Veterans' health and wellbeing: a distinctive Scottish approach

Chapter 6: Conclusions

The topic of veterans health and wellbeing is, by far, the most wide-ranging and complex that I have tackled during my time as Commissioner. Preparing this report has been a fascinating and thought-provoking experience that has exposed my team and me to very many issues and concerns affecting the ex-Service community at a time of significant change across Scotland’s health and social care sector. During the study we have turned, repeatedly, to the four fundamental questions I posed at the outset (and can be found in the Foreword) which were intended to determine whether we are ‘getting it right’ for some of the most deserving members of society. I sincerely hope that my conclusions, and the subsequent findings and recommendations, will assist those responsible for planning and delivering improved outcomes for these individuals.

The first – and probably key – conclusion I have come to is that there is both a need, and a timely opportunity, to rekindle awareness and concern for veterans’ healthcare in Scotland today. I acknowledge that the vast majority of ex-military personnel, especially those with serious and life-changing conditions, have access to impressive standards of treatment and support but the levels of ambition and innovation which characterised Scotland’s approach in previous years have sadly waned since peaking at the start of the decade. My proposal for a distinct Scottish Approach to Veterans’ Health is intended to provide the motivation, agenda and governance structure that will raise the profile of veterans and reinvigorate efforts to provide them with the best possible treatment and care.

At the heart of this proposed approach is an unequivocal emphasis on the small – but vitally important – group of veterans with the most severe and enduring injuries and conditions caused or exacerbated by military service. It is my opinion that the provision of specialist services for these individuals, who have given the most in serving our country and suffered life-changing consequences, should be at the very centre of Scotland’s health system. I should stress that this support, usually delivered by the statutory and third sectors, is very good and that one of the main purposes of any approach should be to protect and enhance this care for current and future generations.

Another area in which the commitment to providing the best possible treatment to veterans, and ensuring it is well planned and resourced, can be most usefully met is in the field of mental health. The Scottish Government, NHS(S) and charities have done much on this front in recent years but there are still concerns about sustainability and, in some instances, accessibility. This has led me to call for a Mental Health Action Plan that secures long-term delivery of dedicated services and support to veterans. I have concluded that this should be one of the responsibilities of a new network focussed on all aspects of veterans’ health. It will be important that the network reflects, both in membership and approach, a significantly changed health and social care landscape and local models of service delivery in Scotland today.

A further factor for ex-military personnel with the most serious and debilitating conditions is ensuring that their changing health and social care requirements are properly planned and met for the rest of their lives. In studying this theme, it became apparent early on that the system in Scotland has undergone transformational change in recent years, most prominently through the integration of health and social care services. I have, therefore, offered suggestions and recommendations which I believe reflect that change and will ensure consideration of veterans’ health issues, especially for this group, is embedded within this new landscape.

While my focus has rightly been on the needs of those with severe and enduring conditions, I also recognised that there are others in the community that merit attention. It is pleasing to report that most veterans are in good health and I have discovered no obvious examples of disadvantage in either the availability of, or access to, services and support. However, there are some who are at an increased risk of facing health inequalities as a result of military service, which in itself constitutes a disadvantage. I have, therefore, concluded that by identifying veterans as a distinct group within the health system, there is an opportunity which must be grasped to redress some of these inequalities and improve the outcomes for a broad number of our veterans.

In one sense this report provides a snapshot of veterans’ health and associated issues in 2018. More than that and with an eye to the future, I hope that the proposals it contains also offer a vision, framework and ideas for ensuring a reinvigorated approach to veterans’ health. Ultimately, I believe Scotland has an opportunity to build on its well-deserved reputation and the quality of care it provides to our veterans community.