2007/05/31 British Medical Association Armed Forces Committee Annual Conference - 31 May 2007

Thank you for inviting me here today.

I'd like to start by paying tribute to the quality of care and support provided by military medical personnel at home and abroad. Over the years you have served our Armed Forces with distinction.

In this, the 25th anniversary of the Falklands conflict, I am reminded of the lives saved by the Field Hospital at Ajax Bay. And lives continue to be saved today, in Afghanistan Iraq and the UK, thanks to the superb efforts of the men and women of the Defence Medical Services.

I have visited our Field Hospitals in both Basra and Bastion. They are outstanding facilities, and will get better still as the tented accommodation is replaced.

Two things stick in my mind in particular. First the clinical facilities - operating theatres, ward equipment - would not be out of place in any modern hospital here in the UK. Second the care and commitment of the medical personnel themselves to saving lives.

I also want to recognise the outstanding work of BMA members - military and civilian - in treating Forces personnel here in the UK in our MOD Hospital Units embedded at NHS hospitals. And the work of our medics in Service sick bays, GP surgeries and regional rehabilitation units up and down the land.

Only yesterday I was speaking to Medical Staff from the MDHU at Peterborough while visiting RAF Wittering.

No doubt we are all aware how the medical support provided to our Forces is under public scrutiny. On one level I welcome this. There should be close interest in the way we look after our wounded. And it gives us the opportunity to showcase our excellent work and tell our story.

The problem is - in parts of the media - the agenda is not about medical support and not about balance. It is political spin. And while editors will pursue their agenda, it should not be at the cost of undermining the confidence of our people - and their families - in how they will be looked after if they fall ill or injured.

You know better than I the excellent medical treatment and care that is provided to our people.

Having got that off my chest let me talk about the DMS and its people. They are excellent... Colonel Timothy Hodgetts from the Royal Centre for Defence Medicine in Birmingham was recently named 'Hospital Doctor of the Year'. Sergeant Rachel McDonald from Swansea, won 'Paramedic of the Year Award 2007' and Private Michelle Norris from the Royal Army Medical Corps - the first ever female recipient of a Military Cross.

Of course it is important that such skilled and dedicated people are properly rewarded. The BMA plays an important role in determining rates of pay for Service medics. Its Armed Forces Committee ensures that those in "medical branches of the armed forces are not disadvantaged in relation to their civilian counterparts."

The Government is delivering on this. There have been two pay awards since last year's conference. First, for 2006, an increase of 2.2%, plus a consolidated payment of £6,500 for Consultants and General Medical and Dental Practitioners.

And then a further 2% increase announced a few weeks ago. I know some of you would have liked more. I understand that. But the two awards together represent a good deal. And one that is in line with the independent Armed Forces Pay Review Body.

Our approach of ensuring long term, pay parity with the civilian world makes good sense. The longer you stay the better it gets. Service Consultants half way through their career will be on equal footing with civilian colleagues, and those towards the end will be better off. The reason being that when you're a bit older - the settled life of an NHS Consultant may seem more appealing. So that's when we pay more.

There is more to do. The current manning figures do not lie. There are shortages in some areas. But I am confident that the manning situation will improve.

With competitive long term salaries, excellence in practice, travel, investment and the variety of case work - DMS is heading firmly in the right direction. I hope the large financial incentive we are offering for nurses will also help to reduce shortages there.

Money is important. But for most medics, more important is the work itself - and the quality of that work.

Let me give you just a couple of examples of how we have embraced innovation in best practice and medicine.

In Afghanistan we include a consultant in the medical team sent to recover severely injured casualties from the front line, drastically reducing the time before the patient receives expert care. Recognising the so called “golden hour” whereby patients need to be stabilized in the first 60 minutes - often before they reach the safety of a field hospital.

In the last year we have introduced new dressings to control catastrophic haemorrhage. And as of this month we have a fully operating CT scanner in Afghanistan. We've had one in Iraq since 2004 - with telemedicine links back to the UK using techniques pioneered by MOD.

DMS clearly champions excellence in military medical care.

An issue that's been under the spotlight in recent months is the hospital care we provide here in the UK. I think this - more than anything else - has been subject to misunderstanding, and indeed misrepresentation, over the last few months.

The Royal Centre for Defence Medicine, which is fully integrated with the University Hospital Birmingham Foundation Trust, provides our personnel with access to a world class pool of expert consultants.

The priority for our wounded personnel is that they get the best possible treatment. Nowhere is better for this than Selly Oak.

