Annex 1: Recommendations and Findings
Recommendation 1 – A Distinctive Scottish Approach to Veterans’ Health
The Scottish Government and NHS(S) should commit to establishing a distinctive Scottish Approach to Veterans’ Health at a strategic level, accept or adapt the guiding principles of this approach and work with their partners to embed it at an operational level.
Recommendation 2 – Improving Collaboration and Partnership
The Scottish Government should reinvigorate senior participation in cross-border networks with a view to improved information sharing and increased involvement in collaborative working and initiatives.
Recommendation 3 – Leadership and Governance
The Armed Forces and Veterans Health Joint Group should refresh its membership and remit in order to provide the vital strategic leadership that will deliver the Scottish Approach to Veterans’ Health
Recommendation 4 – National Managed Clinical Network
The Scottish Government and NHS(S) should establish a network on veterans’ health. The network will have oversight of delivering the Scottish Approach to Veterans’ Health, and will consider the key issues raised in this report and others it deems relevant. It should reflect current structures in the health and social care sector in its membership and approach.
Recommendation 5 – Mental Health Action Plan
The Scottish Government and NHS(S), through the network on veterans health (see recommendation 4), should produce a Mental Health Action Plan for the long-term delivery of services and support. Systemic issues of funding, collaboration, leadership, planning, governance and training of staff will be key.
Recommendation 6 – Drugs Misuse
The Scottish Government and NHS(S) should assess the scale and nature of drugs misuse – especially prescription and non-prescription painkillers – amongst the veterans community in Scotland and introduce remedial measures. This should be taken forward by the Joint Group and network, and included as part of the Mental Health Action Plan.
Recommendation 7 – Barriers to Accessing Services
The Scottish Government and NHS(S) should build on existing work aimed at reducing barriers to veterans accessing mental health services. This will include measures to address issues of stigma, seeking help, and improving awareness and understanding within the medical profession. This should be taken forward by the Joint Group and network, and included as part of the Mental Health Action Plan.
Recommendation 8 – Access to Life-long Services
The Scottish Government, NHS(S), Health Boards and local Councils should make a commitment to veterans with the most severe and enduring physical (and mental) conditions that they can access the highest quality health and social care services for life and as their needs change. Health and Social Care Partnerships and Integrated Joint Boards will be instrumental in planning the delivery of these services and the national network recommended in chapter 2 should assume responsibility for oversight of this work as an early priority.
Recommendation 9 – Funding for Multiple Injuries
The Scottish Government and NHS(S) should give consideration to whether the costs of specialist care for veterans who have suffered polytrauma should be funded through the National Services Division ( NSD).
Recommendation 10 – The National Trauma Network
NHS(S) should include the specific needs of veterans who have suffered polytrauma as part of its work in setting up a national Trauma Network.
Recommendation 11 – Wheelchairs for Amputees
NHS(S) should adapt current arrangements to ensure an appropriate level of funding is available to guarantee that wheelchairs provided by the MOD for veterans with severe amputations can be serviced, maintained and replaced with the best possible equipment commensurate with that individual’s needs.
Recommendation 12 – Chronic Pain Management
The National Advisory Committee for Chronic Pain ( NACCP) should consider veterans specifically as part of their work to improve chronic pain management in Scotland.
Recommendation 13 – Funding Hearing Aids
The Scottish Government and NHS(S) should make funding available so that veterans with the most severe hearing loss as a result of their military service can have access to the best possible hearing aids and support.
Recommendation 14 – The Invictus Games
The Scottish Government should work with partners, charities and others to scope a proposal to host a future Invictus Games in Scotland.
Recommendation 15 – Tackling Health Inequalities
The Scottish Government, NHS(S) and partners should identify veterans as a distinct group in their work to tackle health inequalities. In doing so they should produce proposals for preventing or mitigating inequalities as they apply to this group, with the ultimate aim of improving health outcomes for all.
Recommendation 16 – Identifying Veterans
The Armed Forces and Veterans Joint Health Group should oversee work to increase the number of veterans declaring their previous service to GPs and others in the system. This will likely involve NHS(S), MOD and veterans organisations.
Recommendation 17 – Using Information
The Armed Forces and Veterans Joint Health Group should oversee efforts to improve methods of recording, displaying and sharing information about veterans within the health and social care sector. This will be with a view to providing health professionals with the information needed to better understand and support veterans.
Recommendation 18 – Veterans Champions
The Scottish Government and Veterans Scotland should build on recent work to support the network of NHS and Council champions to develop the role so that it can continue to be effective in supporting the delivery of health and social care to veterans within the new health landscape of Scotland.
Specialist physical and mental health services are a vital and valued part of supporting our veterans with the most severe and enduring injuries and conditions. While their exact make-up and models of delivery will inevitably change and adapt over time, it is imperative that the availability of specialist services – and the outcomes they support – are protected for current and future generations.
Funding for specialist mental and physical health services for veterans is disjointed and in some cases ad hoc. This results in a degree of uncertainty and raised questions about the sustainability of some of these services, which is a worry for those who rely on and value them so much. It is an issue that needs addressed as a priority.
The integration of health and social care services in Scotland provides a unique opportunity to ensure the longer-term needs of veterans are properly planned and met. The new structure of IJBs and HSCPs is the vehicle for delivering this ambition. They must play a central role in decision-making about veterans’ health and wellbeing and the delivery of both mainstream and specialist services.
The publication of the Suicide Prevention Action Plan by the Scottish Government later this year is a welcome step in ensuring everything possible is done to help anyone struggling with mental ill health. Vulnerable veterans, and their particular circumstances, will be an important consideration as the plan is developed.
Rehabilitation services, such as those provided by physio and occupational therapists, can be of huge benefit to those suffering from MSDs. Given the high demand for such services, veterans suffering from severe MSDs as a result of their military service should be given early access as part of their special treatment.