Scoping Review: A Needs Based Assessment and Epidemiological Community-Based Survey of Ex-Service Personnel and their Families in Scotland

SECTION 2: Veteran-Related Policy, Strategy, and Commitments

2.1 Preface

The purpose of this section is twofold. First, it provides an overview of the evolution of Veteran-related policy and strategy in the UK following the launch of the Veterans Initiative in March 2001. Second, it describes the subsequent commitments made by UK Government and the Devolved Administrations in respect of providing health and welfare support for the UK Armed Forces community. In so doing, this section follows a chronological structure determined by the publication date of the relevant key papers and reports identified as part of this review (as shown in Table 1). To set the context within which these developments and commitments to advancing Veterans' affairs are considered, this section begins with providing some background information on the: (i) role, composition, and ethos of the UK Armed Forces, (ii) Scotland's contribution to the UK Armed Forces; (iii) composition of the Veterans community, and (iv) key drivers deemed to have had significant influence with regards to the evolution of the Veteran-related policy and strategy and the fundamental principles on which it is based.

Table 1. Key Strategy and Policy-Related Papers and Reports

Year	Title and Source
2003	"Strategy for Veterans" (MoD)
2003	"Improving the Delivery of Departmental Support and Services for Veterans" (Dandeker et al, Joint Report of the Department of War Studies and the Institute of Psychiatry, King's College London)
2008	"Report of Inquiry into National Recognition of our Armed Forces" (Report to the PM)
2008	"Scotland's Veterans and Forces' Communities: Meeting their Well-being and Welfare Needs" (Scottish Government Consultation Paper)
2008	"The Nation's Commitment: Cross-government Support to our Armed Forces, their Families and Veterans" (Command Paper 7424)
2008	"Scotland's Veterans and Forces' Communities: Meeting our Commitment". (Scottish Government)
2008	"The Government's Response to the Report of Inquiry into National Recognition of our Armed Forces"
2009	"The Nation's Commitment to the Armed Forces Community: Consistent and Enduring Support" (MoD Consultation Paper Cm7674)
2009	"The Nation's Commitment. Cross-Government Support to our Armed Forces, their Families and Veterans" (First Annual Report) (UK Government)
2009 2010 2010 2010	"Annual Report on Scottish Government Support for our Armed Forces and Veterans Community" (Scottish Government) "Fighting Fit. A Mental Health Plan for Servicemen and Veterans" (Murrison, UK Government) "Across the Wire. Veterans, Mental Health and Vulnerability" (Fossey, Centre for Mental Health) "Report of the Task Force on the Military Covenant" (Strachan et al)
2012 2012	"Our Commitments. Scottish Government Support for the Armed Forces Community in Scotland" (Scottish Government) "The Armed Forces Covenant Annual Report" (First Annual Report; MoD)

