Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: September 2020

Attendees and apologies

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
Sandra Pratt	NHS Borders Armed Forces and Veterans Champion	Apologies given
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	Apologies given
Martin Bell	NHS Champion, NHS National Services Scotland	Attended
Sarah Florida-James	Scottish Veterans Care Network	Attended
Andrew Clark	Scottish Veterans Care Network	Attended
Kate Burley	Scottish Veterans Care Network	Attended
Lucy Abraham	Scottish Veterans Care Network	Attended
Nafees Ahmad	Clinical Fellow, Scottish Government	Attended
Katie Hislop	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Ruth Jays	Unit Head, Person Centred Healthcare and Participation Unit, Scottish Government	Attended
Rosie Fay	Armed Forces and Veterans Healthcare policy team, Scottish Government	Attended
Kirstin Davidson	NHS National Services Scotland	Attended

Items and actions

1. Welcome, Introductions and Apologies

Jason Leitch, Chair, welcomed members to the meeting and advised of apologies received.

2. COVID-19

Jason acknowledged the impact that the COVID-19 pandemic has had on much of this group’s work, with some work being paused, and some work being adapted so that it can be carried out remotely. He invited members to comment on how the pandemic has affected their own work.

• Lucy Abraham commented on her experiences of her clinical role in V1P. She said that some veterans have been coping really well throughout the pandemic, but some are really struggling. They have observed almost a 20% increase in suicidal ideation and there is a lot of risk around this. The NHS veteran services have been doing a great deal of high intensity work with veterans. The virtual model is working well for conditions such as depression and anxiety, but for trauma processing and PTSD there is a need for intensive face-to-face work so some are waiting until physically-distanced face-to-face work could resume. V1P has also seen some new clients who are currently homeless, who were picked up by police during lockdown, and require face-to-face contact due to an inability to access technology for remote contact. V1P has been using the space they have where needed, and doing a lot of daily check-ins and intensive work remotely.
• Craig Cunningham has consulted the Area Drug Partnership to ask if any conclusions could be drawn on substance misuse. He recognises that mental health issues and drug misuse are common issues for the veterans community but couldn’t say for certain that there has been an increase amongst veterans during this time. As part of recovery planning, the Partnership are making sure they have access to patients who do need face-to-face consultation. Craig has asked for mental health and drug misuse to be prioritised within remobilisation. He commented that the third sector have been fantastic in their response in reaching out to avoid isolation, but there is no guarantee they are reaching everyone. Jason acknowledged that the added isolation of lockdown will not have helped those with existing problems.
• Neil Morrison described initial findings from a recent survey of Veterans Scotland members, which asked three questions: i) how has COVID-19 affected operations? ii) how have clients adapted? iii) what funding challenges have clients encountered? These are rough responses at this point, but initial insights are that most responses are green to amber, with one red – from Action on Hearing Loss, whose clients have found it extremely difficult to adapt to the pandemic.
• Ian Cumming shared the news that Erskine’s care homes have been COVID-19-free since early June and that visiting has now returned. The Erskine Reid Macewen Activities centre had to physically close and run virtual events only, but outdoor activities have now resumed, and this has been hugely positive for members. The charity sector could be facing a 20-25% reduction in fundraised income next year and Erskine is bracing itself to accommodate this, but will be looking to strengthen and adapt their funding models to meet these challenges.
• Mairi McKinley commented that she has seen a similar situation to Craig in her clinical work. They have a mobile substance misuse unit that is picking up veterans that were not previously in the system, but it’s difficult to quantify numbers. There are also significant numbers coming through primary care. Mairi has spoken to secondary care clinicians who are very concerned about waiting lists, and in particular how to interpret and apply priority treatment for veterans due to the backlog as the NHS remobilises. Clinicians are very concerned as they want to do the best for their patients but capacity is an issue.  
• Sarah Florida-James commented that the Scottish Veterans Care Network (SVCN) are aware of these issues, and currently engaging with stakeholders around mental health service delivery and the effect of COVID-19. This will enable the Network to coordinate a national response. She commented that many organisations have found new ways to work and that there are positives which can be taken forward long-term.

Action: Neil Morrison to share findings from VS Members survey relating to Health and Wellbeing with secretariat.

3. Implementation Group Report to Strategic Oversight Group

Jason briefly described the structure of the Joint Group, comprising the Strategic Oversight Group (SOG) and the Implementation Group (IG), for new members. The SOG will next meet on 1 October 2020, chaired by the interim Chief Medical Officer (CMO) and the IG will write to the SOG with an update on IG progress in advance of this meeting.

