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Dave Rutter
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Dave Rutter
2013-06-06 8:47
I'll just say I'm Dave Rutter, sir. I head the armed forces and veterans' health team here in the Department of Health. I lead a very small team here, but we work very closely with NHS England with regard to delivering the programs and services that we provide.
It's important to note that this is England and not the U.K. Health is devolved within the U.K., so the Scots, Irish, and Welsh would have their own NHS health provision. I apologize if you're already aware of that, but I thought I'd better make it clear that when I speak of the programs that we run, they're predominantly for veterans' families and armed forces in England. Bearing that in mind, of course, with veterans of the military we work obviously with MOD—the Ministry of Defence—which has a U.K.-wide footprint and beyond. Veterans, when they leave the armed forces, will go back to their homes anywhere within the U.K. So we have to work very closely with our colleagues in the devolved administrations and we do so.
Just by way of context, and again apologies in advance if you are familiar with this, the Ministry of Defence here in the U.K. have health responsibility for the primary health care of those servicing, including dentistry, across the U.K. They do in some instances have primary health care responsibility for some families that are registered with their GPs. This tends to be in the very large bases or where they're in outlying areas. For veterans within NHS England, within U.K. as well more generally, the health care is the responsibility of the NHS administration. So within NHS England, we have responsibility for around about 4.5 million veterans, and our program is also designed to help their families as well where appropriate.
My responsibility here within the Department of Health is to take forward the government policies determined by our ministers, working very closely with NHS England, which was just set up quite recently, the first of April this year, with a responsibility for delivering armed forces health. But we also work very closely with service charities as well. You may be familiar with Help for Heroes, Royal British Legion, and others. We have a program designed to just go beyond the statutory services, if I can put it that way.
There are three key areas of work for us, which I'm very happy to answer questions around. One is around the continuity of health care for those who have been seriously injured or wounded during their time in the armed forces. The second key area is the mental health care of veterans, and the third area is the physical care of veterans, particularly those who have lost a limb as a result of their service.
I should say at the outset, although l know a lot about those programs and the wider areas of veterans and family health care, I'm not an expert in relation to the detailed compensation payments, etc., but certainly familiar with the way in which they are applied across the board within the NHS. I mentioned that we work closely with service charities. This is key in delivery. We have a small budget to deliver against these programs. I'm happy to go into that as well on request.
Actually, I think that probably concludes my opening remarks. I'm very happy to start taking questions from you.
View Irene Mathyssen Profile
NDP (ON)
Thank you very much, Mr. Chair, and thank you very much, Mr. Rutter. We appreciate you taking time to tell us about how you look after your service personnel in Great Britain, particularly in England. Of course veterans are our primary concern.
You talked about there being a continuity of care for service personnel and their families. Does this extend to veterans? For example, once someone who's been injured leaves the service, can they expect that they will continue to receive care?
Dave Rutter
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Dave Rutter
2013-06-06 8:52
Absolutely. You'll be familiar with the way in which health care is provided here in the UK, which is obviously free at points of need. One of the things we identified some years ago—four or five years ago when I came into this work—was the difficulty of those who had been seriously injured being discharged from the armed forces and then facing what's been described as a cliff edge in relation to care. That level of care would dip until such time as the NHS and other services of course help with the needs of that individual.
We approach this challenge through welcoming the Ministry of Defence to create a seriously injured leaders protocol. So this puts an onus on the Ministry of Defence working within their own system—their own clinicians, welfare staff, social care staff, etc.—to engage at a much earlier time with the NHS. Rather than leaving it to almost the very end of that person's time within the armed forces, we would expect them to be in contact up to six months in advance of departure, making contact with the statutory services in the area where this person will live, ensuring that the clinical handover is fully understood and any challenges that go with that particular individual—health care challenges with that individual—are seen in advance so that they can be addressed before departure, along with the welfare and living requirements of that individual. They may need adaptations to their home, for example, depending on their injuries.
So we aim for that to be as seamless as possible. The measure of success of that is hard to gauge. With some of these things, you gauge it on the basis of not receiving complaints, difficulties, or issues being raised by individuals. We receive some—and we're talking single figures where there have been difficulties—but the protocol has been designed in such a way that where these do arise, there are contact mechanisms in place to ensure that those are dealt with as soon as possible.
View Ben Lobb Profile
CPC (ON)
View Ben Lobb Profile
2013-06-06 8:57
Thank you, Mr. Chair, and thank you for that endorsement.