2.2 role, composition, and ethos of the UK Armed Forces

• The UK Armed Forces enable the UK Government to fulfil its most important responsibility of providing security for the nation and for its citizens^[4]. Approximately 187,880 service men and women (QMR, 2012) are employed by the Ministry of Defence (MoD) to "...protect and safeguard the United Kingdom and its overseas territories and to support the Government's foreign policy"^[5]. In addition, the UK Armed Forces employ approximately 83,100 civilian staff who predominantly work alongside their respective uniformed counterparts, both in the UK and abroad (QMR, 2011). Overall, 17,610 are women employed in the UK Armed Forces (i.e., 9.7%), of whom 3,830 are officers as of 1 January 2012 (QMR, 2012).
• The UK Armed Forces is a hierarchical organisation that comprises the three services of the Army, Royal Navy [RN], and Royal Air Force [RAF]). In accordance with its Diversity Vision, the MoD seeks to recruit "a workforce that is drawn from the breadth of the society we defend", which is manifested in policies to recruit from a broad section of society including from deprived areas with high levels of unemployment and low levels of educational attainment. Recruits to the RAF and the RN however typically have more technical skills than their Army counterparts which may be in part due to differences in socio-economic status. The recruitment of sufficient, motivated people of the right calibre is regarded as critical to the maintenance of operational effectiveness. Whilst each of the individual Services has its own ethos and attracts recruits in accordance with single-services preferences, the Tri-Service Armed Forces Careers Offices were created in the 1990s to facilitate tri-Service harmonisation and promote the sharing of best practice among the Services.
• The Army represents the largest service with a full time trained strength^[6] of 99,670 Regular soldiers compared with the 38,930 personnel in the RAF and 34,430 personnel in the RN (QMR, 2012). Approximately 87% of service personnel are located in the UK. Of the 24,230 service personnel who are based overseas, 77% are stationed in Germany, Belgium and the Netherlands. Currently the UK Armed Forces have around 9,500 troops serving in Afghanistan^[7], as part of a coalition force comprising more than 100,000 western troops, 65,000 of whom are US military.
• To sustain its defence capability, the MoD has previously maintained that it would need to recruit approximately 20,000 men and women per year to the UK Armed Forces. The last intake in 2010/2011, however, was down to 12,800 in total reflecting the outcome of the 2010 Strategic Defence and Security Review (which sets out how the Government will deliver the priorities identified in the National Security Strategy), which proposed reductions in manpower over the next five years across all three Services and the civilians in Defence.
• Fundamental to ensuring the provision of the UK's defence capability are the Reserve Forces, which comprise both Volunteer^[8] and Regular Reservists^[9]. Among the tri-Services, the nature and strength of the Reserve Force vary and there are several different types of Reserve service. However, all are subject to the Reserve Forces Act 1996 (RFA96). Prior to the late 1990s, the Reserve Forces were only used at times when the vital interests of the nation were under threat^[10]. Since 2003, in excess of 18,000 Reservists have been deployed along with their Regular counterparts. Over the past five years, there has been a strategic shift in respect of their contribution as a part-time professional force to operations. In announcing the Strategic Defence and Security Review on 19 October 2010, the Prime Minister commissioned an independent review of the Reserve Forces, to ensure that their skills, experiences and capabilities are used to maximum efficiency by the MoD. The Commission's final report, Future Reserves 2020 (FR20), recommended that Defence should adopt the Whole Force Concept (i.e., "Defence is supported by the most sustainable, effective, integrated and affordable balance of Regular military personnel, Reservists, Ministry of Defence civilians and contractors"). To effectively implement such a concept requires a substantial increase in the overall proportion of Reservists in the UK Armed Forces structure. By 2015, FR20 recommends increased manning levels across all Reserve Forces to be: Territorial Army (TA; from 20,000 to 30,000), Royal Navy Reserve/ Royal Marine Reserve (RNR/RMR; from 1,900 to 3,100) and Royal Auxiliary Air Force (RAuxAF; from 1,180 to 1,800).
• Although historically women have played a vital role in the UK Armed Forces^[11], it was not until the early 1990's that a significant change in the peacetime duties of women military personnel was effected and their roles were fully integrated resulting in the abolition of the separate Women's Services in the Army and Naval Service. In 1997, the Secretary of State for Defence announced plans to extend opportunities for the employment of women in the UK Armed Forces. Since 1998, women have been able to serve in front line positions on naval vessels, as pilots of combat aircraft, and in combat support roles in the Royal Artillery and the Royal Engineers along side their male counterparts without restriction on deployment unless they are pregnant or where the primary duty is "...to close with and kill the enemy". Thus, women can serve in administrative and supportive roles in the Royal Marines General Service, the Household Cavalry, the Royal Armoured Corps, the Infantry, and the Royal Air Force Regiment, otherwise they are debarred from serving in these units.
• In order for the MoD to meet its recruitment targets and hence operational commitments, the Service also needs to attract those who are under the age of 18 years in order to compete effectively in an increasingly competitive employment market. Whilst previous MoD intake figures to the UK Regular Forces (UKDS, 2007/2008) confirm that over half of the 21,325 new recruits were aged between 16 and 19 years, there are no data available in respect of age distribution for the 12,800 intake reported by UKDS 2010/2011. However, in the Army, potential recruits tend to be aged between 16.9 and 33 years^[12]. The MoD take the view that, by recruiting from this age group, the UK Armed Forces provides a valuable and constructive training and employment to many young people who might otherwise encounter difficulties in obtaining employment in civil life had they not joined up. It is also the case however that, given the very different nature of Service life and commitment, the MoD is keen to recruit individuals before they have made other lifestyle choices ("Government's Response to the House of Commons Defence Committee's Third Report of Session 2004-05, on Duty of Care", July 2005).
• On joining up, all recruits are required to undergo intensive training that is both physically and mentally demanding. Furthermore, all recruits must be medically and physically fit for world-wide deployment. A culture of discipline, reliance on others, and acceptance of others is instilled by the tri-Services to equip their personnel with the necessary skills and attitudes for the full spectrum of military operations (including engagement in combat). There is a clear chain of command^[13] through which orders are issued and problems are dealt with. Commanding Officers are therefore responsible for the care of all Service personnel under their command. Moreover, a strong sense of camaraderie prevails among unit members, which is fostered through shared experiences, hardships and deprivations in training. Such camaraderie therefore is regarded as essential to ensuring that each unit possesses a good esprit de corps. The traditions and honour of a military unit or corps also play a significant part in ensuring a sense of pride, belonging and inheritance by its members.
• Although recruits are required to forsake a few of the freedoms they enjoyed as civilians to adapt to military life and ethos, military life is considered to be "a great leveller" which provides a positive experience for the majority (Dandeker et al, 2003). To this end, most of those who leave the UK Armed Forces suffer no ill effects from being in the military and achieve a successful transition to civilian life. However, understanding the background of recruits is regarded as a key factor when determining how military life may impact on later life. Recruiting grounds have traditionally been areas of economic and social deprivation (Fossey, 2010).

