Armed Forces Personnel and Veterans Health Joint Group’s Strategic Oversight Group minutes: May 2021

Attendees and apologies

Attendees

• Dave Caesar, Deputy Chief Medical Officer (Chair)
• Jason Leitch, Scottish Government Clinical Director of Healthcare Quality and Improvement
• Charlie Wallace, Scottish Veterans Commissioner
• Chris Hughes, Veterans Scotland – Chair
• Neil Morrison , Veterans Scotland – Health representative
• Ian Cumming, Third sector representative: Erskine
• Karen Ross, Army Families Federation
• Surg Capt Mark Henry, Regional Clinical Director (RCD), Defence Primary Healthcare (Scotland & North)
• Sharon Callaghan, Operations Manager Scotland, Defence Primary Healthcare (Scotland & North)
• Colonel Sharon Findlay, HQ DMS Gp – incoming RCD
• Colonel Sandy Fitzpatrick, Deputy Commander of 51 Brigade
• Mairi McKinley, NHS Fife Armed Forces and Veterans Champion
• Claire Wood, NHS Highland Armed Forces and Veterans Champion
• Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion
• Kate Burley, Scottish Veterans Care Network
• Cllr Rod Cavanagh, Armed Forces and Veterans Local Government Champion
• 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
• John Mooney, Veterans and Armed Forces Personnel Unit, Scottish Government
• Paul Hood, Veterans and Armed Forces Personnel Unit, Scottish Government
• Lorimer Mackenzie, Survivor Support Unit, Scottish Government
• Maura Lynch, Survivor Support Unit, Scottish Government
• Shehan Hettiaratchy, Veterans Trauma Network, NHS England
• Beth Lambert, Veterans Trauma Network, NHS England

Apologies 

• Gregor Smith, Chief Medical Officer
• Andrew Carter, NHS Borders Armed Forces and Veterans Champion

Items and actions

1. Welcome, introductions and apologies

Dave Caesar, Deputy Chief Medical Officer, welcomed members to the meeting and apologised on behalf of Gregor Smith, Chief Medical Officer, who was unable to attend.

Michael Ross updated that apologies had been received from Andrew Carter.

2. Brief roundtable catch-up – Reflections from members since last meeting in October 2020

Dave reflected that a lot had taken place since the last meeting. At the last meeting, members were looking ahead to progress work, unaware of an upcoming second COVID-19 wave. Despite the challenge this presented, work has continued and members and their organisations have played a role in combating the pandemic.

Dave invited Charlie Wallace, Scottish Veterans Commissioner, to open the discussion with his reflections. Charlie noted that he was pleased to see progress on the Strategic Oversight Group’s (SOG) priorities continue, although it has been slower than we would have liked. The current priorities are considered topical, given the SVC’s upcoming focus on transition between service and civilian life. The SOG and Implementation Group (IG) should expect questioning on these issues as the SVC prepares his reports.

Councillor Rod Cavanagh reflected on the extensive progress of the Rosewell Centre in Fife, where Veterans First Point (V1P) are located, and will offer a one-stop facility. The centre is due to open shortly and there will be an opening ceremony.

Chris Hughes drew attention to the financial pressures facing the Third Sector, at a time when demand and need has increased. Overall, income from fundraising is down around 30%. While member organisations have not been going out of business, there have been job lay-offs. There is limited ability to fill the gaps in service provision created by COVID-19 due to these funding challenges, and recovery will take time.

Mark Henry provided insight from an armed forces perspective. They expected an increase in mental health cases, which did not transpire. Dave added that this concurs with other areas – such as healthcare – and there is a general need to observe the outcomes to establish need and demand.

3. Implementation Group report to Strategic Oversight Group

Dave thanked Jason Leitch and the IG for the letter and enquired whether members were content with the progress communicated in the letter.

On the topic of hearing aids, Charlie added that this may re-emerge as an issue as there has been improved understanding of hearing loss within the forces. Jason responded that it is not an issue that has been raised recently, and there were positive results to survey engagement on the issue, but if it re-emerges as an issue the IG and NHS Champions are positioned to respond.