A discussion ensued on the potential content of such an update paper, which can highlight achievements and next steps on key areas.  The intention being that this can be shared with group members in advance of the SOG meeting in October.

Wheelchairs

Craig Cunningham commented that a lot of progress has been made in this area already. Other members commented that they are happy with the proposed next steps of writing to all territorial boards to ask them for Assistive Technology services to provide a like-for-like service and to establish autonomy for them to maintain MOD-issued wheelchairs.

It was acknowledged that whilst progress has been made, there is still work to do, and the service still varies around the country.

V1P / Combat Stress

The ongoing delivery of V1P was discussed.  The SVCN’s development of a Veteran’s Mental Health Action Plan will be critical to informing delivery of services in the future.  SVCN will consult with partners in the development of this plan and have already started engagement with both V1P and Combat Stress to understand those services.  No proposals have been developed about the future of V1P/combat stress and Lucy Abraham suggested that any proposals should be informed by the SVCN mapping exercise that involves an extensive performa to all stakeholders in Scotland. This Proforma will be sent out later in the year.

A draft progress update report circulated prior to the meeting to members was reviewed. In relation to V1P it suggested continuing to use digital technologies in V1P services following COVID. There was general support for this as one treatment option. However Craig Cunningham cautioned against exploring a central digital hub approach rather than by individual Health and Social Care Partnerships, at a time when we are seeing increased demand from veterans for mental health support. Craig also noted that funding is only in place for the current V1P service until March 2021.

Neil Morrison agreed that Veterans Scotland would not support a change to the structure of V1P. He shared Craig’s concerns about funding status beyond this date. Neil feels that the model of a drop-in centre with peer support workers has been crucial to V1P’s success, and would like to see this model continuing. Lucy also raised that Combat Stress has the same funding cycle and therefore both funding streams end in March 2021.

Ruth Jays explained that funding for V1P sits with Mental Health policy leads, who would be best placed to advise on the questions raised. It was suggested that a smaller group meet to discuss this issue further. Craig Cunningham offered to be spokesperson for the IG, and Ruth will facilitate. Lucy offered to be representative in terms of SVCN, and suggested Michelle Ramage, Clinical Chair of V1P, could also join.

Action: Secretariat to facilitate a meeting about possible changes to V1P model.

Scottish Veterans Care Network (SCVN)

Sarah Florida-James informed everyone that the official strategy document of the SVCN has been accepted and endorsed by the Chief Executives as of August 4 2020.

A short presentation was given on the vision, aim, structure and strategies of the SVCN. The Network is now formed, with a mission statement of supporting best practice and facilitating a collaborative and holistic approach to care of veterans. An Oversight board gives authority and sign-off to the Network. A core steering group is made up of people from different organisations who will drive work forward. Below this are working groups, accountable and reportable to the Core Steering Group and Network Oversight Board, accountable to Scottish Government, Chief Officers Group (IJB) and Chief Executives Group (NHS).

Sarah Florida-James explained that the Network will achieve its objectives through working groups: Data and Information, Education and Workforce, National frameworks/pathways, and Health and Wellbeing. Everything is informed by forums (Clinical forum, veterans experience forum, service providers forum) and feeds upwards. The Network was formally announced to Parliament last year and the virtual launch will take place in November 2020.

The key deliverable is the Veterans Mental Health Action Plan, sitting within the Health and Wellbeing group. The Network is currently working on a proforma which will be distributed nationwide and will gather a large amount of information from which to build the action plan.

Neil Morrison commented that at each level of the Network there will be representation from one of the groups at Veterans Scotland. Those people have already been nominated and accepted by the Network team.

Ian Cumming asked whether SVCN would be a good starting point for conversations around care at home for veterans, and Sarah Florida-James explained that the early objectives at the moment are around mental health, but of course physical health needs are recognised and there are many conversations taking place about how the two are interlinked. They are aware of the needs going forward.

Discussion ensued about the structure of the Network and the Joint Group (IG / SOG), and the need to avoid duplication of effort around different strands, particularly mental health. It was agreed that a representative from the Network should be a member of both the Implementation Group and the Strategic Oversight Group.

Action: Secretariat to ensure a representative of the SVCN is invited to sit on the IG and SOG and contact lists are updated accordingly.