2.3 Scotland's contribution to the UK Armed Forces

• Scottish military links and heritage play an important role in its national identity^[14] historically with respect to the famous Scottish Regiments (now amalgamated into the Royal Regiment of Scotland). Furthermore, Scotland makes a significant contribution to UK defence both at home and abroad with an estimated 12,000 service personnel^[15], 5,000 volunteer reservists and 10,000 cadets as well as 10 University Squadrons and Corps. The tri-Services have a substantial presence at approximately 400 sites located across Scotland.
• The MoD contributes on average £600 million per year to the Scottish economy. In addition to the 20,000 personnel employed by the MoD and UK Armed Forces, approximately 11,000 Scottish jobs are directly dependent on Defence contracts within industry such as those relating to the production of ships and equipment to support operations.

2.4 Composition of the Veteran community

• The official classification of a "Veteran" pertains to all military personnel who leave the UK Armed Forces (whether Regular or Reserve) having received one day's pay from the MoD (KCMHR, 2006)^[16]. Between 2010 and 2011 the outflow from UK Regular Forces for all three Services was 18,150 (UKDS, 2011). Because personnel leave the Service following different lengths of service and at various stages of their career the Veteran population comprises individuals who require differing levels of support.
• The widows/ widowers and dependants of Veterans are recognised as being part of the Veteran community thereby constituting an extensive and disparate population. Consequently, to obtain accurate estimates of its size in the UK and in Scotland is a key challenge, the reasons and implications of which will be addressed in Section 6. However, the UK Government in devising its Veteran-related policy and strategy have relied on the estimates which originally derived from a Research Surveys of Great Britain (RSGB) omnibus survey of 2005 commissioned by the Royal British Legion.
• The Royal British Legion commissioned-research involved a nationally representative sample of 6,200 UK adults aged 16 years and above living in private residential households, of which 1,200 respondents were in the adult Veteran community. Based on the outcome of that survey, the size of the UK Veteran community (i.e., Veterans and dependents) was estimated to be around 10.5 million people, which equates to 18% (or one in six) of the total UK population. Of these, approximately 4.8 million people were Veterans. The average age of the adult Veteran community was 63 years (compared with 47 years in the general adult population), and were predominantly white. Eighty four per cent of Veterans were men and 94% of adult dependants were women. Veterans typically served with the UK Armed Forces for six years and were discharged from Service over 40 years ago.
• Of the 10.17 million estimated to be living in private residential households in the UK, the Royal British Legion proposed that around 10% reside in Scotland (2005). On this basis, in their 2005 report into the needs of Veterans living in Scotland, Poppyscotland calculated that the total ex-Service community for Scotland would comprise 1.017 million living in private residential households with the remaining 0.4 million residing in communal establishments (e.g., residential homes and hostels). Because the Royal British Legion omnibus survey did not include the latter, Poppy Scotland used the 1.017 million as the basis for estimating the size of the Veteran community in Scotland of which 480,000 were Veterans. The age profile for the Veterans' community in Scotland was generated using the same assumptions. To this end, Poppyscotland estimated that 75% of the adult Veterans' community would be 55 years or more with only 8% falling below 35 years of age.
• In a 2006 publication entitled "Future profile and welfare needs of the ex-Service community", the Royal British Legion predicted that the Veteran population will reduce in size from 4.8 million to 3.1 million by 2020. A more recent estimate of the Veteran population in England based on data from the 2007 Adult Psychiatric Morbidity Survey (APMS) suggested that the 3.8 million Veterans residing in private households would be expected to halve over the next 20 years as the proportion of National Service Veterans reduces with time (Woodhead et al, 2009).

2.5 Key drivers of Veteran-related policy and strategy

• According to Downey (1977), the defence policy of a nation is essentially a reconciliation of the following three inter-related factors.

(i) How the nation assesses threat to its security or its policies.
(ii) To what extent it sees a military response as necessary and justified.
(iii) What manpower, equipment and military organisation can be provided with the money and other resources allocated.

• Historically, however, the human personnel contribution to defence has tended to be sublimated by a focus on strategic and technological issues (Dandeker et al, 2003). Indeed, it is only since the end of the Cold War that human resource issues have assumed a higher priority in forming part of a coherent strategic approach intended to address the provision of health and welfare support in respect of the UK Armed Forces community.
• In 1998, the Secretary of State for Defence, the Rt Hon George Robertson MP, presented to Parliament the White Paper "Strategic Defence Review" (MoD, 1998), which detailed a radical agenda for change to reshape and modernise the UK Armed Forces in an endeavour to meet the challenges of the 21^st Century. For the first time, a "Policy for People" was included which sought to acknowledge the unique operational demands made on those who serve in the UK Armed Forces and their civilian counterparts (as well as the impact on their dependents). In particular, it emphasised the need for the implementation of a number of initiatives which would address key issues relating to the recruitment and retention of personnel including problems associated with undermanning, overstretch, and training wastage. Although some attention was devoted to identifying ways of improving operational welfare provision for Service personnel and their families, the underlying rationale for the initiatives proposed inclined more towards addressing the needs of the military (e.g., enhancing manpower requirements and ensuring a better return on the investment in training) rather than addressing the specific needs of serving personnel and their dependents.
• In February 2002, however, the publication of the first UK Armed Forces Overarching Personnel Strategy (MoD, 2002/2003) document established the broad principles of the UK Armed Forces approach to Service and ex-Service personnel policy by including a theme entitled "Remember" to address the need to provide ex-Service personnel and their dependants with help and support, particularly with regard to resettlement back into civilian life.
• In July 2003, the publication of a joint report of the Department of War Studies and the Institute of Psychiatry (King's College London [KCL]) entitled "Improving the Delivery of Cross Departmental Support and Services for Veterans" (Dandeker et al, 2003) identified five strategic themes as being fundamental to shaping the Veterans Initiative, viz, identity, communication, care, recognition and education. Table 2 summarises the objectives for each theme and its associated benefits in enhancing the overall status of Veterans in accordance with that proposed by the KCL team. The development of a more effective partnership between the UK Government and Veterans' organisations was also highlighted as being crucial to achieving these objectives. The underlying rationale for the strategic themes has been attributed largely to those moral, economic, and political factors, which impact on the status of Veterans in civic society and determine the extent to which there is public support for the UK Armed Forces community (Dandeker et al, 2003). A summary of the nature and implications of each of these three factors is provided below.