The first question I have this morning for Mr. Rutter is on the topic of mental health services.
I know that's under your mandate, and I wondered if you could give us an idea of how that has evolved in the last number of years and what the situation is today. Is it deemed to be a success or a work-in-progress at this point?
Dave Rutter
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Dave Rutter
2013-06-06 8:57
We have taken the work in relation to veterans' mental health quite some way over the last two years, or over the last four years, actually. But it's only over the last two that there has been real progress made. Any veteran will of course have access to the National Health Service mental health services in any event. They will have immediate access to that.
As for what we've done, Dr. Murrison, MP, produced a report in October 2010 called “Fighting Fit”. It's publicly available. It can just be googled.
The report made a number of recommendations around veterans' mental health, including such things as an online mental health provision, which we do in partnership with Big White Wall, and the creation of veterans' mental health teams around England. We've put in place 10 veterans' mental health teams around England. We've also put in an e-learning package for GPs, so that when somebody presents in front of them, they have that to refer to. We have a 24-hour helpline that we've put in place in partnership with Combat Stress, one of the leading veterans' mental health charities here.
We're in the process of producing something called the veterans information service. This will be a process whereby folk who have discharged from the armed forces will be contacted a year or so after discharge by e-mail, and by letter if needs be. Basically, they will just be asked how they are and whether they need help with certain mental health problems, but also with other issues, such as housing, welfare, benefits, etc.
We're working in collaboration with the Royal British Legion here to provide a one-stop shop to help with those problems. Obviously, depending on their problem, they may go on to statutory services or charity services.
We've also created the National Veterans' Mental Health Network, which brings together the devolved administrations of Wales, Scotland, and Northern Ireland, and also brings in the service charities and the statutory services. The idea there is to bring together the learning as we're presenting these programs, and to bring the best of those programs together. We're now at the stage where we're looking beyond 2014 and 2015, if you like, to see how we actually embed these services into the NHS.
So have they been successful or a work in progress? Both. I think it's an 80:20 situation. We still have more to go.
View Ben Lobb Profile
CPC (ON)
View Ben Lobb Profile
2013-06-06 9:02
Okay.
From the time a veteran comes forward to discuss an issue to the time he or she would see a specialist or see a doctor and start to receive care, what kind of timeframe is that? I know it's pretty vague because there can be a multitude of different issues, but is that something you measure? Where are you with that right now?
Dave Rutter
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Dave Rutter
2013-06-06 9:02
We're in very early stages. The last of the teams came into being at the back end of last year and early this year, so it's a bit of a rolling program getting those up to speed. Early indications are that veterans are able to access care faster than they would through other National Health Service avenues. They will see a clinician within the first week or two of being referred, depending on the need, and certainly within six weeks.
View Peter Stoffer Profile
NDP (NS)
Thank you.
Sir, one of the debates going on in Canada is the issue of mental health concerns, not just within the military and veteran community but also in the general population. One thing we have in Canada is a shortage—it's unfortunate but it's the reality—of mental health providers, psychologists, psychiatrists. Do you suffer the same concern in England? If you do, how do veterans achieve the help they require in order to obtain the counselling they deserve?
Dave Rutter
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Dave Rutter
2013-06-06 9:17
Yes, we have similar challenges over the numbers, with regard to mental health. There are a number of programs that are being run in the wider sphere of mental health care, including the IAPT, or improving access to psychological therapies program. A number of initiatives have been taken forward for the wider population.
With regard to veterans, partly because of the military ethos, the culture, and the type of individual likely to be within the armed forces, we realized we had a smaller, hard-to-reach group, which might be reluctant to admit to a mental health problem, and even harder still, to take steps to deal with it.
The report by Dr. Murrison that I mentioned earlier picked up on that theme and looking to recommend initiatives that would help encourage those individuals to come forward to access the mental health services that already exist. The 10 teams that I referred to earlier are very much geared toward providing that encouragement, and also to raising public awareness of veterans' mental health issues. They are able to signpost people to the services that we have more promptly than has previously been the case.
Dave Rutter
View Dave Rutter Profile
Dave Rutter
2013-06-06 9:18
There is a mixed community there. The teams that I mentioned earlier have set themselves up in a slightly different ways. There are some teams that have recognized the impact of mental health problems on veterans' families, and they give their services not just to the veteran but also to the wider family unit.