Identification of Veterans / Priority Treatment

Neil Morrison has spoken to ex-military contacts working in GP surgeries to discuss various ideas around reaching out to veterans to encourage them to make their veterans status known. Ideas such as posters and TV screens have been suggested.

Jason Leitch felt we should ask GPs how best to do this. There would be options such as putting a message in with repeat prescriptions, and engagement with the Primary Care community will inform how best to approach this.

Mairi McKinley is taking forwards some pilot work in Fife looking at recording and highlighting veterans status in referrals in NHS e-health systems. She has recently met with Fife practice managers who had a simple, technical solution to identifying veterans so this is being taken forward.

Sarah Florida-James added that one of the objectives of the Network is around data and information, and they are currently setting up a working group with Public Health Scotland, the MOD and wider stakeholders to include issues around identification of veterans.

Neil Morrison brought up that it has been over two years since guidance was sent out to Health Boards, NHS Champions and GPs on the Armed Forces Covenant and Priority Treatment and that he felt now would be an appropriate time to audit impact, to measure how effectively this advice has been adopted. Initiating this work has been delayed due to COVID-19, but he wished to make clear the intent is there to do this.

Ruth agreed that SG is primed to take this work forwards in due course, but said that now is not the right time to place additional pressures on GP surgeries, particularly as we move into winter planning. She felt we need to take stock and revisit when the time is right. Neil Morrison added that he would be happy to engage on this effort in terms of reviewing the aim and measuring impact.

Andrew Clark informed the group he has previously worked in Healthcare Improvement Scotland (HIS) on the Practice Administrative Staff Collaborative, around workflow optimisation and care navigation. He added this may be a useful link to make in terms of identifying veterans and is happy to connect with contacts there.

Action: Secretariat to keep this under review and revisit with primary care and GP practices when conditions allow. 

Scottish Veterans Commissioner (SVC) Recommendations

Martin Bell suggested we should go back to the SVC Interim Report of June 2020 to ensure that nothing on the Update Paper conflicts with the SVC’s report.

Neil Morrison commented that out of 18 recommendations, 5 or 6 of these are wrapped up in the Network. The Network itself is a recommendation, but a few others are contained within this, for example a Veterans Mental Health Action Plan. He would like to see this reflected in the letter that goes to the CMO / SOG.

Action: Secretariat to draft letter to IG members and CMO two weeks before SOG on 1 October 2020.

Employability

Jason expressed the view that Employability should be given a higher priority for 2020-21, and others agreed.

Ian Cumming added that it is worth considering whether there are employment opportunities for veterans within social care, and reflected on the valuable contribution that military charities make to social care in terms of volunteers and peer support. He added that Erskine has 1000 employees, 250 of these being volunteers. Jason Leitch agreed that whilst we have always thought about this in terms of service leavers being best-placed to go into the NHS, this is not necessarily the case and that as public, private and third sector become increasingly integrated, this should be expanded to more than just the NHS.

Mairi raised that the Armed Forces Covenant Legislation Focus Group (chaired by Laura Cox of 51 Brigade) has Employability on their agenda, and whether there is duplication of effort. There is also a focus group which is part of UK-wide work around Covenant, looking at Employability and Priority Treatment, and some other IG members are in this focus group.

Neil Morrison commented that while Laura Cox of 51 Brigade is focussing on military leavers and the Career Transition Partnership (CTP), Shaun Cauvin from Veterans Scotland has perspective on Employability relating to the whole of the veteran population of Scotland, and has been working hard in this area and it would be worth engaging with him.

Action: Secretariat to review possible duplication of effort between Employability focus groups

Action: Mairi McKinley to provide contact details for Armed Forces Covenant Legislation Focus Group

Orthopaedic Pathway

Sarah Florida-James said she would like to understand more about this and whether it relates to the Scottish Trauma Network and the work they are doing. She appreciated that this was a pilot and evaluation may need to take place prior to the potential to it being rolled out nationally.

Action: Secretariat to look at linkage between Orthopaedic Pathway and the Scottish Trauma Network and report back to SVCN, noting that the pilot has not progressed due to Covid 19.

4.  AOB

Jason invited any other business from the group – no issues were raised.

5.  Next Meeting

It was agreed that the IG should meet again soon after the SOG on 1 October, to agree an approach to the 2020/21 priorities.    

Action:  Secretariat to canvass for dates in November 2020.