The changing landscape of veteran healthcare

The last 15 years have seen increased survivability of military casualties. Many will need physical and mental healthcare support for the rest of their lives. There is pressure on the NHS to provide cohesive and specialised veteran care.

However, veterans and healthcare professionals are sometimes unclear what veterans are entitled to and what additional NHS services are available. This article outlines what is required, what the expectations are and what the NHS provides.

Armed Forces Covenant / NHS Constitution

These critical policies stress that all should not be disadvantaged from accessing appropriate health services. The former states that veterans are entitled to ‘priority treatment for any health condition so long as it relates to their time in service and is subject to the clinical needs of others’.

The challenge for those delivering healthcare is that these statements are open to interpretation. What is service related? What is priority care? Should a wounded veteran receive care ahead of an injured fireman or nurse? Managing expectations on all sides is vital. Visit here for more information.

What veterans can expect

There is a wide spectrum of expectations from veterans, ranging from a reluctance to be identified as veterans, to the idea that veteran status propels them to the front of the queue. It’s very important that veterans understand what the NHS can/should do for them. One of the commonest issues is that veterans are only entitled to veteran specialist care for service related injuries or illnesses - being a veteran, per se, is not enough.

What is being done

Though many organisations are involved in veteran-related services, the NHS is the only health body that is legally required to do so. For many years there was no special veteran care pathway through the NHS – one that complements all NHS access. Over the last few years great efforts have been made to create veteran-specific pathways and services and increase awareness of veteran issues among NHS staff.

Primary healthcare

GPs need to be aware of their registered veterans and what is available for them. The Royal College of General Practitioners (RCGP) Midland Faculty and NHS England have launched a pilot to encourage GP practices to become ‘veteran friendly’ accredited. This helps practices to better identify and treat veterans, ensuring they get access to dedicated care if appropriate. To date, over 100 practices have signed up, with plans for a national roll-out.

In addition, when registering into the NHS from Defence Medical Services, the registration form asks the individual and GP to identify whether the patient (or their family) have ever served. This should lead to better identification. Finally, the RCGP has veteran healthcare in the professional examination for GP qualification, ensuring all future GPs are veteran aware.

Secondary healthcare

Mental healthcare

Veterans’ mental health has been a huge focus for improvement and over the last few years has seen the launch of the Transition, Intervention and Liaison Service (TILS) and the Complex Treatment Service (CTS). The TILs provides early access to mental health care and is aimed at personnel leaving the military and veterans with lower levels of mental health difficulties.

The CTS deals with more complex cases, including PTSD and co-morbidities and includes those who have not improved with previous treatment. Both can provide help with housing, finances, employment and alcohol misuse, as well as support for families coping with the consequences.

Since April 2017, approximately 4,700 patients have been referred to the TILS and CTS. Visit the NHS website for more information.

Physical healthcare

The Veterans Trauma Network (VTN), the first clinical pathway for service attributable veterans’ physical healthcare, consists of 10 regional trauma centres and five trusts that undertake specific veteran care and co-ordinate all service-related physical health veteran GP referrals. The centres include seconded military clinical professionals who work closely with military charities and the TILS and CTS to ensure holistic care is provided.

The VTN was and continues to be informed by veterans who can access the service via GP referral, as explained on the NHS website.

Conclusion

Whilst these specialised services do not absolve the responsibility of mainstream services to identify the particular needs of veterans and to seek to treat them to ensure ‘no disadvantage’, the NHS is making significant progress to create an integrated veteran pathway. It is vital that this is done with sensitivity to all NHS users.

Learning from military cohorts will always inform civilian practice – especially around blast injury and trauma. The NHS is designed to be able to deal with both basic and the most complex health needs. It is therefore only right that veteran care is anchored in the NHS, as it is the NHS that kept military casualties alive in all wars since 1947. The current initiatives aim to create a veteran-aware and sensitive healthcare system that will educate, deliver and endure.

Shehan Hettiaratchy is clinical lead at the Veterans Trauma Network. Email him here.