Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group: progress update letter – May 2021

As Chair of the Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group (IG), I am pleased to provide a report on the progress made on priority work delegated to us by the Strategic Oversight Group (SOG) in October 2020 In addition, the IG has continued work on 2019-20 priorities and this letter reports progress on these.

In progressing the priorities, the IG has met four times, with a sub-group being created on employability, which has met separately. These meetings have enabled valuable discussion and strategic direction on issues delegated to us and beyond.

The information presented below sets out the achievements and next steps. You will be aware that Charlie Wallace, the Scottish Veterans Commissioner, published an interim update report in November 2020. The RAG ratings quoted below stem from this latest update report.

I would like to thank members of the IG for their continued work during what has been a very unique time. I look forward to the 25 May 2021 meeting, and to our continued joint work in improving the health and wellbeing of Scotland’s armed forces and veterans community.

Yours sincerely

Professor Jason Leitch CBE

Continued progress on priority work set by the SOG for 2019-20

Wheelchairs (SVC rated amber)

Achieved:

• a letter was sent to Health Boards on 30 December 2020 requesting that Wheelchair and Seating services maintain and replace wheelchairs used by veterans to at least a level commensurate with that issued to them at the time of their discharge, provided it is safe and continues to meet their clinical and wheeled mobility needs. In addition, it was requested that any additional costs associated with servicing, maintaining, replacing – which are expected to be low – will be met by the providers.
• as a Scottish Government policy area, long-term wheelchair provision current sits with the Rare Disease & National Planning Team in the Planning & Quality Division. A desktop scoping exercise was recently carried out to ascertain if this policy area requires review and it was concluded that it does.

Next Steps:

• at the appropriate time, work will be undertaken to assess the impact of the letter. This will likely take the form of engagement with service users and service providers via surveys.

• a Short-Life Working Group (SLWG) will be established to look at options on how best to review long-term wheelchair policy, with the end goal to establish whether people in Scotland requiring wheelchairs for long-term use are receiving the best possible care available.
• a remit and terms of reference for the SLWG will be drafted shortly and shared at first among the SG colleagues that we will want to involve in the SLWG. Membership will be drawn from this and we expect this to include a representative from Armed Forces & Veterans Healthcare policy. Timescales on the work have still to be determined.

Hearing Aids (SVC rated amber)

Achieved:

• engagement through surveys – one for service users and another for audiology departments – was used to assess the impact of the 2019 joint letter from the National Clinical Director and Adrian Carragher, Head of Audiology at Ayr University Hospital, which went to the heads of audiology departments across Scotland.
• while presentations to NHS audiology services may have been curtailed by COVID-19, the survey results highlighted that there were a very small number of presentations since August 2019, the requests in the letter were being carried out, and there were no issues.

Next Steps:

• the situation will continue to be monitored. The survey can be repeated if considered necessary at any stage.

Priority work set by the SOG for 2020-21

Priority Treatment (not directly related to a specific SVC recommendation but links into various recommendations)

Achieved:

• officials and stakeholders have continued to participate in the UK four nations Priority Treatment Working Group, which involved contributing to discussions on the revision of the terminology and definition of “Priority Treatment”.
• the Working Group have now agreed a route forward in establishing a cross-nation sub-group to undertake engagement with the Armed Forces & Veterans Community to establish and understand their need, so that any revision and future messaging will be fit for purpose.

Next Steps:

• officials will continue to take part in the Working Group, feeding into UK-wide revisions of the “Priority Treatment” terminology, which will complement the new statutory guidance on the UK Armed Forces Covenant legislation. Following agreement of terminology at UK level, it would be appropriate for the SOG to consider Scotland-specific work around the newly developed terminology.

Employability of veterans within the NHS (SVC rated amber)

Achieved:

• a cross-sector sub-group, with a wealth of expertise and experience, was established to:
  1. Identify and make links across areas of pre-existing and ongoing work
  2. Discuss solutions and progress actions
• officials have designed and issued a short survey for armed forces personnel and veterans to gain information on their perceptions of the NHS as an employer and their experiences of the recruitment process. We hope to use these data to identify the main barriers to recruitment and inform how we target employability support for veterans. The survey will close at the end of April and we plan to share the findings with partners in due course.
• officials have sent out a request for volunteers who are veterans working within the NHS to provide video and written interview career case studies. This is to assist the promotion of NHS careers to veterans and highlight the application of transferrable skills from the Armed Forces to NHS jobs.

