Gisela Stuart MPWorking hard for Bartley Green, Edgbaston, Harborne and Quinton

Adjournment debate on the Royal Centre for Defence Medicine // November 11th, 2009 // Speeches, Articles and Interviews

The text of the adjournment debate I secured on November 10th in the House of Commons is below. The minister’s response is here. A recording of the debate can be found here.

I am extremely grateful to have the opportunity to speak about the work done by military and NHS clinical staff at the centre at Selly Oak hospital. Over the years, the centre has been mentioned in Parliament-usually in response to ill informed comments, which have not always been confined to the press. I want to put on the record the centre’s achievement, in its entirety.

The centre was formally opened by Her Royal Highness the Princess Royal in 2001. A year later, in 2002, it was given approval by Her Majesty the Queen and could use the title “Royal”. It was fitting that the Princess Royal performed the opening ceremony, as her husband, now Vice-Admiral Timothy Laurence, wrote the original Ministry of Defence report advocating the creation of the centre for defence medicine.

The first RCDM staff arrived at University Hospitals Birmingham in September 2000, when seven nurses joined the accident and emergency department. They have since been joined by almost 600 doctors, nurses, therapists and support staff, who work throughout the trust.

I thank my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) for allowing me to trespass slightly on her territory. I hope that I can justify that on two grounds. Incidentally, I am glad to see that my hon. Friend the Member for Birmingham, Northfield (Richard Burden) is also present. The first ground is that the trust very much covers the south of Birmingham. The other excuse, which is probably much more important, is that I was in the Department of Health when the decision was made to restructure the way in which medical care was delivered to our armed forces.

Setting up the centre was not uncontroversial. I remember participating in Adjournment debates that made me extremely unpopular in places such as Gosport. Military medicine has extra dimensions beyond the usual care for patients. Military commanders need advice on how to maintain the health of their troops and how to deal with injuries suffered on or away from the battlefield. They usually operate in extreme conditions-extreme in terms of climate, terrain and personal security. Just to complicate things, there are tropical diseases and wound contamination.

There is now agreement that free-standing dedicated military hospitals cannot provide the best clinical care. Much of the criticism in the past was based on the mistaken assumption that unless there were dedicated hospitals and wards for servicemen, they would receive second-rate treatment. The opposite is true: what matters is the appropriate setting and clinically optimal care.

The British Medical Association, in response to today’s debate, stated that

“whilst the desire to build a separate, military hospital is understandable, the practicalities of providing up to date expert clinical care by well trained staff working in acute hospitals make this impractical as a solution”.

The BMA wants to see the necessary improvements to provide the best health care overall for our military patients, using the best that the NHS has available but ensuring that the care is given in an environment with the appropriate military ethos.

I should like to remind the press and the media that they, too, have a responsibility, which goes beyond their daily circulation figures. Of course when things go wrong, they need to be highlighted. I am glad to say that most recently the press and the string of visiting politicians have acknowledged the excellent work done at Selly Oak, but some may wish to look back and reflect on some of the things that they have said and written in years gone by. Sad to say, we still get stories, such as that in The Sun on 24 September, that are simply factually inaccurate. They fail to understand that counting “military beds” tells us little. Misrepresentations of that type damage the morale of recovering injured soldiers and clinical staff, and morale is a component of fighting power. Stories such as those worry troops, staff and families alike.

The Defence Medical Services is the collective term for some 6,500 trained regular uniformed medical personnel from the Royal Navy, Army and Royal Air force. The hospital treatment of armed forces personnel is carried out through the use of NHS facilities under partnership arrangements. The Defence Medical Services staff are grouped into five MOD hospital units across the country. I am referring to Derriford, Frimley Park, Peterborough, Portsmouth and Northallerton, plus the Royal Centre for Defence Medicine. On average, the total number of military in-patients in NHS hospitals across the UK, for all illnesses and injuries, is about 60 to 75 personnel, although the numbers fluctuate.

