Armed Forces Personnel and Veterans Health Joint Group’s Strategic Oversight Group minutes: May 2022

Attendees and apologies

Attending

• Gregor Smith, Chief Medical Officer, Scottish Government
• Jason Leitch, National Clinical Director Scottish Government
• Charles Winstanley, Chair Implementation Board
• Neil Morrison, Veterans Scotland – Health Representative
• Ian Cumming, Third Sector Representative: Erskine
• Mairi McKinley, NHS Fife Armed Forces and Veterans Champion
• Jo McBain, NHS Highland Armed Forces and Veterans Champion
• Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion
• Andrew Carter, NHS Borders Armed Forces and Veterans Champion
• Sharon Callaghan, Operations Manager Scotland, Defence Primary Healthcare (Scotland & North)
• Jessie Owen, Director Office for Veterans Affairs
• Karen Ross, Army Families Federation
• Annalena Winslow, Armed Forces and Veterans Healthcare policy team, Scottish Government
• Laura-Isabella Muresanu, Armed Forces and Veterans Healthcare policy team, Scottish Government
• Lindsey Restrick, Armed Forces and Veterans Healthcare policy team, Scottish Government 
• Maura Lynch, Trauma, Adverse Childhood Experiences and Resilience Unit, Scottish Government
• John Mooney, Veterans Unit, Scottish Government
• Paul Hood, Veterans Unit, Scottish Government

Apologies

• Office of the Scottish Veterans Commissioner (SVC)
• Scottish Veterans Care Network
• Cllr. Rod Cavanagh, Armed Forces and Veterans Local Government Champion
• Roddy Neilson, Medical Military Liaison Officer

• Colonel Sharon Findlay, Defence Nursing Advisor, HQ DMS GP – incoming RCD
• Colonel Anthony Phillips, Deputy Commander of 51 Brigade
• Surg. Capt. Mark Henry, Regional Clinical Director (RCD), Defence Primary Healthcare (Scotland & North)

Items and actions

Welcome, introductions, and apologies

Gregor Smith welcomed members to the meeting and recognised that, while there had been various challenges caused by the pandemic both in people’s professional and personal lives, there has been a lot of encouraging work that has gone on over the past year in what have been incredibly difficult circumstances.

Gregor also noted that in March the tenure of the Scottish Veterans Commissioner, Charlie Wallace, came to an end. Gregor thanked the Commissioner for the valuable contribution that he has made to this work. The recruitment process for the new SVC is underway.

All members acknowledged apologies as listed.

Brief roundtable catch-up – Reflections from members since last meeting in May 2021

Gregor thanked everyone for the work that has been done during the past year, recognising the continued challenge represented by the COVID-19 pandemic and the subsequent recovery efforts.

Gregor invited Mairi McKinley to open the discussion with her reflections. Mairi noted how difficult the last 12 months have been for NHS Fife, with a critical period between December 2021 and March 2022 when the entire NHS Board was on maximum alert. Several discussions have since taken place regarding the mental health and wellbeing of healthcare workers, and efforts are ongoing to offer support and encouragement. Gregor acknowledged that this is an especially important matter, and caution must be taken to understand the language being used and be open to active listening and communication.

Sharon Callaghan seconded Mairi’s reflection regarding the relentless pace of work, and noted that from a primary healthcare perspective, the expectation is to deliver business as usual, despite services still being impacted by COVID-19. Additionally, Sharon drew attention to the issue of retention in the workforce, mentioning that there is currently a high proportion of retirements.

Neil Morrison remarked on the resilience of all third sector health and wellbeing charities that have continued at a pace the efforts for improving veterans’ health and wellbeing. Neil reported that COVID-19 had not been an inhibitor to progress in this regard.

Gregor noted that everyone is currently entering a new phase of work where a supportive environment will be increasingly important. The stress accumulated during the past two years requires a safe space to be shared and met with understanding, as well as optimism. The upcoming months will be a time for reflection, but also for taking decisive action towards making a difference and implementing some of the plans that have been put in place.

Implementation Group report to Strategic Oversight Group

Gregor thanked Jason Leitch, Chair of the Implementation Group, for the letter detailing the Implementation Group’s progress during the past 12 months and invited members to provide comments on the work done.

Mairi and Craig acknowledged that despite the challenges of the past year, there has been a persistent effort to move the work forward by taking a collaborative approach.

Gregor recognised that the landscape for healthcare services has changed permanently, and that communication with all members of society will be vital in understanding the new context and where the work on veterans’ health and wellbeing will fit.