Next Steps:

• colleagues in NHS Education Scotland (NES) are currently working to update the NHS Careers website and are developing specific content for veterans. This is expected to include new guides on NHS Scotland and the application process, as well as case studies and interviews with veterans. It is hoped that the work being undertaken by the Scottish Credit and Qualifications Framework (SCQF) on military qualifications will also be included when that project is complete.
• findings from a pilot project, undertaken in NHS Highland, will provide insight on the efficacy of veteran-centred job advertising websites.
• output from the survey will inform future strategy.
• work is ongoing to utilise the skills and talent of the veteran community in the ongoing creation and staffing of National Treatment Centres, which forms part of the 2016 National Clinical Strategy.
• officials will continue to engage with key stakeholders to ensure co-ordination and progression of the various ongoing work streams.

Mental Health (SVC rated amber)

Achieved:

• The Scottish Veterans Care Network (SVCN) was successfully launched in November 2020, with a specific current focus on mental health.
• The Network has enabled Scotland to undertake a holistic review of existing veteran mental health services and has created a vehicle for all partners and stakeholders to deliver a national strategic approach to veterans mental health services.
• alongside the other nations of the UK, officials have contributed to the work of Northumbria University detailing veterans’ mental health services across the UK. Mental health representatives from each country have agreed to meet on a quarterly basis to exchange information and co-ordinate any UK-wide activity.

Next Steps:

• The Scottish Government has commissioned the SVCN to produce a Veterans Mental Health Action Plan, which is expected to be published in Autumn 2021. It is anticipated that the plan will provide a new strategic direction for veterans’ mental health services in Scotland, building on the considerable knowledge and experience that is already available. The new plan will make recommendations to the Scottish Government and NHS Scotland.
• future work on mental health will be informed by the SVCN Mental Health Action Plan.

Other areas of work

Identifying Veterans (not directly related to a specific SVC recommendation but links into various recommendations)

Achieved:

• preparation continues for a pilot project with NHS Fife GP cluster practices on the identification of veterans and appropriate coding within NHS IT systems, which will improve veterans’ access to services and ensure a more person centred approach to their treatment at primary and secondary care level.
• the project is progressing well. Recent developments include:

• Dr John Kennedy, Clinical Director for HSCP East Division, has facilitated an introduction to the Fife-Wide Cluster Quality Leads group, who are happy to support the project.
• as a result of that discussion, it has been agreed that Dr Andrew Halpin, a GP within Rothes Medical Practice and a Navy veteran, will champion the project
• it has also been agreed that the Dunfermline and North East Fife clusters will be involved in the project – these areas will provide a useful basis for comparisons.

• the issue of identifying veterans has been consistently raised as a stumbling block to veterans accessing the services that they are entitled to.

Next Steps:

• the next steps of the pilot are to engage with practice managers from the two clusters.

Veteran Aware Hospital & GP Accreditation (not directly related to a specific SVC recommendation but links into various recommendations)

• there was previously agreement to progress hospital veteran accreditation ahead of GP accreditation. However, this work was paused due to the COVID-19 pandemic and the significant pressures facing health services.
• we would now suggest progressing GP accreditation first and would therefore welcome this as a priority for 2021-22. Our approach will be informed by learning from the GP accreditation scheme in England and engagement with key stakeholders.

COVID-19 related financial difficulty

• through our various channels of engagement, including the Implementation Group, we have repeatedly heard about the financial difficulties facing Third Sector organisations.
• the COVID-19 pandemic and related measures taken to mitigate the impact of the virus has resulted in both the loss of income and greater expenditure for organisations, as methods of fundraising have been curtailed while they have endeavoured to continue to provide vital services, adapted delivery to keep users safe, and met additional need brought about by the pandemic.
• we will continue to be mindful of these concerns in our collaborative working with stakeholders and partners.

Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group: progress update letter – May 2021

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