The Healthcare Commission, which checks health services in England, reviewed Defence Medical Services earlier this year and found that rehabilitation services were “excellent” and that the system of regular reviews of best practice in trauma and rehabilitation services meant that care was “continuously improving and innovating”. Patient diaries, kept for personnel recovering from injury in hospital to help with short-term memory loss, were described as “innovative”.

Most recently, the excellent work done by the RCDM, led by Brigadier Chris Parker, was recognised at the military and civilian health partnership awards in Edinburgh in November 2009. Moira Kane, from 202 field hospital, Birmingham, won the deployed health care award for her work as a senior nurse in the emergency department at Camp Bastion. Dr. Heidi Doughty, also from 202 field hospital, who is a colonel in the Territorial Army, won the reservist of the year award for her pioneering work on improving blood platelet donation by soldiers to injured colleagues. The ortho-plastic team at Selly Oak, led by Professor Keith Porter, won the team of the year award. Those who watched the BBC documentary “Wounded”, which followed the treatment of two seriously injured soldiers, will be familiar with the team’s work.

Having been critical of the press, I can pay tribute to the Birmingham newspapers; the Birmingham Mail and The Birmingham Post have always been fair to the centre, acknowledged its achievements and drawn it to the public’s attention.

In last year’s new year’s honours list, Professor Colonel Tim Hodgetts was awarded the CBE for his services to emergency medicine. He has deployed frequently, recently in Afghanistan. In preparing for the debate, I asked where he is now and was told that he has just come
back. While in Afghanistan, he was the medical director of the field hospital in Camp Bastion. I am also told that during that time, the Danish provided half the staff for the hospital, with a quarter being British and a quarter American; apparently, Tim learned Danish before he was deployed. I mention all that because when talking about Afghanistan, we tend to think only in terms of the British troops. However, the contributions from other troops and how regularly we work with them are often not mentioned enough or underestimated.

Colonel Peter Gilbert, the Officer Commanding of the hospital squadron at Camp Bastion, in charge of the Territorial Army’s 256 City of London field hospital, heads a squadron of about 170 men and women. He said that

“on an average day we see more major trauma here than all the UK hospitals put together”

and their wounds, like all war wounds throughout history, are likely to be heavily contaminated.

A study soon to be published examines the period from 2006 to 2008 and estimates that there have been more than 40 “unexpected survivors”, with the figure expected to rise. Unexpected survival or extreme recovery is largely due to three things. The first is rapid treatment on the ground in what is referred to as the “platinum” 10 minutes; by applying tourniquets or staunching blood with clotting powder, catastrophic haemorrhaging is avoided. The second factor is the rapid evacuation of the injured by medical emergency response teams using Chinook helicopters manned by a consultant, nurse and paramedic who are highly skilled in trauma care.

Thirdly, those whose combat injuries require even more specialist treatment are brought into Selly Oak. There are weekly case conferences between UK and Camp Bastion staff. Once in Birmingham, the injured have access to a hospital with more than 1,250 beds, 43 specialties, 30 operating theatres and 76 critical care beds-that number will increase to 100 when the new hospital opens next year. Only last week, some of the soldiers injured in the shooting involving the Afghan national police force were flown into Birmingham International airport for transfer.

At every stage, our forces-and in the case of the Afghan theatre, Danish and Estonian soldiers who fight with us-receive medical treatment that is second to none and always in the most appropriate setting, with the aim of getting the most skilled and most qualified medics to them as quickly as possible.

Incidentally, the skills and expertise acquired at Selly Oak when treating battle casualties and non-combat injuries ultimately benefit all patients treated in the NHS. Military care, medical care and support care, with the services and their families, come together at Selly Oak. When the injured arrive, their families are informed and cared for by the Defence Medical Welfare Service, with the support of the Soldiers, Sailors, Airmen and Families Association. Families can be accommodated in specially designed flats, which are literally across the road from the hospital. Too often, we deal with extremely complex medical cases, but there are also very complex family situations.

Lynne Jones (Birmingham, Selly Oak) (Lab): My hon. Friend is making excellent points and has grabbed all the ones that I might have made in intervening.
10 Nov 2009 : Column 67WH
However, I would like to point out that in Selly Wick road, SSAFA has a home from home where family members can come so that they are close to their loved ones.