Charlie noted that the terminology surrounding Priority Treatment is an important issue and it must fit with the Covenant. Jason added there has been UK-wide work on Priority Treatment and Charlie’s assistance may be of use in addressing any future challenges.

Neil added that he believes Priority Treatment terminology is widely misunderstood by both clinicians and veterans. The review and revision of the terminology, that he has been involved in, is welcomed. The sub-group working on the issue are close to distributing surveys to Primary and Secondary Care clinicians to clarify their understanding and interpretation of the current terminology.

Dave added that the language utilised is very important. Currently there are waiting list issues across the NHS due to challenges brought about by the COVID-19 pandemic, and the Scottish Government are devising a clinical priorities framework to assist recovery.

For the employability the NHS priority, Jason commented that this will be on Charlie’s radar if his focus moving forward is on transition. Charlie agreed and re-stated that veterans are talented and this should be utilised widely. Part of the issue is raising awareness of the vast array of opportunities available in the NHS that veterans could take up.

Dave added that there may be improvements in this area with the period of relative peace, evolving role of the armed forces, and the assistance they provided in the COVID-19 response and vaccination rollout. There may be a greater understanding of the skills ex-personnel possess within the NHS and beyond.

Sandy Fitzpatrick raised that this work links in with the Veterans Employability Strategic Group. John Mooney responded that Scottish Government Health Workforce colleagues are involved in this work and also attend the Veterans Employability Strategic Group. Officials are conscious of joining up the work.

Ian Cumming added that veterans’ skills can also be utilised in employment within Social Care. Other members commented that Local Authority Armed Forces and Veterans Champions have a role to play in encouraging job opportunities within councils too.

The conversation then turned to potential additional priorities for the upcoming year and Dave requested members’ opinions on the possibility of adding GP veteran aware accreditation as a priority for 2021-22. Jason input that the IG see value in progressing this as a priority, but are wary that accreditation badges and awards may not be backed-up with substance. The IG are eager to do it correctly. Dave agreed that the activity should centre on improving outcomes.

Mairi advised on the related NHS Fife pilot project, which centres on improving the coding of veterans on health records. Mairi feels there may be delays due to the potential UK-wide impact. Michael added that we are trying to ensure we update the correct groups and stakeholders – as advised by analytical colleagues – at the correct points in the project, which may mean taking a paper to the MOD/NHS England/Devolved Administration Partnership Board. We will continue to report to the IG on this project.

Neil agreed that there has to be appropriate content to the GP accreditation framework and stressed the importance of GPs as an entry into health services for many people.

On the topic of data, Sandy questioned whether the census, planned for 2022, will ask questions on veterans that will prove useful. John responded that the questions have already gained parliamentary agreement and his team are working with Office for Veterans’ Affairs (OVA) to learn about the census analytical processes.

Jason added that the IG will also embed a focus on transition in taking forward future priorities, to align with Charlie’s priority of examining the transition from service to civilian life.

4. Update from Scottish Veterans Care Network (SVCN)

Kate Burley updated that the SVCN are currently working on the Mental Health Action Plan. They are currently undertaking a series of engagement exercises with different aspects of the healthcare system, such as IJBs, veterans, MOD, NHS Boards and NHS Champions. Some of the engagement is complete and analysis is underway. The engagement activity has been co-produced with veterans via a focus group, Microsoft Teams channel, and NHS AF&V Champions. Stakeholders have raised concerns about the short timescales in producing the plan. Additionally, pressure has been experienced due to resourcing. Positive talks have taken place with Scottish Government Mental Health colleagues, who fund the Network to deliver the Mental Health Action Plan, but they are awaiting final confirmation. Lorimer Mackenzie added that they expect confirmation on the funding shortly.

Dave asked if there had been negative impacts on the work due to the pandemic and whether the engagement had encompassed COVID-19 experiences. Kate responded that the engagement has been relatively unaffected and stakeholders have been generous with their time and enthusiastic.

