Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: April 2021

Attendees and apologies

Attendees

Name	Organisation	Attending / Deputy / Apologies
Jason Leitch	Scottish Government Clinical Director of Healthcare Quality and Improvement (Chair)	Attended
Neil Morrison	Veterans Scotland – Health representative	Attended
Ian Cumming	Third sector representative: Erskine	Attended
Andrew Carter	NHS Borders Armed Forces and Veterans Champion	Apologies
Mairi McKinley	NHS Fife Armed Forces and Veterans Champion	Attended
Claire Wood	NHS Highland Armed Forces and Veterans Champion	Attended
Craig Cunningham	NHS Lanarkshire Armed Forces and Veterans Champion	Attended
Sharon Callaghan	Regional Clinical Directors Operations Manager, MOD	Attended
Martin Bell	NHS Champion, NHS National Services Scotland	Attended
Lucy Abraham	Scottish Veterans Care Network	Attended
Katie Hislop	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Michael Ross	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Ruth Jays	Unit Head, Person Centred Healthcare and Participation Unit, Scottish Government	Attended
Annalena Winslow	Armed Forces and Veterans Healthcare policy team, Scottish Government	Attended
Fiona Cameron	St. John & Red Cross Defence Medical Welfare Service	Attended - Observing

Items and actions

1. Welcome, introductions and apologies

Jason Leitch, Chair, welcomed members to the meeting.

Jason noted that it is Katie Hislop and Ruth Jays’ last meeting, before they move on to new roles. On behalf of the group, he thanked them for their contribution to Armed Forces and Veterans’ (AFV) health policy.

2. Scottish Government Update

An update paper had been distributed to members in advance of the meeting.  Michael Ross spoke to this paper, highlighting key progress as follows:

Hearing Aid Surveys

In 2019, a letter was distributed by this group to audiologists requesting like-for-like replacement and maintenance of Ministry of Defence (MOD) issued in the ear (ITE) hearing aid devices. In January 2021, two surveys – one for veterans and the other for audiologists – were distributed to assess the impact of the letter. The survey findings confirmed expectations that a small number of people are impacted, as the results indicated that between an estimated 3-5 people had presented to audiology services with issues, and repairing hearing aids had been the most common solution offered. Therefore, the results are positive and the issue the Implementation Group examined in 2019, as indicated by the Scottish Veterans Commissioner, would appear to be resolved. This will continue to be monitored at official level.

Jobs within NHS

Work continues in progressing the actions of the Group’s employability sub-group. A short survey has been distributed to veterans to gauge perspectives and inform the Scottish Government’s (SG) health workforce team’s strategy on the issue of veteran jobs within the NHS, and any barriers veterans may have experienced. Around eighty responses have been received so far.

NHS Education Scotland (NES) are developing a central website page to collate all veteran-centred employability information. Alongside other materials, the veteran case studies which we have requested and identified volunteers for will be located on this webpage.

Martin Bell updated that work between NHS Job Train and the Careers Transition Partnership (CTP) is progressing. This will, once development is completed, allow NHS jobs to be automatically loaded onto the CTP website. Once complete it is hoped a similar arrangement can be made with Forces families jobs website. This work was agreed by NHS HR Directors and the NHS recruitment group. The sharing of NHS job postings across various platforms will increase the visibility of NHS jobs amongst the veteran community. Martin noted awareness of an anonymised negative case study relating to agenda for change and suggested that this may be shared with NES so that it can be taken into account as part of their work on translating the military experience into an NHS environment.

Martin questioned why those who volunteered to provide NHS career case studies hadn’t been contacted to progress them yet. Michael responded that NES colleagues co-ordinating the work had previously stated they would progress the work when COVID-19 restrictions allowed, but it would be worth requesting an update on this.

Action: Secretariat to check-in with NES on the career case studies.

NHS Fife Identifying Veterans – Quality Improvement Project

The project to trial new methods of coding veterans on health records and, consequently, identify them more easily within the health system is progressing. Two GP clusters are involved in the pilot – North East Fife and Dunfermline. Dr Andrew Halpin, a GP in Rosyth and a Navy veteran, is championing the project.

Mairi McKinley added that an issue has been identified with the particular codes used, and a direction given to GP surgeries from MOD, will inevitably slow progress as it was unanticipated. However, once resolved, this will have a significant impact on the coding of veterans and there are already good local examples. Thereafter, there will be work to be done on encouraging veterans who may be reticent to identify themselves, to do so.

Further updates will be given as work progresses.

Mental Health

The Mental Health Action Plan is expected in Autumn 2021. SG mental health colleagues have been contributing to cross-UK collaboration on veterans’ health issues. It was suggested that sharing of veterans’ experiences may be helpful, as would the sharing of interim / draft key priorities.

Covenant Legislation

There were two UK Parliamentary appearances at the Select Committee on the Armed Forces Bill committee in March on behalf of SG. Graeme Dey, Minister for Parliamentary Business and Veterans, and Jason Leitch, National Clinical Director, appeared.

Details of the Ministry of Defence’s engagement on the legislation have been released, showing it takes the form of different groupings of stakeholders.

The next priority is for the MOD to produce statutory guidance to accompany the legislation. This will be published in January 2022. An engagement exercise on draft guidance will take place in the coming weeks.