Table 2. Summary of Strategic Themes, Objectives and Potential Benefits

Themes	Objectives	Potential Benefits
Identity	Increase self worth Establish acceptance in civilian society.	Enhance recruitment and retention for Regular and Reserve forces.
Communication	Enable two way interaction between MoD and Veterans.	Facilitate the monitoring of health and social welfare. Target resources to those most in need.
Care	Observe "duty of care". Provide appropriate care. Facilitate integration into civilian society.	Reduce prevalence of psychological and social problems. Enhance positive perception of the UK Armed Forces by the public.
Recognition	Increase understanding of Veterans' achievements and issues.	Enhance the media portrayal of the UK Armed Forces and its personnel (Serving and ex-Service) Improve the image of the UK Armed Forces community. Garner public support.
Education	Improve civil-military understanding. Engender appreciation for the sacrifices made on behalf of the nation.	Obtain public approval for the investment in Veterans.

2.6 Moral and social factors

2.6.1 Recognition of Sacrifice

• By joining military service, personnel agree to sacrifice certain civil liberties and to follow orders including those which put their lives at risk in defence of others. Deployment to support UK national interests or to strengthen international peace and security operations may arise unexpectedly and for indeterminate periods of time. As part of a fighting force, this also exposes those deployed on operational duties to dangerous and potentially life threatening situations, which carry a risk of physical and psychiatric injury. In return for that sacrifice there was a reciprocal promise that the Nation will help and support the UK Armed Forces and their families, particularly in respect of those who have been damaged in military service.
• Acknowledged by all three Services, this mutual promise was enshrined in the "Military Covenant"; a term coined in 2000^[17] to describe an inherent social and moral commitment that exists among the Nation, Government and Service personnel. Thus, in return for the sacrifices that Service personnel made, the State had an obligation to recognise that contribution and retain a long term duty of care toward Service personnel and their families. It embraced the expectation that the UK Government should recognise the unique demands placed on military personnel, which sets them apart from all other occupational groups who serve and protect society (e.g., police, prison officers and ambulance personnel) The responsibilities detailed therein included a lifelong duty of care to provide for the physical and psychological wellbeing of all serving and ex-Service personnel and their dependents. Dandeker et al (2003) suggest that one of the key benefits for the UK Government in reminding the public of the nation's moral obligation to repay its debt of gratitude is that it should help Veterans to feel valued by society thereby boosting their self-esteem and perceptions of self-worth which in turn will improve public perceptions (particularly by means of positive reporting in the media). Moreover, an enhanced understanding and appreciation of the UK Armed Forces by the public should elevate levels of recruitment and retention and support for military operations.
• In view of the fact that the Military Covenant had no statutory basis, in 2010 the Coalition Government made a commitment in their "Programme for Government" (May 2010) to "work to rebuild the Military Covenant" using a series of "low-cost policy ideas". The Government subsequently indicated an intention to enshrine the Military Covenant in law for the first time. An independent Task Force on the Military Covenant, chaired by Professor Hew Strachan, was established in summer 2010 to support the work to "rebuild the Military Covenant" and published its Report on 8 December 2010. A number of recommendations were made by the Task Force as to how the Government could rebuild the Covenant through various local and national initiatives, such as the "Armed Forces Community Covenant", the principal aim of which was to enable central and local government, charities and society to more widely embrace and support the "Armed Forces Family"^[18] from "cradle to grave". Three big themes were identified, as follows.
  • Local partnerships - to facilitate effective delivery of support to and recognition of Veterans within civilian communities.
  • Education - to promote greater understanding of the UK Armed Forces by the general public, and help Serving personnel to remain in Service longer and be better prepared for the transition to civilian life.
  • Communication - to promote a wider understanding of the UK Armed Forces, and to make Serving personnel aware of their rights and opportunities available to them.
• The Armed Forces Covenant was published in May 2011. Its core principles are based on the premise that members of the UK Armed Forces Community should not suffer disadvantage as a result of their service and that where appropriate they may receive special treatment (especially those that have been injured or bereaved). As such, it defines the following 15 themes within the scope of the Covenant.
  • Terms and Conditions of Service
  • Healthcare
  • Education
  • Housing
  • Benefits and Tax
  • Responsibility of Care
  • Deployment
  • Family Life
  • Commercial Products and Services
  • Transition
  • Support After Service
  • Recognition,
  • Participation as Citizens
  • Changes in Defence and Recourse
• The principles of the Armed Forces Covenant were subsequently enshrined in law for the first time after the Armed Forces Bill received Royal Assent on 3 November 2011. The new Armed Forces Act 2011 creates the requirement for an annual Armed Forces Covenant report to Parliament each year by the Secretary of State for Defence. The first Armed Forces Covenant Annual Report was published on 6 December 2012 to summarise achievements since the interim report last year (e.g., introduction of the Community Covenant with a £30m grant scheme to support it) and planned initiatives and commitments to address the disadvantages that remain (e.g., obtain funding for a study into support for the bereaved and the families of those who have been injured).