Ms Stuart: I have seen the photographs of the accommodation provided there by the local SSAFA, which works really well with the military services. Despite the initial horror of the news that families receive, we do give them the best care and support once they are brought to Selly Oak. In that respect, families who are in a difficult situation are not helped when certain sectors of the press exploit people’s vulnerability for their own purposes, rather than to get the best services for our servicemen.

We could not do what we do without the support of charities. Governments have always worked with charities, but the co-operation is more profound on this issue than on any other. There are established charities, such as the Army Benevolent Fund and the Royal British Legion-today is, of course, the day before Armistice day, and we are all wearing poppies. However, there are also more recent charities, such as Help for Heroes, whose multicoloured wristbands have captured the imagination of a whole new generation.

In last week’s edition of The House Magazine, of which, I confess, I am the editor, the hon. Member for Newbury (Mr. Benyon)-unfortunately, he cannot be here today, although I told him that I would mention him-recounts meeting Stephen Vause, who had been injured in Basra while serving with the 4th Battalion the Rifles. That encounter in Selly Oak, and the awareness that we need much more support for the rehabilitation of our servicemen, eventually led to the creation of Help for Heroes. The charity is now one of the most successful of modern times and has raised more than £32 million in just two years.

There is a covenant between the Government and our servicemen, which makes it clear that we should look after our servicemen for as long as necessary. The defence medical rehabilitation centre at Headley Court in Surrey provides an excellent service. It has a staff of more than 300, including rehabilitation specialists from all sectors. Together with Help for Heroes, it will deliver a new rehabilitation complex, including a state-of-the-art swimming pool and a new gym.

That brings me to my real question to the Minister. We have immensely improved the way in which we care for our injured servicemen-the survival rates would not have seemed possible five years ago-but that means that cases require much more complex and much more long-term rehabilitation. I would therefore like the Minister’s assurance that the effort that has gone into ensuring that our medical treatment is the best will also go into rehabilitation. That is a question not just of years, but, in some cases, of the rest of someone’s life.

In that context, we have decided that servicemen and ex-servicemen should have priority when receiving NHS treatment. However, I am not convinced that our record-keeping is sufficient to allow us to identify those who should be given priority. In addition to wanting to know more about our plans for rehabilitation centres, therefore, I think that it would be helpful if the Minister had discussions with his colleagues at the Department of Health. The bottom line is that we will achieve full recognition only when literally every GP in the country, on first encountering a patient, asks them whether they have ever been in the services. That will allow us to ensure that servicemen and women get the treatment that they deserve and which we owe them.

The Parliamentary Under-Secretary of State for Defence (Mr. Kevan Jones): I congratulate my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) on securing the debate. She has given me an opportunity to celebrate the success at Selly Oak and to say thank you to the military personnel and NHS staff who work there. She rightly mentioned service charities, and I would also like to put on record my thanks for the dedication shown by the staff at SSAFA and other organisations that have supported the families of patients at Selly Oak.

As my hon. Friend said, Selly Oak came in for some unwarranted criticism a few years ago. I was privileged to be a member of the Select Committee on Defence when it did a report on the Defence Medical Services. When I first visited Selly Oak and spoke to the chief executive, I asked her about some of the more salacious comments in the papers. She had tried to rebut a lot of them, but what disturbed and astounded me was that some of them were completely untrue, and it was sad that they had had an effect on some of the hard-working staff. If people are going to report on our injured, we should tell them, “Please report the facts.” One thing that we hear all the time is that people in Selly Oak are not allowed to wear uniforms. When visitors walk around the Selly Oak military managed ward, however, all they will see is military uniforms, so such claims could not be further from the truth. It is important that we treat our most severely wounded in that military context, because that is part of aiding them on the road to recovery.

My hon. Friend mentioned the wider work of the Defence Medical Services, and I want to put on record my thanks for the partnership working that takes place between the military and the NHS. She rightly noted that last year’s Healthcare Commission report said that the service was exemplary and that its work in areas such as trauma care could be taken up in the NHS. That is the key point, and the Defence Medical Services and the Surgeon General certainly see the partnership approach as the way forward. A couple of weeks ago, I was pleased to be in Edinburgh for the second Defence Medical Services and NHS awards, where Chris Parker and his team were rightly recognised; that was well deserved.