We are in the process of undertaking another project, with an organization called Mental Health First Aid. This is to train people who will train others in mental health first aid within the armed forces community. So they can help identify those who may be displaying signs of mental health problems. They can give initial advice, and they will be able to signpost them in and refer them to the right level of care. That's a new program that we hope to launch later this year.
View Bryan Hayes Profile
CPC (ON)
Thank you.
You mentioned that one year after a veteran retires, they're contacted either by email or by phone simply to see how they're doing. I want to speak a little bit in terms of what services you might have available online for veterans, online programs and websites. What we have in Canada is fairly extensive, but I don't know where the U.K. is in terms of online services and whether veterans can go online and see everything that's available to them—all the associated costs and all the associated processes.
Dave Rutter
View Dave Rutter Profile
Dave Rutter
2013-06-06 9:43
Certainly, that's where we're heading with the Royal British Legion, as part of the service that I described. At the moment, we're in a bit of a hybrid situation in which they're being informed, and in effect, emailed a letter that will signpost them to some of those key agencies: SPVA, Royal British Legion, statutory services, and others. The objective going forward...the Royal British Legion are redesigning their services so they will have an online one-stop shop for veteran services, where they can advise or refer to other services as appropriate. That would go down to the level of a Royal British Legion welfare officer visiting that individual in their home, if that's what's needed.
We also have the online mental health service, which is the big Whitehall service I referred to earlier on. We have commissioned that. We fund that. It allows veterans, their families, and those who are serving, to access that site where they can talk with others from that community, receive online one-to-one mental health counselling, etc. That's the other arm of that service we've been developing.
View Sylvain Chicoine Profile
NDP (QC)
Thank you, Mr. Chair.
Mr. Bishop, thank you for joining us. Given your sense of humour and quick wit, I have no doubt that the Korean War veterans are very well represented. In addition, you have received several medals. I thank you for and congratulate you on your contribution.
You talked at length about health care. So I have a question about that.
Committee members have often said that the allowance was a better way to help the poorest veterans. Now that the transfer of the last hospital is looming, I would like you to tell us how satisfied you are with the level of health care provided to Korean War veterans. Moreover, are you concerned about the future of long-term health care?
John Bishop
View John Bishop Profile
John Bishop
2013-05-23 9:01
Generally speaking, because of the circumstances when we first came back from Korea, we didn't even count. It was many a long time before we got the same benefits as World War II veterans. A lot of people lost interest and wouldn't even try to get them.
Of course, when they get older and they have a disability and they're spread all across Canada.... For example, in British Columbia, where I live, the veterans are spread throughout the province. When we have a meeting, it takes some people four days to drive in, get organized, come to the meeting, and go back. So they give up.
First of all, I would say most veterans don't even bother trying to apply because they've been turned down from the early days. I'm not saying it's all bad now. It is trying to change; there's no question about that. It is getting better, so I don't want to say that it's terrible now.
I would also say there's the other factor. The first battalion that I was with that went to Korea, for about six months before the brigade arrived we were Canadian army special force. We joined up for 18 months. Many of them served longer than some of the veterans did in World War II who only fought in Europe, because they did 13 months or so in Korea before they were brought home.
Then they got out of the forces and disappeared into the fabric of society. Now that sounds impossible, but from D-Day until the end of the war, they served longer than people served in World War II in combat. I'm not trying to overstate it. I'm just saying that's a fact. A lot of those people are not even interested. They don't even join KVA. We're not even able to find them to take them back to Korea on a revisit, with half their airfare and all of their expenses paid for by the Korean government.
Remember now, somebody aged 85 to 90 wonders why in the hell should they bother. There's a lot who don't even try, and they should, because there's an amazing number who cannot walk properly now. They've had a couple of hip operations. They've had a knee operation. Their health is not very good. But those who have assistance and do apply.... A lot of service officers who are serving with the Royal Canadian Legion help the Korean veterans, and they are a great help in getting people assistance for some of their problems.
I would support a statement that says not everything that's wrong with them is likely due to the Korean War. But I can tell you right now that almost all veterans, without question, only apply because of the way they look at it. There are things that were caused in Korea, such as climbing a mountain in the ice and the snow and losing a grip and falling 500 feet. Boom, boom, all the way down. I've seen it happen.
Generally speaking, Korean veterans only apply if they have a real problem.
I don't know if I've answered your question the way you—
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