Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: August 2022

Attendees and apologies

Attendees

• Jason Leitch (Chair), National Clinical Director, Scottish Government

• Neil Morrison, Veterans Scotland, Health Representative

• Mairi McKinley, NHS Fife Armed Forces and Veterans Champion

• Sharon Callaghan, Operations Manager Scotland, Defence Primary Healthcare (Scotland and North)

• Robert Reid, Regional Manager Scotland and Overseas, Defence Medical Welfare Service (DMWS)

• Maura Lynch, Trauma, Adverse Childhood Experiences and Resilience Unit, Scottish Government

• Kari Magee, Project Manager, NHS Highland, deputising on behlaf of Jo McBain

• Amanda Cronin, Improvement Advisor, Leading Improvement Team, Scottish Government

• Laura-Isabella Muresanu, Armed Forces and Veterans Healthcare policy team, Scottish Government

• Lindsey Restrick, Armed Forces and Veterans Healthcare policy team, Scottish Government 

Apologies

• Ian Cumming, Third Sector Representative, Erskine

• Andrew Carter, NHS Borders Armed Forces and Veterans Champion

• Jo McBain, NHS Highland Armed Forces and Veterans Champion

• Martin Bell, NHS National Services Scotland, Armed Forces and Veterans Champion

• Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion

• Annalena Winslow, Person Centred Team Leader, Healthcare Quality and Improvement, Scottish Government

Items and actions

Welcome, introductions and apologies

Jason welcomed all to the group and noted the apologies as above. He updated the group that Annalena had been successful in gaining promotion and was now working in another part of the directorate and thanked Annalena for her contribution to this work.

Bob Reid of Defence Medical Welfare Services (DMWS) introduced himself to the group as this was his first meeting. He gave a brief overview of the work of DMWS and highlighted that the service is present in 5 NHS Scotland Boards.

Brief roundtable catch up

Jason referenced a recent positive meeting that he had with Dr Peter Homa (Director General of Defence Medical Services). This meeting was an opportunity to engage with Defence Medical Services (DMS) and explore where improvements can be made to better support the transfer of medical records to service personnel when transitioning.

Sharon mentioned that there is an imperative to role Project Cortisone (broadly speaking this is the UK wide project that is intended to improve the ability for DMS to exchange information with NHS systems and services across all four nations of the UK) and it has been arranged that Leuchars Medical Centre in Fife become a pioneer site for the roll out of the VISION element within the wider DMS project.

The roll out of the whole project delivery will then take place across the Defence Primary Healthcare (DPHC) simultaneously with a current timeline of early 2024.

Scottish Government officials and DMS have arranged further engagement to take forward actions from this meeting. 

Implementation Group (IG) priorities agreed at the last Strategic Oversight Group (SOG) meeting

Lindsey gave an update on the priorities that were agreed at the recent Strategic Oversight Group in May. These are largely a continuation of the priorities from last year but due to the ongoing pandemic-related pressures on the NHS we have been unable to complete some of these projects to fruition.

General Practice Armed Forces and Veterans' Recognition Scheme

This is inspired by the GP awareness scheme that is in operation in England. The content of the scheme is being tailored to the Scottish landscape. Training is currently being developed aimed at administrative staff, practice managers and clinicians.

Fife Coding Project

This project has similar aims as the recognition scheme, in that by identifying veterans, this could lead to streamlining referrals to appropriate services.  

Neil commented that he had recently attended a webinar hosted by the University of Chester which focussed on how to identify the veteran community within a healthcare setting and suggested that issues raised in the webinar may further support both the recognition and coding schemes.

Scottish Veterans' Treatment Pathway (SVTP)

This is informed by the Veterans Trauma Network (VTN) that has been developed in England, but reflecting the Scottish health landscape. It is intended that the pathway will support the person as a whole, including linking into the implementation delivery of the Mental Health and Wellbeing Action Plan. A working group has been convened, to help deliver the vision of the pathway and the first meeting of this group was held recently.

Bob advised that DMWS work alongside the VTN in England and offered to support the ongoing work to develop a SVTP.

Female and LGBTQ+ veterans

This is a new priority and needs to be more fully defined, so that we can understand what the challenges might be to these demographic groups and how we can effect a positive change. Further updates will be provided at future meetings.

Lindsey acknowledged the importance of the previous priorities of employability of veterans in the NHS and delivery of the Mental Health and Wellbeing Action Plan (MHWAP). However, these are being taken forward by a bespoke NES project and the MHWAP Implementation Board respectively, and therefore not being led by the IG. Jason was clear that there is still a keen interest of the IG in these two projects and regular updates should be provided. 

Action point: SG officials to invite employability programme lead (due in post 15th August) to discuss project.

Progress on Scottish Veterans Commissioner (SVC) recommendations since the 'Positive Futures' report

Jason highlighted that a new Commissioner, Susie Hamilton, has been appointed, and is due to come into post 22 August. Prior to Charlie Wallace’s tenure ending, he produced a final report in the series on transition and invited the group to comment on any further activity that can help to achieve these recommendations.

Lindsey commented that we are working on delivering these recommendations, through the recognition scheme and the MHWAP work. Through our engagement with DMS it is hoped that this will further assist in progressing the recommendations further.

Action point: new SVC to be invited to attend the next meeting of the IG.

Implementation of the Mental Health and Wellbeing Action Plan (MHWAP)

Maura was invited to give an overview of the delivery to date of the MHWAP. The first Implementation Board (IB) meeting took place in June and Combat Stress have been officially commissioned to take forward this work.

See Me have been commissioned to develop an anti-stigma campaign, to encourage veterans to seek help and support if they are struggling with mental ill health. See Me have advised that it has been difficult to get veterans on board, but when they have engaged the information that they have provided has really useful. This campaign is likely to be rolled out towards the end of the year.

Feedback from veterans is that often they don’t know where to go to access services. To address this the MHWAP plans to works with services to encourage operating a ‘one door’ policy. Taking on board the positive response to OpCourage which is in place in England, the Leith Agency have been engaged to support the branding of the MHWAP and working with See Me to further the potential reach of the campaign.

Neil commented that he is encouraged by the openness of the IB to input from the third sector.  

General Practice Armed Forces and Veterans' Recognition Scheme

Laura gave an overview of the progress of this scheme to date. Following consultation with the project sub-group, in the first instance, training is being developed aimed at different roles with the practice i.e. admin, practice manager and clinician. This training ,which will include clinical case studies, will then be piloted in practices across several NHS health boards.

Jason cautioned that training in itself does not confer implementation. Laura advised that the project plan does include considering how this scheme can be implemented successfully beyond the initial practices and how to evaluate the scheme achievements. The intention is to provide a project report in time for the SOG in May 2023.

Fife Coding Project

Amanda gave an overview of the project to date. This project was prompted by trying to understand, where the veterans are within primary care. Understanding local process identified that the landscape was confusing with no consistency in marking veteran status on medical records. Through collaboration with NHS Fife and colleagues in the other administrations there is now agreement on how to apply this consistency.

Mairi through her work in Board is driving the local changes, with NHS Fife acting as an anchor institution. It is hoped that this local experience can be scaled up to other board areas.

Any other business (AOB)

Neil raised an issue about a particular case that he had been involved in, and Jason confirmed that action had been taken in this highly complex case. 

Bob reminded colleagues about an event that is taking place in parliament on 21 September, which is raising awareness of the work of DMWS. 

Date of next meeting

The next meeting will take place on Tuesday, the 8 November 2022.