Some people still argue that we should have stand-alone military hospitals, but the Defence Committee came to the conclusion-most of the professionals I have spoken to have reiterated this-that what we have now is better at providing clinical care and ensuring that we provide the best. We simply do not have sufficient numbers going through our military units-last week, the figure was about 32 individuals, some of whom were in Selly Oak, while others were in other military managed units throughout the UK. People often mention the US, and somebody did so again yesterday when I was speaking at a conference, but we have to recognise that the US has a very different system. It has larger numbers of servicemen and it does not have the health service that we do.

We should take pride in the work done at Selly Oak. Not only is it leading to the discovery of new techniques, but it is at the leading edge of research into dealing with some very complex injuries and, as my hon. Friend said, with infections that servicemen and women unfortunately pick up when they are in Afghanistan and Iraq.

My hon. Friend rightly pointed to the pathway from the front line, and a key point is that embedding medics right on the front line is making a real difference to the use of tourniquets and so on. As a result, people have survived who would not have survived even a few years ago. My hon. Friend is right to describe that pathway, including the medical evacuation teams that take servicemen and women back to Camp Bastion. I have visited Camp Bastion a number of times and seen the tremendous work that NHS and military personnel do there. They not only assist servicemen and women with their wounds, but treat Afghan civilians, and I saw them treat some children who had been injured-there is that role, too.

I want to put on record my thanks to the aeromedical evacuation team at Lyneham. I visited members of the team last year, and they are remarkable individuals. They are on constant 24-hour call. They fly into Camp Bastion and bring back severely wounded patients. Dealing with somebody in a critical situation in hospital is difficult, but doing it at 30,000 feet, while flying back to this country for 10 hours, is quite remarkable. On one occasion earlier this year, the team brought back three patients whose conditions required intensive care. We therefore have to thank the team.

The partnership at Selly Oak works. Patients are received at Birmingham airport, and I should put on record my thanks to the local ambulance service and the police, who make sure that the transition to Selly Oak is as smooth as possible. We have come a long way and can be proud of what we have achieved. I thank my hon. Friend the Member for Birmingham, Edgbaston for giving me an opportunity to talk about what I see as the next piece of the jigsaw, which is what happens next-an issue that she raised.

There are now some young servicemen and women who have had terrible wounds that a few years ago they would not have survived. I was at Headley Court last week. On such occasions I am always humbled by the strength of the individuals and their families and their determination to ensure that those life-changing experiences-and many have horrible wounds-will not set them back. We are also pushing at new frontiers of rehabilitation at Headley Court, with respect to prosthetics and technologies for new limbs. It is not an accident that the individuals concentrating on that work in the limb department are RAF technicians: they use the latest computer technology to provide some of the most up-to-date prosthetic limbs.

To return to my hon. Friend’s key point: what next? I think that we are doing the best for those servicemen and women now, but the question that concerns us is what will happen to them in 10, 20 or 30 years’ time. That is the big test for Government and for society: how do we look after those people? I am passionate about getting that right, and that is why I am undertaking some work with the Surgeon General and others to see how we can establish a care pathway for them. I shall announce that early in the new year, and it will involve working with not only our NHS colleagues but service charities. I should like to nail once and for all the idea that Government should do everything. I do not believe that. Partnership working with the likes of Help for Heroes and the Royal British Legion is the way forward.

The idea that I am pursuing is to put what I should call a welfare bubble around the people concerned. Once they leave the armed forces, if they do, and make the transition to civilian life, some will be able to go into work, and it is important that we should put in place training for them, and support from employers. A number of employers are willing to work with us, and we shall be doing that. My hon. Friend is right to say that it is important for local authorities to recognise the uniqueness of the individuals we are considering. That is why last week I was pleased to launch with Kent county council what I have called the welfare pathway. It is not rocket science: it is intended to make sure that when local authorities develop policies they think about veterans-and although it is Kent in the present pilot, I remind hon. Members that I am looking for other councils to take part. Kent, for example, has a one-stop-shop gateway, which will ask the simple question, “Have you ever served in our armed forces?” Secondly, and importantly, the council has a champion for veterans-someone who will be championing this approach. I hope to roll it out with other councils and with my counterpart in Scotland later in the year. The idea is to join up services to ensure that those responsible think about veterans.

