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

Attendees and apologies

Attendees

• Jason Leitch, National Clinical Director, Scottish Government (chair)
• Neil Morrison, Veterans Scotland – Health representative
• Ian Cumming, Third sector representative: Erskine
• Andrew Carter, NHS Borders Armed Forces and Veterans Champion
• Kari Magee, NHS Highland
• Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion
• Martin Bell, NHS Champion, NHS National Services Scotland
• Lucy Abraham, Scottish Veterans Care Network
• Michael Ross, Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)
• Alex Dunn, Unit Head, Person Centred Healthcare and Participation Unit, Scottish Government
• Annalena Winslow, Armed Forces and Veterans Healthcare policy team, Scottish Government
• Fiona Cameron, St. John & Red Cross Defence Medical Welfare Service
• Lindsey Restrick, Health Workforce, Scottish Government
• Charlie Wallace, Scottish Veterans Commissioner

 

Apologies

• Mairi McKinley, NHS Fife Armed Forces and Veterans Champion
• Jo McBain, NHS Highland Armed Forces and Veterans Champion
• Sharon Callaghan, Regional Clinical Director’s Operations Manager, MOD

Items and actions

1. Welcome, introductions and apologies

Jason Leitch, Chair, welcomed members to the meeting. Apologies, as reflected above, were noted.

2. Update from Scottish Veterans Commissioner

Jason welcomed Charlie Wallace, the Scottish Veterans Commissioner, to the meeting.

Charlie provided an update on his upcoming report concerning the health and wellbeing elements of service leavers transitioning from the armed forces to civilian life. The report is part of a series centred on the different aspects of transition. It will look at what areas of Scottish and UK policy can be improved.

There are four points of focus within the report: preparation for leaving the armed forces, delivery of care and how to progress the distinctive Scottish approach into practice, wellbeing and integration into communities, and the future demand for veterans’ services – what this looks like and what factors impact demand.

The report will be outcomes-focused and is intended for publication early in 2022. Charlie and his team will be consulting with a broad range of partners and stakeholders, including the Implementation Group, as they work on producing the report.

Jason thanked Charlie for providing his update and noted he particularly likes the idea discussed around measures to sustain the wellbeing of those who are presently well. Jason also questioned whether mental health will be at the centre of the report.

Ian Cumming responded that he has noticed an increase in mental health issues in Erskine’s work.

Charlie stated that the report will specifically focus on those about to leave the armed forces, with an aim of setting a strong foundation for positive longer-term progression. He is conscious of the importance of mental health and questioned whether this importance is appropriately reflected in the processes for preparing individuals to leave the armed forces.

Neil Morrison offered to meet with Charlie and discuss his report in more detail. Charlie responded that he has plans to contact Veterans Scotland.

Craig Cunningham suggested that performance targets focused on the timeframe of transferring medical records from Ministry of Defence to NHS Scotland could be an area worth exploring.

Charlie thanked members for their input and left the meeting.

3. Scottish Government Update

Michael Ross provided an update on progress of the group’s priorities.

Priority Treatment

The four-nations Priority Treatment Working Group met on 8 September. The Working Group were updated that the cross-nation review of the priority treatment terminology has not moved forward since the last meeting in February/March due to the change in the Secretary of State for Health and Social Care.

UK colleagues are seeking time to update the Health Secretary on the veterans’ health portfolio and gain agreement to progress this work, but this is subject to broader demands and it may not take place for a number of months. The next meeting of the Priority treatment Working Group is scheduled for March 2022, but it will reconvene earlier if there are developments.

UK Armed Forces Covenant Legislation

Following the first engagement session, Scottish Government (SG) officials are still waiting for a second draft of the statutory guidance from UK colleagues and information on the second stage of engagement. This is expected shortly and stakeholders who previously volunteered to input into the statutory guidance sessions, hosted by UK colleagues, will be updated as appropriate.

NHS Fife Pilot Project

The planned pilot project centres on identification and clinical coding of veterans within a GP cluster in NHS Fife. A paper that the project team submitted to the four-nations Partnership Board in July, centred on gaining cross-nation clarity on the conflicting clinical coding advice for veterans, was well received.

Since the Partnership Board meeting, the project team have been informed that similar work on identification of veterans and coding has been commissioned by NHS England and is also due to take place. In the coming weeks, the project team will be meeting with UK colleagues to discuss aligning and progressing the projects. Ian Thompson, a professional advisor in Primary Care eHealth, is representing the SG on the NHS England commissioned work.