Jason noted that steps have been taken to bring coherence to the work, and this will continue in the future. There are still issues of accessibility for veterans, as well as difficulties in identifying them.

Mental Health and Wellbeing Action Plan – introduction of the Implementation Board

Gregor thanked the Scottish Veterans Care Network for the valuable contribution they have made through their rigorous research and development of the Mental Health and Wellbeing Action Plan (MHWAP), published in December 2021. A ministerial debate took place in March, which endorsed the principles of the MHWAP and called for a veteran led Implementation Board (IB) to support its delivery. Dr Charles Winstanley has been asked to chair the IB, and Gregor asked Dr Winstanley to offer an introduction to the work of the board.

Charles advised that the IB will be in place for 18 months / two years and will report directly to Scottish Ministers, including those whose portfolio is beyond health. He has gathered a 15-strong board, and this will meet quarterly, with the first meeting due on 15 June. Charles reiterated that the new IB will provide both continuity and expertise, with around eight to nine workstreams being established to carry forward the principles of the plan. These will consider equity of access and health inequalities and will complement efforts to improve employability and housing of veterans. A permanent governance arrangement will be created following the two-year period for delivery.

Jason noted that it will be important for the Implementation Group to stay close to the work being developed by the board. This will facilitate the streamlining of any processes and the sharing of good practices.

Craig discussed services preferred by veterans and made a personal observation on the increase of investment in community healthcare. He noted that there is potential for maximising the linkages with these services and taking an approach that is focused on community engagement.

Agreement of 2022/2023 priorities

All members agreed the priorities for 2022/2023:

• development of the Veteran Aware GP Accreditation Scheme
• progressing the Fife Coding Project
• establishment of the Veterans Treatment Pathway
• understanding the experience of female and LGBT veterans

Neil mentioned that Fighting with Pride is a third sector organisation focused on LGBT rights that is currently a member of Veterans Scotland and is establishing a strong presence in Scotland. Their input could be beneficial for the Implementation Board. Jason agreed that occasional consultation would be helpful to the work, and the Implementation Group will investigate how this can be achieved.

Army Families Federation presentation

Karen Ross introduced the work of the Army Families Federation, which provides confidential information, advice and signposting support for Armed Forces and Service Personnel families. The Army Families Federation deals with health issues such as maternity and obstetric care; infertility treatments; NHS dental and orthodontic provision; ASD and ADHD assessment pathways and transfer of assessment; social care provision; COVID-19 vaccinations. Karen referenced several relevant publications, including "Duty and Care - Armed Forces Family Mobility and Health Care Report", which will be sent to all members alongside the meeting minutes.

Lindsey Restrick and Annalena Winslow thanked Karen for the powerful content presented and reiterated the need for a closer collaboration.

Health Innovation Fund presentation

Jessie Owen presented the Health Innovation Fund, which was announced by the Chancellor in October 2020. This is a one year £5 million fund aimed at promoting innovative projects in the veterans’ healthcare space that can address unique and often complex needs. The UK-wide fund will help to better understand veterans’ needs, support modern technologies and treatments, and aid in capacity building for projects that had previous success and could progress from trial to pilot stage. Additionally, this could also have positive implications for the civilian population. The fund has been established using a mixed-economy model, with half of the money allocated to solicited bids, and the other half used for a procurement-style open competition that will result in grants awarded to academic institutions and charities. Jessie mentioned that approval from the Cabinet Secretary will be sought in June 2022, followed by a formal invite for the solicited bids.

Gregor acknowledged that the fund constitutes a valuable opportunity to achieve positive impact across all four nations.

Jesse reinforced that the fund will be allocated fully on the base of merit, with no intention to pro-rata according to which nation of the UK the bids come from, and the results are to benefit veterans throughout the UK.

AOB

Karen Ross queried the progress being made on the Step into Health programme, a NHS England initiative aiming to support the employability of veterans in the NHS, and with which the Army Families Federation is involved. Gregor noted that in Scotland work is ongoing that mirrors this approach, including a NHS Scotland webpage dedicated to the employment of veterans in the healthcare sector. A project is in place that will expand on this. In addition, further work is currently being undertaken on the Place and Wellbeing programme to explore the development of the NHS as an anchor institution. This will support the creation of employment opportunities at a local level, and there is potential to connect it to the veterans’ community.

Gregor concluded by recognising the importance of investigating the gendered experience of veterans, and the opportunity to collaborate with the Scottish Government on the Women’s Health Plan currently under consideration.

Close and date of next meeting

The group will next meet in May 2023.