2.6.2 "Duty of Care"

• In response to the exceptional demands of military service^[19], Service personnel have a right to expect the MoD to fulfil not only its legal obligations as an employer but also it moral ones as part of its "duty of care". In so doing, the demands placed on both Service personnel and their families should be reasonable in order to mitigate the stresses and difficulties associated with Service life. Part of the conditions of their employment, as stated in The Armed Forces Overarching Personnel Strategy is that, where circumstances permit, the MOD will "take steps to minimise risks to life or health, and where appropriate, provide treatment, rehabilitation and after care" (MoD, 02/03, p.10). In undertaking such steps, Dandeker et al (2003) argued that improvements in the provision of health and social welfare support of Service personnel and Veterans will reduce the likelihood of damaging media coverage thereby helping to increase public support for the UK Armed Forces community.

2.6.3 No Disadvantage

• Strategic thinking on Veterans' issues has been underpinned in particular by the fundamental principle that those who serve in the UK Armed Forces should not suffer any disadvantage by virtue of their Service commitment to protecting the security of the nation and its citizens, particularly in terms of that which is incurred as a result of the Service mobility requirement. Such thinking is based on the moral obligation by the UK Government to ensure fair treatment and to implement appropriate measures to ensure that special provision is rapidly made available and in accordance with need.

2.7 Economic factors

2.7.1 Recruitment

• To sustain a sufficient war-fighting capability in accordance with the UK Government's strategic objectives, it is estimated that the UK Armed Forces requires approximately 18,000 personnel to join the trained strengths having successfully completed basic training; a target which typically demands around 25,000 new recruits per year (Armed Forces Overarching Personnel Strategy, MoD, 2002/2003). The recruitment and retention of personnel however represents an ongoing challenge for the MoD as numbers fluctuate by virtue of changes in the socio-economic climate. When national economic conditions are favourable, the UK Armed Forces have fewer recruits thereby restricting choice during selection. In times of economic adversity, the number of recruits increases as does the choice for selection whilst fewer leave military service prematurely (Fossey, 2010).
• Public perception of the military and its appeal as a career are also considered important factors in affecting recruitment rates as evidenced by the recruitment policy cited in the Armed Forces Overarching Personnel Strategy which declares that one of the key principles of recruitment is to "...project the Armed Forces as careers of first choice for all people" (MoD, 2002/2003).

2.7.2 Retention

• Overstretch in the UK Armed Forces has been heralded as a common and complex problem due to the extent to which the two major combat operations in Iraq (OpTELIC) and Afghanistan (OpHERRICK) have exacted a substantial toll and will continue to do so for the foreseeable future. Despite the fact that operations have since ceased in Iraq, it could take a considerable number of years to resume normal operating tempo particularly given that operational demands in Afghanistan may negate any gains achieved from the withdrawal of troops from Iraq. To sustain the high demand for troops^[20] has required that many serve for longer periods and on a more frequent basis in theatre; a circumstance which is exacerbated by the six month deployment policy that requires massive redeployment twice a year. A gap of one year between operational deployments is therefore not uncommon. Moreover, troops may spend a significant proportion of time prior to deployment away from home to undertake essential training and preparation. During 2008, approximately 10.3% of the Army were in breach of the Harmony Guidelines^[21] (particularly the infantry among whom 30% of all soldiers exceeded the separated allowance guidelines), and 6.2% of RAF personnel were deployed in excess of 280 days.
• The direct link that exists between overstretch and manpower requirements means fewer Service personnel available to deal with the rise in operational demands. A previous report by the National Audit Office (HC 1633, 2005-06) found that deployment spent on overseas operations and time away from home represent key reasons for leaving the UK Armed Forces. However whilst financial incentives^[22] used by the MoD as a means to improve recruitment and retention may be successful in the short term, a House of Commons Committee of Public Accounts Report (HC 43, 2007) suggest that key reasons for leaving (e.g., inability to plan ahead in life outside work and the impact of Service life on family life) have not been addressed adequately.

