DELIVERING OUR ARMED FORCES' HEALTHCARE NEEDS:
A CONCORDAT BETWEEN THE UK DEPARTMENTS OF HEALTH AND THE MINISTRY OF DEFENCE
1. INTRODUCTION
1.1 The Government, in the NHS Plan, has reaffirmed that the NHS will provide a universal health service, based on clinical need, not the ability to pay. Identical commitments have been made by the Devolved Administrations for those parts of the UK. The NHS must be responsive to the different needs of different populations, and health services will continue to be funded nationally and available to all citizens of the UK, when in the UK. The NHS Plan sets out a new spirit of partnership: there should be no organizational or structural barriers to the delivery of high quality healthcare to those who need it, when they need it.
1.2 Modern and effective medical support is a fundamental part of Britain's military capabilities. The UK's Armed Forces must have the best clinical support to be able to mount and sustain operations overseas and also to ensure a fit and healthy Service population ready to deploy at any time.
1.3 The prime purpose of the uniformed Defence Medical Services (DMS) is to provide treatment and healthcare for Service personnel in deployed operations. When not deployed, DMS personnel require training and education, in accordance with the requirements of the relevant Professional bodies, and the means of maintaining their clinical skills in order to be available to deliver their operational role. For many years, the DMS and the NHS have been working together to make most effective use of the vital national resource that our healthcare services - across both the defence and civil sectors - represent.
1.4 The Government and the Devolved Administrations are committed to strengthening this important relationship, and looking at ways in which the NHS and the DMS can further develop their co-operation, for the benefit of all patients, whether military or civilian. This Concordat accordingly confirms our joint intent to renew and strengthen the partnership between the defence and civil healthcare services at national level. It describes a crosscutting partnership aimed at enabling the DMS and NHS to collaborate with and support each other, and offers value for money for the taxpayer, continuing high standards of care for patients, and effective defence of the nation.
2. THE DEFENCE PERSPECTIVE
2.1 The twin health goals required by Defence are
- A trained and deployable operational healthcare capability, and
- The maintenance of a fit and healthy Service population by means of effective health promotion and injury prevention policies and the provision of prompt and effective diagnosis, treatment and rehabilitation.
2.2 To maintain the required level of deployable healthcare capability required for deployed operations, the DMS will benefit from:
- Arrangements with NHS Hospital Trusts, both those which host MOD Hospital Units and others, which enable DMS clinical personnel to be trained, to maintain their skills in the NHS environment, and to be released to support deployed operations and exercises when required.
- Development of joint initiatives with NHS Hospital Trusts and Primary Care Trusts to encourage civilian healthcare personnel to join the volunteer Reserves, or to support defence medical requirements in other ways, so providing an invaluable additional operational capability for the DMS.
- Assistance with loan or secondment to the DMS of NHS personnel to fill civilian medical management appointments in the DMS.
2.3 To achieve enhanced levels of fitness and healthcare across the Armed Forces the DMS will benefit from:
- NHS expertise to assist in the development of an overall defence-wide health needs analysis and healthcare strategy.
- A co-ordinated approach to planning for the provision of primary care to Armed Forces personnel and their dependants, particularly in areas with large Service populations.
- A co-ordinated approach to planning for the provision of appropriate secondary and tertiary care, including rehabilitation, to Armed Forces personnel, both at home and on operations and exercises.
- High standards of clinical care, developed and sustained through training, life-long learning and clinical governance.
3. THE NHS PERSPECTIVE
3.1 The NHS provides a universal health service for all, based on clinical need, and centred on the needs of the patient. Alongside these commitments, the NHS will play its part in supporting the UK's Armed Forces, and by working in partnership with the DMS will develop opportunities to improve services for NHS patients, and to enrich professional and personal development opportunities for the NHS workforce. The modernisation agenda presents a range of possibilities for innovative partnership working to the mutual benefit of both the NHS and the DMS.
3.2 The NHS will benefit from working closely with the DMS to improve delivery of NHS services, including:
- Making optimal use of the skills of DMS clinicians to meet NHS requirements when not on deployed operations and exercises.
- Identifying clinical issues of common concern which might be addressed through joint DMS/NHS work.
3.3 The NHS benefits from, or has the potential to benefit from, working closely with the DMS to improve professional and personal development opportunities for NHS staff, consistent with the principles of Improving Working Lives:
- Encouraging and supporting NHS staff to become members of the Volunteer Reserve Forces, thus enabling staff to develop new skills, both professional and personal, and to help staff achieve a healthy balance between work and their life and interests outside.
- Opportunities for clinical attachments and secondments to Ministry of Defence facilities in the UK and overseas, thereby providing a professional development for NHS clinicians and benefits to the NHS in terms of development of leadership skills.
- Access to defence specialist medical establishments and units, offering professional clinical, research and training opportunities for NHS staff in fields, such as rehabilitation, aviation medicine, NBC hazards and occupational health. Potential benefits include exploiting particular areas of expertise developed by the DMS for wider dissemination in the NHS.
4. PLANNING AND WORKING TOGETHER
4.1 At the same time as delivering a major programme of investment and reform in the NHS, the Government is also committed to strengthening the DMS and enabling the Armed Forces to achieve enhanced delivery of the two key goals of deployable operational medical capability and fit and healthy Service personnel. These are challenges which cross departmental and organisational boundaries. They require a joint approach by the DMS and their partners in other healthcare delivery sectors, principally the NHS.
4.2 This Concordat is an enabling document. It leaves the detailed decisions about service delivery to be made locally by those who know and understand the delivery of local healthcare services, and those who understand the needs and best interests of the Armed Forces and their families. Most importantly, it sets out a partnership approach, which enables the DMS to work together with their colleagues in the NHS in planning and organising the delivery of the two principal defence medical goals. The effectiveness of this agreement will be monitored through the MOS/NHS Partnership Board, which will explore mutual areas of co-operation.
Signed on ………………………………………………………………… 2004 in duplicate, one copy to be held by the Ministry of Defence and one by each of the Health Departments of the UK Government, the Scottish Executive, the National Assembly for Wales and the Northern Ireland Administration.