The most severely wounded will have a separate pathway, and we need to make sure that we look after those people for life. My hon. Friend has made a key general point. I was very proud that the service personnel Command Paper, launched two years ago by the Secretary of State when he was Minister for the Armed Forces, did it right. It was the first piece of work in which we looked across Departments to see how we could make priorities for servicemen and women and veterans.

One relevant issue, as my hon. Friend mentioned, is priority access. Have we got that right? No; I do not think that we have. At a national level there is a very good buy-in, and I thank my colleagues at the Department of Health, who are pressing the case very hard. However, we need to work on how we get the GP or service provider, such as a mental health trust, to recognise veterans. That is why I had a meeting a couple of weeks ago about our hope to be able to track veterans, once they leave, through the NHS system, so that it will become second nature for a GP or hospital to ask someone whether they have been in Her Majesty’s armed forces.

I do not want to take up time by making all my announcements in advance, but I want to mention another announcement that I shall make in the new year, about local advocacy. It is important that veterans and servicemen and women should locally have someone, or a group of individuals, who speak up on their behalf.

I think that we are in an exciting time, because if we can marry the best that we have in NHS medicine and military medicine at Selly Oak with rehabilitation, and achieve a joined-up approach at local level, we shall be able to achieve what I want, which is that when people leave the armed forces after serving their country they will get all the support they want. As my hon. Friend knows, some of the people concerned have very complex health care needs that will require looking after for life.

It is no good to expect them to be passed from pillar to post between different organisations. I am determined to make sure that there is a pathway for them.

The public mood and the media are rightly concentrated on those who are severely wounded, but many individuals are injured every year through training accidents and other illnesses. It is important that they should also be taken care of, because although they may not have been injured at the height of battle, they were serving their country. The Surgeon General and I are determined that the approach should be joined up.

Next year there will be an exciting milestone for Selly Oak, which my hon. Friend mentioned: the opening of the new hospital, which will have a separate, military-managed wing. That will bring in the most modern facilities anywhere in this country or Europe, and will also embed together the relevant culture and working practices. The other side of the issue-and it is something else that has been worked on at Selly Oak, and about which I am passionate-is the fact that as well as dealing with the physical scars that we can see, we need to make sure that mental health services are in place to support those who are severely wounded, and in some cases their families, who suffer from the trauma. If we can get that right we can have a centre of excellence.

I know that the Surgeon General is very proud of another aspect of his vision: research. It is important that we press forward on that. Selly Oak is becoming not just a national but an international centre of excellence for defence medicine. Work being done with Birmingham
university, among others, can help that to grow, so that our centre of excellence will be not just for complex injuries but for everything from mental health to the work of military anaesthetists. That is becoming internationally recognised, with co-operation between us and the US.

Another important aspect of the matter is not to allow past negative stories to continue to dog the great work being done at Selly Oak. On the many occasions I have been there, I have been impressed by individuals and by the dedicated, caring nature of the NHS staff. They do not get too many thanks, and I should like to put on record my thanks to them. I also want to thank the management of the trust, who have been innovative and forward-looking in their approach and in taking some difficult decisions, which my hon. Friend alluded to. We have something that we can be proud of.

I want to finish where I began. We should celebrate and be proud of what has been achieved at Selly Oak. It is very sad that it is needed for the young men and women who are returning from Afghanistan and Iraq, but we are providing the best medical services for them. We need to celebrate that and build on it. In closing, I want to say thank you once again to all those who work very hard. My final thought in this week of remembrance is to remember those who have been injured-some in life-changing ways-in the service of this country.

Leave a CommentYour e-mail will not be displayed on this website

1. Name *
2. Email *
3. Comments *