Healthcare case studies: Understanding Armed Forces needs

July 18, 2024

Re-assessment of local needs

• Following the closure of RAF Cottesmore and the establishment of Kendrew Barracks (an Army base), Rutland County Council identified the need to reassess its health offer to the new Armed Forces Community. The Council’s Armed Forces Officer and Public Health team worked with local units to conduct a health needs assessment to understand the different needs of an RAF station vs an Army base, how those needs differ to the local civilian population, and whether military and civilian health services could meet the new demand. It established the local population and their health needs – particularly those impacted by Service life. It used literature reviews for health conditions, policy reviews, primary qualitative data collection (in the form of interviews and focus groups) and quantitative analysis. National data, as well as local data, was used. A report was published, and a Health & Wellbeing Board was dedicated to the health needs of the Armed Forces Community. The report informed the Council’s Joint Strategic Needs Assessment.
• The local Armed Forces Community in West Norfolk raised concerns that there was insufficient dental service provision near the local base, RAF Marham. The views of families, supported by research from Healthwatch Norfolk into local health provision and user needs, were fed into the Norfolk Health Overview and Scrutiny Committee, ensuring the commissioning process reflected local, as well as regional, needs. Led and negotiated by the Norfolk Armed Forces Covenant Board, partner organisations then collaborated to find a solution to meet those needs. NHS England worked closely with RAF Marham and the Defence Infrastructure Organisation to address the gap by opening the first NHS dental practice based on an MOD site.

Conducting research to understand local Armed Forces healthcare needs

• Harborough Locality Integrated Leadership Team has representatives from public and third sector organisations working to enhance individuals’ health and wellbeing experiences through collaborative working. A Local Authority and HealthWatch survey of Armed Forces Community members found that many respondents had mental (22%) and physical (29%) health issues directly related to Service, but felt they had a lack of support, access, and understanding from their public service providers. The Locality Integrated Leadership Team responded to the survey findings and reached out to the NHS to improve this experience. They worked with Armed Forces officers and case workers providing healthcare support to members of the Armed Forces Community. The result was an online training workshop to improve health practitioners’ awareness of Service life and related health concerns. Anecdotal evidence showed increased engagement with Armed Forces Community clients and referrals to specialist providers.
• Hertfordshire Armed Forces Covenant Board worked with Healthwatch Hertfordshire to undertake to conduct a survey, interviews, and focus groups with 100 local veterans, as well as NHS professionals, funded by Hertfordshire Public Health. This led to an action plan, including action to increase understanding of Service life and the Armed Forces Covenant among secondary care practitioners, promotion of Veteran Aware to local hospitals, and the Royal College of General Practitioners’ Veteran Friendly GP Practice scheme to local surgeries.
• Rutland County Council led tri-Council work (with Harborough and South Kesteven District Councils) to commission HealthWatch to create a user-friendly survey of the military community online and on paper over a four-month period. The Rutland Armed Forces Officer worked closely with HealthWatch to construct the survey and promote completion across the community. Supported by a communications strategy (social media, radio, posters, and visiting bases), this led to 700 verified responses and a report that assisted in policy changes.
• In 2020, research by the Veterans’ Gateway found that, out of all issues facing the veteran community, at least 23.27% of searches on its online portal were for mental health services, and at least 6.75% of searches were for physical health issues. In order of highest number of searches, veterans were most concerned about: accessing support; support groups; treatment; drug, alcohol, and rehab services; bereavement; home and physical mobility aids; GPs; blindness; limb loss; and end of life care.
• Reports are also available from wider experts and Armed Forces advocates that identify issues for veterans and families, and make recommendations over how public bodies can respond. For example, the Scottish Veterans Commissioner’s reports Veteran’s Health & Wellbeing A Distinctive Scottish Approach and Are We Getting It Right?

Improving GPs’ awareness of their local veteran healthcare needs

• Westfield Surgery in Leominster, Herefordshire, is accredited as veteran-friendly. By going through the accreditation process, it has been able to support Armed Forces patients in a way it would not otherwise have done. It has a nominated clinical lead for veteran health. It has supported a number of patients through fast-tracking treatment for a military-related injury, and has been able to put lonely veterans in touch with appropriate social contacts. It has established links with local military charities and support agencies. It has successfully encouraged veterans to identify as such on the surgery’s systems, for example the telephone messaging asks patients that are veterans to make the surgery aware. Through ongoing training of its staff, it continues to improve its awareness of the specific needs of the Armed Forces Community, enabling correct support or care pathways to be followed.

