Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: November 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)

• Andrew Carter, NHS Borders Armed Forces and Veterans Champion

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

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

• Aleksandra Brokman, Trauma, Adverse Childhood Experiences and Resilience Unit, Scottish Government

• Susie Hamilton, Scottish Veterans Commissioner  

• Duncan McKinnon, Head of Military Access

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

• Gary Cocker, Armed Forces and Veterans Healthcare policy team, Scottish Government 

Apologies

• Ian Cumming, Third Sector Representative, Erskine

• 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

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

Items and actions

Welcome, introductions and apologies

Jason welcomed all to the group and noted the apologies as above.

Brief roundtable catch up 

No update given.

Update on Implementation Group (IG) priorities

Lindsey gave a progress update on the current priorities.

The General Practice Armed Forces and Veterans' Recognition Scheme

Training has been developed, including case studies, and this is to be uploaded to TURAS for the practices involved in the pilot to access. As part of the pilot, practices are being asked to complete some survey information, which will help inform meaningful changes required. We are also exploring how this training could be adapted into an e-learning module with the potential to contribute to Continuous Professional Development (CPD). 

Scottish Veterans’ Treatment Pathway (SVTP)

The working group that we have established is continuing and supporting the development of this priority. We are looking to adopt the principles of Getting it Right For Everyone (GIRFE), ensuring that the SVTP will work with existing services, particularly given the small numbers involved. Working in step with the implementation of the Mental Health and Wellbeing Action Plan is key. We are also linked in with colleagues across the UK who are developing and implementing their Veterans Trauma Network. This enables us to learn from their service design and apply this to a Scottish context to potentially mitigate against some of the challenges.       

Fife Coding Project 

Feedback from the pilot practice has indicated that the process to re-code is straightforward and the code is being applied consistently to new registrants. However, the coding exercise has had little to no impact on referrals. The training as part of the General Practice Recognition Scheme will go some way to address this by highlighting the need to mark veteran status on referrals and explaining the benefits in doing so, but we will need to consider other approaches to see impact.    

Female and LGBTQ+ veterans

The General Practice Recognition Scheme training includes a section on female and LGBT+ veterans. This highlights the circumstances that may have had an impact on their health. The Mental Health and Wellbeing Action Plan has a workstream dedicated specifically to supporting the mental health of female veterans. There is much ongoing research into the impact of service on female physical health, and we will keep close to developments in this area.   

The Mental Health and Wellbeing Action Plan (MHWAP)

The plan is in its implementation phase. Recruitment of the Implementation Team is ongoing. Funding for a Veteran Mental Health Research Hub has been secured by Edinburgh Napier University from the Veteran Foundation. Launch of the 'See Me' veteran campaign is planned for the 29th of November. Branding and marketing work continues at pace. Negotiations with health boards on their contribution to the veterans' Mental Health and Wellbeing Action Plan are underway.

Veteran employment into the NHS

Duncan Mckinnon, Head of the Military Access Programme, to give an overview of the programme.

Jason invited the group to comment on the update.

Neil advised that the route pathway for the SVTP has been developed and there is a synergy with mental health.

Maura provided a further update regarding the MHWAP. The Chair of the Implementation Board has met with CEOs to get local health boards involved in the navigator programme, and this has been received warmly.

The 'See Me' campaign will be launched at Waverley Station on the 29th of November, and details of this will be circulated. A poster campaign is being launched, encouraging veterans to seek timely help. This campaign will also be followed up with a series of podcasts.

Susie asked, as the 'See Me' campaign is in advance of the plan being implemented, whether there is provision to support veterans coming forward. Maura advised that the Scottish Government funds  Combat Stress and V1P, and as a result, it can be ensured that this is joined up.

Mairi commented on the Fife update advising that the optimal solution would be for the code to be pulled through on referrals. However, until we can explore how feasible a solution this is, the project will continue to ‘sell’ the advantages of coding to GPs. The role of the navigator and link workers can provide some additional support in this regard. 

Welcome to the Scottish Veterans Commissioner (SVC)

Susie reflected that as the third Commissioner, she is reaping the rewards of the work that her predecessors did. There has been lots of positive progress. Part of the upcoming work will be to meet some of the NHS Armed Forces Champions in person.

Susie highlighted her interest in underrepresented groups and noted that some of this work is being reflected in the MHWAP, and also noted that the cost of living crisis is an area of particular concern currently. 

Another area of concern is around families, and particularly when transitioning out of the service, dentistry is a topic that comes up regularly. 

Kari advised that a group has been formed for services families through the Naval Families Federation. Information is shared to support families in knowing what to expect. 

Mairi commented that there is often a misunderstanding of local process, and providing this information could be helpful. 

Jason asked if Susie could be connected with the service families group. This was agreed.

Military Access Programme (MAP) 

Duncan gave an introduction the Military Access Programme (MAP). This is a Scottish Government commissioned programme to recruit individuals from the Armed Forces Community to the NHS. The programme sits within National Education for Scotland (NES). Duncan acknowledged that there is lots of good work going on in this area, and the programme is intend to add coherence to this.

The MAP is looking to enhance the current webpage on the NHS careers website, host insight days, and support the work of the Golden Jubilee and the NHS Academy. The programme will also, in turn, enhance the work of the Implementation Group.

Bob queried if there was any data regarding the current numbers of veterans already working in the NHS, and that he would be keen to discuss ex-service personnel in third sector employment linked to the NHS. 

Duncan advised that the current information is inconsistent, but there are plans to better track veterans and reservists. 

Neil suggested that Duncan link in with Sean Colvin, Veterans Scotland, to support this work. Andrew commented that there are many opportunities for ex-service personnel, and the programme is a vehicle to shine a light on these.

Kari and Mairi both reflected on the difference in pay scale between some job roles in the military and NHS, and the need to manage expectations will be important to this programme. 

Jason offered to provide what support he can to the programme, including assisting with accessing various boards and meetings, and suggested that communications and marketing colleagues may be able to help also support to the programme.

IT connectivity  

Sharon gave an overview of Defence Medical Services (DMS) in Scotland, and provided an update on issues around IT connectivity between DMS and NHS services. There is a mix of issues which limit the how the systems can link. This ranges from having a limited number of terminals that can communicate to a mix of software being used. DMS are working with Technical Architects within Scottish Government to support mitigation activity. Sharon highlighted that she would welcome an IT contact within health boards to support this work.  

Project Cortisone is the longer term solution and has an anticipated roll out date of last quarter of 2023 or first quarter of 2024. The centre at Leuchars has been identified as an early adopter site.  

In addition, DMS are engaging with Scottish Government to explore how NHS services can best support serving personnel who require treatment.

Any Other Business (AOB)

Neil recognised the fact of delayed waiting times, and said that this can have an impact on mental health. He highlighted a case that he had become aware of, regarding waiting times of 18 months, and suggested that keeping patients regularly informed of progress, particularly with current delays, would be beneficial to mental health in some cases. Jason advised  that a system waiting lists was initiated during the coronavirus pandemic and health boards should be adhering to this guidance.

Jason thanked all for their attendance and closed the meeting.

Scottish Government officials will send out a placeholder for the next meeting in due course.