Jobs within the NHS

SG officials will reconvene with SG Health Workforce colleagues to consider what more can be done under this priority. There is also the possibility of reconvening the sub-group that previously progressed various strands of work under this priority.

GP Veteran Accreditation

A cross-sectoral sub-group was convened and the first meeting took place on 29 July. It was a productive meeting, with a range of actions that have provided the basis for a plan on a possible approach to the accreditation scheme. There is further work ongoing to establish the detail, specifically on the content of the accreditation scheme and how this should align with the UK scheme.

At the appropriate time, the sub-group will be reconvened to further progress the work and a paper detailing the planned approach will be brought to this group for input and approval.

The UK scheme is self-accreditation, so a key challenge is balancing this with appropriate scrutiny, as colleagues have raised this as Implementation Group colleagues have previously raise this as an important factor.

Scottish Veterans Trauma Network

SG officials will begin to reach out to key partners and stakeholders to better understand and scope the Scottish health landscape surrounding a potential trauma pathway and the specific gaps in service and needs. Officials are conscious of aligning this work with other ongoing projects, such as the Scottish Veterans Care Network’s (SVCN) Mental Health Action Plan.

Discussion

Michael opened for questions and Jason asked about the progress of the NHS Fife pilot project. Michael explained that the coding instructions from different organisations, nations and included within key processes differs, which complicates progression of the project. Michael highlighted an example where the Scottish coding advice, from Primary Care Informatics (formerly known as Scottish Clinical Information Management in Practice (SCIMP)), is different to the instruction listed on the F Med form, which is provided to service leavers upon discharge and should be passed to GPs when registering. Michael said he has an upcoming meeting to hopefully identify solutions and provide a basis for progressing the project.

Jason thanked Michael for his update.

4. Scottish Veterans Care Network Update

Lucy Abraham updated that the SVCN’s focus remains on the mental health action plan, which was submitted in draft to the Scottish Government on 10 September. Lucy thanked members for their contributions to the plan.

Lucy outlined that a central emerging issue from the engagement in preparing for the plan is that veteran’s find the health landscape confusing and difficult to navigate. As a result, some of the key areas the plan centres on are regional teams working locally, ensuring clear pathways, promoting access to services, and improved support for those who support veterans.

The three underlying principles of the plan are: equal access for all veterans, access for the right help at the right time, and collaboration in delivering the plan’s actions. The SVCN and SG Mental Health team are discussing the consultation process for the plan, and this will be confirmed in the near future.

Jason thanked Lucy for providing her update and reflected that the content of the plan sounds very positive. Jason questioned whether it will require a formal SG consultation process. Lucy responded that it will not be required to go through formal consultation, but she still needs to determine detail of the consultation approach with colleagues.

Jason noted that it may be useful for NHS Armed Forces and Veterans Champions to see the plan, as they will play a key role in implementation. Neil also suggested that Veterans Scotland would appreciate being included in circulation and he is keen to ensure that equity of service provision remains front and centre. Lucy confirmed SVCN are eager to ensure circulation across all appropriate spheres at the correct time. Lucy also clarified that equity of provision sits at the heart of the draft plan.

Craig commented that if the financial aspects of the plan are met, there should be less issues in delivery. Craig feels the plan is a useful blueprint of what is expected across NHS boards and the NHS Champions Network have been supportive of it. Lucy responded that SVCN are conscious of the importance of funding structures, and that the plan also contains costed information for the SG’s attention.

Jason concluded the discussion by stating that it is exciting to see the work progress.

5. Scottish Veterans Commissioner Recommendations: Annual Update from Scottish Government – Draft responses

Jason invited Michael to introduce the agenda item. Michael outlined that an excel document containing responses to the Scottish Veterans Commissioner’s recommendations had been circulated in advance of the meeting. This is part of an annual process whereby the Commissioner evaluates progress on the recommendations from his past reports. Michael stated that, as the responses summarise the shared work of this group, he is eager to provide an opportunity for members to input.

Members shared their thoughts on the draft responses. Ian noted that, while it is not specifically included in the Commissioner’s recommendation, he would like to see work towards the recommendation on promoting and supporting the veteran community gain NHS employment broadened to include social care.

Neil suggested that the recent presentation on the National Care Service that SG officials provided to the Veteran’s Scotland Health and Wellbeing Group could be included. Kari questioned the detail of the Scottish Credit and Qualification Framework veteran work and Jason requested she provide further information on this to Michael offline.

Overall, members were content with the draft responses.

6. Next meeting

The group will reconvene in January 2022.