2.7.3 Litigation

• The circumstances under which military personnel might sue the Crown in respect of personal injury suffered in a theatre of combat is an issue with which the MoD has had to contend since the suspension of statutory immunity in 1987 (Rowley, 2004).
• The class action brought against the MoD by Veterans suffering from Post Traumatic Stress Disorder (PTSD) has since served to highlight the potential financial costs of failing to implement policies^[23] to protect Service personnel from psychological injury.
• Although the judgement handed down in May 2003 was in generic favour of the MoD^[24], the judgement contained a number of criticisms of the MoD in respect of prevention, training, detection and treatment. Two important mental health initiatives were set up by the MoD in response to that judgement. The first was an Overarching Review of Operational Stress Management and the second was the establishment of the Mental Well Being Steering Group (MWBSG) which considered policy and practice on suicide, deliberate self harm, and stress in the workplace, including the application of the new Health and Safety Executive stress management standards.

2.8 Political factors

2.8.1 Public Support

• A public understanding of the military and recognition of their role is considered fundamental in determining the climate within which the military can effectively recruit and the willingness of the taxpayer to finance the UK Armed Forces^[25]. Yet, there is an increasing concern that civil-military relations are being compromised due to a substantial reduction in the visibility of the military^[26] (Strachan, 2003).
• Dandeker et al (2003) provide a comprehensive review of the mitigating circumstances deemed responsible for the divide that exists increasingly between the military and civic society. One of the key reasons for the diminishing military footprint is the fact that, since 1914, the proportion of the British population who have either had direct experience of the UK Armed Forces or who have a family member with such experience has substantially decreased. Hence, the number of those who directly experienced the legacy of the First and Second World Wars which included a "...sense of righteous struggle, an affirmed nationalism, and a pride in military achievement" (Black, 2004, p.10) are rapidly becoming a minority^[27].
• More recently, as challenges to the security of the nation become increasingly focused on the threat of terrorism (particularly on an international level), a number of changes in military practice have resulted in a substantial restriction on; (i) the wearing of uniforms by military personnel in public^[28]; (ii) access by the public to military installations (exacerbated also by health and safety" regulations), and (iii) military displays and Open Days.

2.8.2 Social Exclusion

• By virtue of a wider political agenda, the UK Government have sought to address the needs of those vulnerable groups who are most at risk of social exclusion^[29], particularly in respect of people with mental health problems (e.g., the National Social Inclusion Programme, 2004).
• In addition to the moral case for helping those in need, Dandeker et al (2003) have also highlighted the financial gains for the UK Government in enabling their citizens to make a productive contribution to society. Whilst the evidence suggests that the majority of Veterans effect a positive adjustment to civilian life following demobilisation, there are a significant minority who, for a variety of reasons (including service-induced ill health and/ or injury) are at risk of social exclusion. To this end, the case for assisting Veterans may pertain more to the fact that they are entitled to effective support from the UK Government because they fall within the socially excluded category rather than because of their unique and deserving social status as a Veteran per se.
• Furthermore, it has also been argued that this particular issue has been instrumental in determining the UK Government's decision to adopt the most inclusive definition of the term "Veteran" in developing a Veteran-related policy and strategy^[30].

2.9 Evolution of Veterans policy and strategy

• In March 2001, the Veterans Initiative (which subsequently became known as the Veterans Programme) was launched to raise awareness of the role and contribution of Veterans in society and to address specific issues of concern to the Veteran community. A Minister for Veterans (Rt Hon Don Touhig MP) was appointed by the Prime Minister to provide a UK Government focus for Veterans' issues to ensure that they were approached in a systematic fashion cross government. In addition, the Minister for Veterans is responsible for helping the country to understand and celebrate the achievements of its Veterans as well as chairing the Veterans Task Force, the Veterans Forum and the Veterans Plenary^[31].
• In March 2003, the Strategy for Veterans was launched based on framework that comprised three key "pillars", as summarised in Table 3. Communication, research and adequate sources of funding were regarded as essential to underpinning the success of the work undertaken in affiliation with the three work streams. In adopting the so-called "through life" approach the Strategy for Veterans recognised the need for an "evolutionary" approach to accommodate any changes that ensued over time with respect to the nature, size and requirements of the Veteran community. On this basis, the strategy also sought to target Service personnel (on the grounds that they represent future Veterans); ex-Service organisations (given that they represent Veteran groups); the public (with particular emphasis on the younger generation), and service providers. A structured plan of action was also formulated to enhance service delivery in respect of those Veterans presenting with specific needs that are distinct from those civilians who have not served in the UK Armed Forces. The primary nature of the roles of each of the key partners along with examples of their designated responsibilities is provided in Appendix A.

