In my initial paper, the main focus was on the mercifully small group of ex-Service men and women with severe and enduring health conditions acquired as a result of military service. Some had been wounded in action while others either suffered serious injuries or had been affected by life changing illness while serving their country. In every case these are the people who have sacrificed the most and will live with permanent conditions for the rest of their lives.
This paper set out the compelling moral case for these men and women to receive the very best medical treatment and social care that Scotland has to offer. Anything less, I suggested, would be a betrayal of the promises made in the Armed Forces Covenant and by the Scottish Government in its Renewing Our Commitments strategy.
It has been reassuring that in every conversation and interaction since publishing that paper, there has not been a single person who has disagreed with or questioned that argument. Put simply, this group of veterans has earned the right to be considered a strategic priority for politicians and all who provide support within our health and social care sector. Ultimately, this is the central and recurring theme throughout most of this report.
In highlighting this cohort, however, it is also important that we don’t overlook the wider veterans community and their health needs. Theirs will not necessarily fall into the most serious category of severe and enduring injuries or conditions but they still deserve as good treatment as possible with an appreciation that their condition might be attributed, in some way, to their military service. This group will be typically treated by mainstream services within the NHS but, even here, their unique background and common experiences need to be recognised if the best outcomes are to be achieved.
Structure of Report
My original intention when scoping this subject had been to produce separate papers that focussed, in turn, on veterans suffering from severe and enduring conditions, followed by a later one on the broader health needs of our wider ex-Service community. Since then my team and I have come to realise that so many of the issues across these groups are intertwined and have, therefore, decided that there is greater merit in publishing a single report that covers the full range.
Chapters 1 and 2 cover subjects that are relevant to the health of all veterans but with a particular emphasis on those who suffer from the most severe and enduring injuries and conditions. The first culminates in a proposal for a distinctive approach to veterans’ health in Scotland, and the second considers the main challenges as to how that approach might be delivered.
Chapter 5 is more wide-ranging and considers the general health of the veterans community and where there might be opportunities to improve health and wellbeing outcomes for all.
Chapter 6 comprises my conclusions having spent many months investigating the issues. I hope this provides a useful summary of a complex and challenging agenda.
The full list of my recommendations can be found at Annex 1 . As in previous reports, extracts and quotes from case studies are included throughout. These offer a fascinating insight into the subject matter and I am extremely grateful to the contributors for providing such candid and meaningful material. Annex 2 contains these case studies in full.
‘Severe and Enduring’ Explained
The term ‘severe and enduring’ is a phrase used throughout this report to describe the most serious and life-changing injuries and conditions faced by veterans. For some in the military community this equates to those who are ‘wounded, injured or sick’ ( WIS), but for the wider population the term severe and enduring provides a more recognisable description. It may, though, leave the reader begging the question exactly which injuries and conditions fall into this category and which do not. This is never going to be an easy question to answer.
I want to be clear that it is not my place to define, prescribe or list what constitutes this type of injury or illness. It would also be wrong for me to direct the medical profession when trying to determine how contingent such conditions might be on previous military service. These are decisions that must be left to experts.
I do, though, recognise that making such decisions can sometimes be far from straightforward – a view that has been crystallised during discussions with a range of medical and allied health professionals. There will always be grey areas where the severity of the illness or injury, and its unequivocal link to military service, divide opinion or are difficult to establish.
It is, therefore, imperative that those professionals who are being asked to make such decisions have as good an understanding of veterans’ health issues as possible and are provided with advice and support where necessary. Ultimately, verdicts about whether a veteran who presents with particular injuries or illness falls into the category of severe and enduring – and therefore has access to ‘special’ care over and above that typically provided by mainstream services – will never be an exact science. I would, however, urge those involved to err on the side of the veteran in borderline cases. These individuals have already served their country and now struggle with conditions that may be wholly, or partly, the result of this service.