Obviously, a priority for patients severely injured will be to stabilize them. Then, as people begin to recover, a military environment becomes increasingly important. So, as and when patients' clinical needs allow, they are brought together in a military managed ward.

The military managed ward at Selly Oak reached initial operating capability just before Christmas. A combined team of military and civilian personnel provide care for military patients whose condition allows them to be in that ward. There are now military managers involved at every level on the ward, with a total of 26 military nurses. By this summer it will be 39 - when the ward reaches full operating capability.

By using military doctors, an increased number of military nurses and by bringing military patients together in this manner, personnel can benefit from a more military environment and still have access to top NHS resources and facilities.

The new hospital will offer a new opportunity with the possibility of a military ward being looked at by the Chiefs.

There has been much debate - often well intentioned but ill informed - about whether military managed wards are the right approach. The Service medical community believes it is. And having seen the excellence of the facilities myself, and spoken to staff and patients, I am convinced that they are right.

As the Chief of the General Staff, General Sir Richard Dannatt said in March, "There is nowhere better in the country, nowhere more expert at polytrauma medicine, than that hospital in Selly Oak, that's why our people are there."

Elsewhere, the MOD's Defence Medical Rehabilitation Centre at Headley Court is the premier facility for the rehabilitation of injured Service personnel. There is nothing quite like it in the NHS, and both the facilities and the staff who work there are second to none.

As you know its main purpose is to provide rehabilitation for complex injuries, including amputees and brain-injured patients. It also houses a new Complex Rehabilitation and Amputee Unit. This provides high quality appropriate prosthetics and adaptations, manufactured on site and individually tailored as necessary to the patient.

Let me now address Mental Health.

Over the years there has been growing awareness of the need to care for military patient's mental health as well as their physical health. We recognise mental health illnesses, including PTSD, as disabling conditions. But conditions that can often be treated - in a way that focuses on recovery and rehabilitation.

Our mental health services are configured to provide community based mental health care in line with national best practice. Last year - a Kings College study into the health of Service personnel on operations in Iraq, funded by the MOD, noted an increased effect on mental health for the Reserve Forces.

So, we responded. And last year I announced the Reservists Mental Health Programme. A highly comprehensive programme, which in my opinion is an excellent package for Reservists.
Under the Programme, we liaise with Reservist's GPs and offer a mental health assessment at the Reserves Training and Mobilisation Centre in Chilwell, Nottinghamshire.

If someone is diagnosed to have a mental health condition related to service on recent operations, we offer out-patient treatment at one of the MOD's 15 Departments of Community Health. In more acute cases, the Defence Medical Services will assist access to NHS in-patient treatment.

With UK Health Departments, we are taking steps to address concerns about NHS provision for those suffering mental health problems as a result of service. In particular, we will shortly be piloting a community-based arrangement to provide treatment for veterans, by establishing networks of expertise in military mental health within the NHS - across the UK. The first pilots for this scheme are due to launch this summer.

Other good news is that our mental health support to patients in Birmingham has increased. A military nurse now visits every military patient treated at a Birmingham hospital 3 times every day.

And I also want to mention the Medical Assessment Programme at Guys' Hospital. Although it's not a DMS unit - it offers a service that allows veterans concerned about their mental health to get an expert assessment - opening doors for further treatment.

There is lots more I could talk about: the new defence medical information system and the DMS Top Structure Review. These projects have same aim - to improve the care we offer patients.

Both our information management and the governance of DMS should be boosting not hindering your service. I won't go into detail on this because I know the Surgeon General will talk about the Review in a moment.

Then there is our smoking policy. It is already MOD policy that all messes or clubs are non-smoking. There has in general been very good compliance with the ban throughout the Armed Forces, and early indications are that more people are trying to give up smoking since the ban was introduced.

So we have already taken the right steps world-wide. Come July, the rest of England will be catching up.

Everything you do and everything I've talked about shows our commitment to providing our Armed Forces with the best possible medical care. Central to that are medics themselves - you.

And while I appreciate there have been difficult times in the past I want to assure everyone in the Service medical community that we are committed to ensuring that you are appropriately rewarded and properly supported in the vital work that you do.

Finally, I've not done this before - but I'd like to take this opportunity to ask DMS personnel to act as advocates. As you know - medical care in the military comes under regular attack for political reasons.

And as you know the standard of care that we - or rather you- provide is world class. When you say that, it carries so much more weight than when I do. So I would ask you to always keep in mind that you are the best ambassador for the Defence Medical Services.

Thank you