Table 3. Summary of Key Components of the Strategy for Veterans

Objectives of Key Pillars	Focus of Pillar-related Work Streams	Intended Activities
"To ensure excellent preparation for the transition of Service personnel back to civilian life"	Transition	(i) In-Service improvement of: training regimes healthcare (treatment and rehabilitation) educational opportunities, personal development, qualifications (ii) High quality pension schemes and no fault compensation schemes for Service-induced injury and illness (iii) Improved identification of and response to the needs of vulnerable Service leavers.
"To provide advice and support for those Veterans who require it"	Support	(i) Provision of information and practical assistance to war pensioner and widow(er)s (ii) Working in partnership with those responsible for the delivery of the programme to ensure: needs are reflected in wider public policy and support arrangements. problems associated with social exclusion are adequately addressed. awareness of health issues and special needs are raised with civilian healthcare providers.
"To ensure that the nation recognises, understands and commemorates Veterans' contribution in society."	Recognition	(i) To promote: public awareness of the contribution of the UK Armed Forces the contribution of Veterans to society. commemorative events and projects including an annual Veterans Day.

• A subsequent review of the Strategy for Veterans was undertaken to establish whether a change of direction was necessary on the basis of progress achieved. The outcome of this review was presented by the Minister for Veterans (Rt Hon Don Touhig MP) in the form of the revised Strategy for Veterans. Although the review confirmed that the broad approach of the original strategy remained pertinent (thereby endorsing retention of the three key pillars of the strategy, viz, transition, support, and recognition), it also proposed some specific changes which were associated with the importance attributed to:
  • recognising the importance of feeding back appropriate lessons learned into the MoD policies;
  • reinforcing the importance of research (as evidenced by the intention to instigate a separate Veterans Research Strategy);
  • raising awareness among the general public, service deliverers and Veterans themselves about issues that affect Veterans and the help available to them;
  • improving communication among those responsible for the delivery of services and policies for Veterans (given that this particular element is regarded as being pivotal to the success of the Veterans Programme);
  • exploring ways to improve service delivery, and
  • setting clear and measurable objectives to demonstrate real improvements in the lives of Veterans.
• In 2004, the Veterans Policy Unit (VPU) was formed from the merger of the Gulf Veteran's Illnesses Unit and the Veterans Affairs Secretariat. The role of the VPU is to provide support to the Minister for Veterans and Under Secretary of State for Defence. Comprising both military and civilian personnel, the VPU covers a wide range of policy issues and Veteran-related projects in accordance with the remit of the Strategy for Veterans.
• Commissioned by the Prime Minister (Rt Hon Gordon Brown MP), the first ever cross-Government strategy for supporting the UK Armed Forces community was originally announced by the Minister of State for the UK Armed Forces (Rt Hon Bob Ainsworth MP) on the 8 November 2007.
• In December 2007, the Prime Minister, Rt Hon Gordon Brown MP (with support from the Secretary of State for Defence) requested an independent inquiry^[32] into the relationship between the UK Armed Forces and the rest of society based on evidence derived from 300 serving members across all ranks in the three Services and a substantive consultation with a wide range of stakeholders and persons of influence in respect of military matters.^[33] Views were also sought from personnel in USA, France and Canada, by virtue of the experience of these three democratic countries in regularly deploying their forces in combat operations. The rationale for this Report of Inquiry was based on concerns about a decrease in public support due to the anticipated erosion of their familiarity and understanding of the UK Armed Forces (as described in Section 2). In line with a public opinion survey conducted by the MoD, the evidence taken from serving military personnel suggested that civilians lacked an understanding of them, their way of life, and their career choice. In an endeavour to address these concerns, a series of practical recommendations ("…that would involve minimum diversion of scarce Defence resources…") were directed predominantly at the UK Government with a view to:
  • increasing visibility
  • improving contact
  • building understanding
  • encouraging support

The UK Government's response to that Report was announced in a Written Ministerial Statement on 19 May 2008^[34] by the Rt Hon Bob Ainsworth MP followed by a paper detailing the nature of response ("Report of Inquiry into National Recognition of our Armed Forces", October 2008). The UK Government accepted the majority of recommendations (albeit with qualification or modification in some cases). Where appropriate, the Devolved Administrations were responsible for progressing recommendations in co-operation with the MoD and the UK Armed Forces in Scotland, Wales and Northern Ireland.)

• Following an extensive consultation^[35] and liaison with other UK Government Departments and the Devolved Administrations, the Secretary of State for Defence (Rt Hon Des Browne MP) presented to Parliament the first cross-Government strategy on the 12 July 2008. Commonly known as the "Service Personnel Command Paper" (SPCP), the cross-Government strategy retained the two key principles^[36] that underpinned the revised Strategy for Veterans. On this basis, the strategy sought to:
  • put an end to any disadvantage experienced by Service personnel and their families (particularly in respect of the requirement of mobility both nationally and internationally).
  • address the provision of support and recognition for those military personnel who have been injured in Service.
• In an endeavour to redress any potential disadvantage incurred by Service personnel during the course of duty, the SPCP endorsed the need to ensure that the following key aspects were embraced on an enduring basis.
  • "As much lifestyle choice as any citizen" - to facilitate a balance between the demands of Service life (including mobility), personal development, and family stability.
  • "Continuity of public service" - regardless of the location of Service and whenever Service mobility is required.
  • "Proper return for sacrifice" - based on a "through life" provision of treatment and welfare support.
  • "The Armed Forces community matters" - in respect of policy or legislative proposals.
• On this basis, the UK Government made a pledge to undertake 47 specific commitments in respect of the nine areas listed below.
  • Compensation
  • Health
  • Housing
  • Education and skills
  • Transport
  • Support for families
  • Benefits
  • Building careers
  • Foreign and Commonwealth Service personnel

An outline of the measures associated with the commitments by the UK Government in respect of each of these nine areas is provided in Appendix B.