Chris Hughes questioned what form of forward-planning has taken place and what the focus will be after the Mental Health Action Plan. Kate responded that the current aim is to deliver the plan by the deadline and then the priority will turn to delivering the recommendations with the NHS and the Scottish Government.

Craig Cunningham agreed that delivery of the plan’s recommendations and outcomes is very important, as mental health is far-reaching and link into issues such as substance misuse and pain management. There has been significant discussion between the NHS AF&V Champions, which has highlighted an array of approaches on mental health. Moving forward, consistency may be useful.

Lorimer agreed, adding that the commission for this work was clear that a Scotland-wide approach should be taken. The current publication deadlines are designed to align with the budget cycles, which will provide awareness of resources and assist implementation further down the line.

5. Presentation from NHS England’s Veterans Trauma Network and discussion

Dave introduced Beth Lambert and Shehan Hettiaratchy, who is known as H, and thanked them for coming to present on the NHS England Veterans Trauma Network.

H provided the presentation, which provided an overview of the Veterans Trauma Network. The presentation covered the logistics, functionality, performance, challenges, and successes of the network.

Dave thanked H for the presentation, and noted the broad and evolving commitment to trauma in Scotland. There is a Scottish Trauma Network (STN), which isn’t specific to veterans, but is positioned to look at an array of issues such as wellbeing – including financial, mental health, etc. – which links in with veterans’ issues. Due to this context, Scotland is well placed for a similar Veterans Trauma Network to take shape, but there would be further work required to examine what is required for the veteran-specific aspects.

The group were in agreement that proceeding with a similar network in Scotland is agreeable. Dave questioned whether the SVCN would be best positioned to take forward the development of this, as it would complement the Mental Health Action Plan and Kate was involved in the set-up of the STN.

Kate felt this was a positive idea as the veterans who feed into the work of the SVCN often draw attention to the links with physical trauma and there are already links between SVCN and the STN. In addition, the STN is approaching its fifth year and consequently has established a repertoire of intelligence, networks and knowledge. Kate’s only concern with this approach would be resourcing, as this would need to be in addition to any funding for the Mental Health Action Plan due to the extra time commitments it would entail.

Lorimer agreed that there are links between mental health and trauma. There is widespread eagerness to make connections between these areas.

Mairi mentioned that failures in the transition of healthcare for veterans often means that health issues are compounded and people can be at a point of crisis by the time they receive the support that they require. A system like the single email address that H described in his presentation may help those who struggle to access services. Dave agreed that services are not easy to access and this is accentuated for veterans moving from a military setting, where they receive very inclusive care during their service, to post-service life.

H added that within the health system it is often the same clinicians providing care to veterans and serving personnel. It is a small network, where individuals know one another. The issue is creating the links to utilise this. H added that Scottish colleagues could link-in with NHS Wales colleagues who have also established a Veterans Trauma Network. Kate noted that the SVCN have regular contact with the Welsh Veterans Trauma Network colleagues.

Dave summarised that there appears to be a clear desire to progress this and build upon the existing Scottish landscape to develop a Scottish equivalent to the NHS England Veterans Trauma Network. The IG will explore progressing this work alongside the SVCN.

6.Agreement of 2021/22 priorities

Dave summarised the discussion that had taken place. There was agreement among the group for the IG to continue to progress the priorities set in October 2020, with some additional work. Therefore, the following priorities were set for 2021-22:

• mental health
• priority treatment
• employability within NHS
• GP veteran aware accreditation

In addition, the IG, alongside the SVCN, will explore the set-up of a Scottish equivalent of the NHS England Veterans Trauma Network. The IG will also approach these priorities with a close focus on transition, in alignment with the SVC’s priority.

7. A.O.B

It was noted that, following the election, Keith Brown MSP, Cabinet Secretary for Justice and Veterans, now has ministerial responsibilities for veterans.

Charlie noted concerns about a lack of awareness across the country of the armed forces and veterans. There is a need to amplify positive messages to reduce this and where possible re-emphasise the positive impact armed forces personnel and veterans have in their communities.

8. Close and date of next meeting

The group will next meet in May 2022.