where appropriate, to dedicated NHS services (such as the Veterans’ Mental Health Transition, Intervention and Liaison service (TILS), the Veterans’ Mental Health Complex Treatment Service (CTS) and the Veterans Trauma Network) and capture better epidemiological data to improve future health provision. It also means that the NHS is better able to meet the health commitments of the Armed Forces Covenant, whereby the Armed Forces community, including veterans, should face no disadvantage in accessing health services and should receive priority care for military attributable conditions, subject to clinical need.
Accreditation involves a simple process where practices are required to meet specified criteria and to provide evidence that they are supportive of veterans’ healthcare. For more information on accreditation and how to apply, visit here