• To complement the steps undertaken by Whitehall, the Scottish Government undertook a consultation^[37] with key stakeholders on its approach to the delivery of services to the UK Armed Forces community residing in Scotland. The purpose of that consultation was set out by the Scottish Government in the April 2008 Consultation paper "Scotland's Veterans and Force's Communities: meeting their well-being and welfare needs". Scottish Ministers subsequently detailed their commitment to the UK Armed Forces community in a paper entitled "Scotland's Veterans and Forces' Communities: meeting our commitment", the publication of which was in parallel to the SPCP of July 2008. The commitment pledged by the Scottish Government comprised the following six areas.
  • Healthcare
  • Housing
  • Transport
  • Education
  • Employment and employability
  • Local co-operation

An outline of the measures associated with the commitments by the Scottish Government in respect of each of the six areas is provided in Appendix C.

• In order to build on the commitments and practical measures proposed in the Service Personnel Command Paper, the MoD published a Green Paper in July 2009 entitled "The Nation's Commitment to the Armed Forces Community: Consistent and Enduring Support". Its purpose was to launch a consultation process to identify ways to improve the health and welfare support given to the UK Armed Forces community using a consistent and enduring approach which would uphold the principles of the SPCP across all levels of UK Government. A number of broad and wide ranging options were proposed, which included the creation of a Charter for the UK Armed Forces Community; exploration of the value of a legal duty being imposed on public bodies, and the availability of a UK Armed Forces hotline to enable complaints to be made in the event of dissatisfaction with service provision. Linked to these options were 29 consultation questions, the responses to which were to be used to inform UK Government thinking on how "…to ensure that the principles of no disadvantage and special treatment where appropriate are recognised, understood and upheld at all levels of administration, from policy formulation right through to service delivery" (p.5). The public consultation was closed on the 31^st October 2009.
• In November 2009, the first annual report of the evaluation of the UK-wide commitment was published. Undertaken by an External Reference Group (ERG)^[38], the report addressed what has been delivered, the extent of progress made, and the impact of that progress, in respect of each of the 47 specific commitments made in July 2008^[39]. On this basis, the ERG concluded that:
  • work dedicated to raising the profile of the needs of the UK Armed Forces community and in fostering support across the UK Government should continue to remain high on the political agenda.
  • time is required to assess the improvements made in respect of specific deliverables where measurement is more difficult such as those pertaining to Veterans' health needs.
  • empirical evidence is lacking in some areas thereby hampering the extent to which progress can be demonstrated.
  • communication remains a substantial challenge as a key factor in ensuring success at the point of service delivery, raising awareness in the UK Armed Forces community, and countering the scepticism as to whether the commitments will effect a real difference for their dependents.

In order to build on the initial progress made and to maintain the momentum achieved thus far, particular emphasis was placed on further work to be undertaken with a particular focus on the key area of communication and the development of suitable measures^[40].

• The Scottish Government published a parallel report comprising an evaluation of achievements and progress made in respect of the Scottish commitment (a summary of which is presented in Appendix D). In terms of the measures detailed in that report, mention was made of only two empirically-based initiatives, viz, the Veterans First Point (V1P) pilot project and research commissioned by Poppyscotland to identify the employment needs of disabled and vulnerable Veterans in Scotland (Hurley et al, 2009). Moreover, in addressing what steps should be taken to build on that which has been achieved to date in Scotland, no mention was made of the need to address the paucity of empirical evidence to ascertain the effectiveness of measures implemented despite the fact that research activity forms a significant part of the Veteran-related policy and strategy. Only two statements appeared in the section dedicated to presenting the "next steps". The first endorsed the need for more time for the work to be delivered. The second referred to the intention of the Scottish Government to play a "full part" in addressing the emerging issues reported in July 2009 (MoD Consultation Paper Cm7674 "The Nation's Commitment to the Armed Forces Community: Consistent and Enduring Support") to ensure that the implications for Scotland are considered and that their implementation fulfils the needs of the target population in Scotland.
• To complement the values set out in the Armed Forces Covenant (UK Government, June 2011), the Scottish Government has increased its efforts to ensure that no member of the UK Armed Forces community in Scotland faces disadvantage when accessing services and support. In September 2012, the Scottish Government published a document entitled "Our Commitments. Scottish Government Support for the Armed Forces Community in Scotland" to illustrate what it has achieved by working with strategic partners in the statutory and voluntary sectors and through the Firm Base Forum^[41] in terms of providing appropriate public and support services within the domains of health, housing, education and justice. In addition, it provides a summary of specific initiatives for future implementation, which take into consideration the harsh economic climate and the anticipated increase in the military footprint in Scotland^[42].