Priority Treatment Working Group

An engagement exercise to assess clinician understanding of Priority Treatment has been proposed, subject to approval from the Partnership Board. A sub-group has been created to work on the content of this engagement and Neil Morrison of Veterans Scotland will represent Scotland.

3. Scottish Veterans Care Network (SVCN) Update

Jason invited Lucy Abraham to provide an update.

The current SVCN priority is the Mental Health Action Plan.

A Health and Wellbeing facet group, comprised of clinicians and interested parties, met on 28 April 2021.

A diverse range of engagement is underway on issues such as: forces families, transitions, and differing experiences due to geographic variation. Lucy requested that that the group assist in the distribution of engagement exercises so that a wide range of perspectives can be captured. This is particularly important for the veteran engagement activities, as it is widely recognised that veterans must have a strong input into the development of the work.

SVCN are currently working with the University of Edinburgh on a systematic literature review. This will be the first of its kind in Scotland, and is therefore a very positive step.

In addition, there are monthly meetings on a variety of different themes, such as transitions and pathways.

Neil raised concerns that expectations surrounding the Mental Health Action Plan are very high, the work is comprehensive, and resources – with the SVCN’s staffing resources equating to one full time position – may not reflect the importance of this. Neil said that the staffing constraint limits the SVCN to horizon-scan, look ahead, and mitigate future obstacles. Jason suggested that resourcing discussions between SG and SVCN can be progressed offline.

Action: Lucy to email group with details of engagement exercises she wishes to be distributed.

Action: SG and SVCN to discuss resourcing of the network offline.

4. Reporting to Strategic Oversight Group (SOG) – May 2021

Jason reminded the Group that, historically, the Implementation Group has reported progress to the Strategic Oversight Group by letter, in advance of the SOG setting new priorities.  A draft letter was circulated to Group members in advance of this meeting for consideration. Jason stressed the importance of the content of the letter to the SOG, stating that anything included may then become future priorities for the Implementation Group, and highlighted this as an opportunity to influence upcoming work.

In terms of the update, much of the content had been discussed during agenda item 2. Jason invited any further comment on work already in progress, but nothing was offered.

The main question Jason had for members focused on items the IG may propose as new priorities. One option is GP and Hospital veteran aware accreditation. Jason reminded this group of discussions around these in 2019 and the decision to pause – but not lose sight of – this work in acknowledgement of NHS capacity in 2020/21.  Neil advised of his recent background work on GP accreditation. He has been gaining insight on the English system of GP accreditation, which has highlighted that there are very little resource implications to the work. Neil believes, like in England, the Royal College of General Practitioners (RGCP) could progress the work in Scotland, and if this work becomes a priority it could be quickly achieved. Jason noted existing positive links with RGCP Scotland.

Mairi cautioned against the accreditation potentially appearing hollow, as the maintenance of standards may not always be monitored. Jason agreed that such an outcome is not desirable, and we would want a better system. Jason suggested a possible 12 month period to progress the GP accreditation work, which members agreed with. It was suggested that, if the SOG set GP accreditation as an IG priority, a working group should be established to take the work forward. Such a group could potentially include representatives from SG, RCGP Scotland, Veterans Scotland, and others as appropriate.

The discussion then turned to the fragility of funding for the Third Sector, echoing discussions at previous meetings, with members recounting their experiences over the last year and the additional challenge of external demands for efficiency savings. It was agreed that a paragraph on this could be included in the letter to the SOG.

Action: Secretariat to add GP accreditation as a suggested priority to the SOG letter.

Action: Secretariat to amend the SOG letter to make reference to the financial difficulties being experienced by the Third Sector.

5. Transfer of medical records between Ministry of Defence and GP practices

On 24 March, at First Minister’s Questions, Maurice Corry MSP stated there were delays in GPs receiving veteran health records and queried the First Minister. The First Minister committed to respond, and a letter was sent from the National Clinical Director on 29 March, in which he stated he would consult with this group to gain insight on the issue.

Group members shared their perspectives on the issue of transferring records between MOD and GPs. Martin advised he was on a joint MOD/NHS group, which focusses on improving connectivity, and that encrypted medical data from MOD, which doesn’t correspond with Scottish health systems, is a key area of concern. It is believed this may remain an issue when Cortisone, a project to deliver an integrated information capability that will fully and effectively support the delivery of evidence-based medical and dental health and healthcare outputs, is implemented.

Sharon Callaghan agreed with Martin that there are issues in connecting IT systems. Sharon also raised that, due to the various stages in transferring the medical record, the delays may form at other stages too. Sharon advised they are working on the issue, by asking people to identify where the delay is located. Jason requested that this remains an area of focus for this group and that we hear regular updates. If necessary, Jason suggested a ministerial letter could be used to communicate the urgency of the issue and, in turn, progress things quicker, but timing of such communication is essential to its success.

Action: Martin / Sharon to bring this issue back to the Implementation Group to update as necessary.

6. A.O.B.

Neil thanked Katie and Ruth and recounted their significant contribution to AFV health policy.

The next meeting will take place in late June, to look at 2021/22 priorities.

Action: Secretariat to canvass members for meeting dates.