Creating a toolkit for GPs to improve services for veterans

• The RCGP worked in partnership with NHS England and NHS Improvement, consulting the Ministry of Defence and other stakeholders, to conduct and collate research into the healthcare needs of veterans and their families. The RCGP published its findings in the form of a toolkit that could be used by GPs to help meet veterans’ healthcare needs. The toolkit includes the following.
  • Information on the Armed Forces Covenant and NHS Constitution.
  • A list of dedicated services for veterans and contact information, both inside and outside the NHS.
  • Information on the nature of veteran-sustained physical and mental health injuries.
  • Information on requesting a veteran’s medical records from the Armed Forces.
  • Learning resources, such as webinars, podcasts, and videos.

Training of healthcare staff about Armed Forces issues

• NHS Education for Scotland identified a lack of awareness in frontline health practitioners of how Service life impacts members of the Armed Forces Community. It approached NHS Highland and the Department for Community Mental Health to develop and trial a 4-hour, online training session on the Armed Forces Community for final-year trainee GPs. Training covered the journey of a Service person through the Defence and NHS medical systems, the barriers and challenges potentially facing veterans and Service families, and introduced the Armed Forces Covenant. It was supported by Q&A sessions. Training also included a GPs’ toolkit, links to research hubs and papers on Armed Forces Community healthcare issues, such as non-freezing cold injury. Feedback was positive, with trainees noting it had not been covered in medical school or GP training.
• York St John University has delivered training courses to public service workers in local authorities and health services, who had identified a lack of awareness and understanding of Service life. Participants received resources and training from the University and BLESMA (Military Charity for Limbless Veterans) to better support veterans and their families. The training benefitted those in occupational therapy, physiotherapy, counselling, and psychology.
• The Sussex, Kent & Medway (NHS) Armed Forces Network runs its award-winning, CPD-accredited, Service Champions Training, for attendees from the NHS and other organisations such as local authorities. There are about 50 attendees per month. It is delivered in partnership with local reservists, veterans, and military charities. It is designed for people interested in the services they offer becoming more focussed on the Armed Forces. Through the training, a support network of Service champions is formed to help further develop knowledge and skills across different organisations.
• Some health bodies use internal communication methods to promote Armed Forces Community issues and the Armed Forces Covenant among their staff. In Wales, this has been realised, in part, by the Welsh Health Circular – a detailed instruction to all health boards and staff in Wales which outlines key information on topics such as identification of veterans, the Covenant, mental health, the Veterans’ gateway, limb loss and adaptations.
• NHS Highland also developed an internal, bi-annual newsletter about healthcare and the Armed Forces Community, providing definitions (e.g. what is a veteran), a directory of useful contacts, and upcoming events. It also developed an intranet site with a repository for resources, tools, and information.

Sharing good practice between healthcare providers

• In 2014, The Chavasse Report analysed care provided to the Armed Forces and veterans to find ways to improve care while raising NHS standards. One of its recommendations was to create a support network of hospitals. This led to the creation of the Veterans Covenant Healthcare Alliance and their Veteran Aware accreditation programme, and the eight manifesto standards that healthcare providers use to aim to improve the healthcare that veterans, and the wider Community, receive from the NHS. The Alliance works closely with NHS Improvement, NHS England, Service charities and the Ministry of Defence. The Alliance seeks to showcase high quality veterans’ healthcare, and support NHS Trusts to learn from each other by sharing good practice. This includes committing to the Armed Forces Covenant, raising awareness among staff of veterans’ healthcare needs, and establishing clear links with Service charities and local support providers.

Improving identification of veterans on NHS systems

• In 2018, in response to data highlighting the veterans’ code was applied to veteran patients in only 7.9% of cases, Prof. Alan Finnegan created a study to find ways to motivate veterans to notify primary care staff of their veteran status or register with a GP, and to improve primary care staff’s understanding of veterans’ health issues. The study found that, after a 6-week intervention period centred on an advertising campaign, the number of patients with a veteran code increased by 200% (180 to 537 in Lancashire).
• Gateshead Armed Forces Network identified that there were very low numbers of veterans registered and coded at GP practices in Gateshead, and Newcastle Gateshead Clinical Commissioning Group (CCG) agreed to carry out a project to increase this. From 2014-15, the project involved the CCG including veteran identification as one of its Quality Indicators that practices could choose to focus on. During 2016-17, veteran identification was also added to the CCG’s master templates installed on all practice clinical systems. At the start of the project there were only 368 veterans registered, identified and coded in Gateshead. By February 2019 this had increased to over 7000. As a result of this, GP practices in Gateshead can now better identify veterans with long-term conditions which might be due to Service. This means veterans can then be sent to appropriate NHS services, which could be veteran-specific. The CCG has also been working to further share and extend this best practice across Newcastle, and across the North East Armed Forces Forum (covering 12 local authority areas).