A series of spending reviews following the end of the Cold War led to the closure of military hospitals and closer co-operation between the Defence Medical Services (DMS) and the NHS.
The government said there weren't enough patients to justify military hospitals in the long term. The small volume of patients was also considered inadequate to maintain the skills of armed forces medical personnel.
Although the change was passionately opposed by many people in the armed forces and beyond, a review of the decision said that it was “the right one”.
“We see no evidence that the care offered to military personnel has suffered as a result,” said an independent report by the House of Commons Defence Committee in 2008.
The report states: “The clinical care for servicemen and women seriously injured on operations is second to none. Defence Medical Services personnel in the NHS provide world-class care.”
The partnership between the NHS and the DMS has enabled the armed forces to provide modern and advanced clinical care and give its medical staff the broadest and most up-to-date training and experience.
Structure
Medical services are delivered to nearly 193,000 servicemen and women by the DMS, the NHS, charities and welfare organisations.
The DMS is staffed by around 10,000 regular uniformed and reserve medical personnel from all three services: the British Army, Royal Navy and Royal Air Force. The current head of the DMS is Surgeon Vice Admiral Philip Raffaelli.
The DMS mostly provides primary care, such as general practice, dentistry, occupational medicine and community mental health services within the UK and at defence outposts overseas.
It is responsible for delivering healthcare, including secondary care, on operations overseas and rehabilitation through Headley Court Defence Medical Rehabilitation Centre and regional units in the UK and Germany.
The DMS commissions services from six NHS trusts, including University Hospitals Birmingham (UHB), for personnel and their families needing hospitalisation in England.
Military casualties
Armed forces personnel returning from operations for treatment in the UK usually go to UHB’s Queen Elizabeth Hospital (QEH), which is the home of the Royal Centre for Defence Medicine (RCDM).
During their treatment at QEH, most military patients are grouped together in a secure trauma ward staffed by military and NHS medical staff.
The RCDM and UHB have earned an excellent reputation for treating the complex injuries typical of military casualties.
Treatment and rehabilitation
Armed forces personnel who are seriously injured abroad are airlifted to the UK by the RAF’s aeromedical evacuation squadron at RAF Lyneham.
Military patients in the UK in need of hospital treatment visit one of the five Ministry of Defence Hospital Units (MDHU), where they are given priority access.
A fast-track system, funded by the Ministry of Defence (MoD), is also in place. This means servicemen and women receive fast access to treatment (generally for muscle, bone and joint problems) through the NHS as well as the private sector.
Armed forces members recovering from orthopaedic and neurological problems are treated at one of 15 Regional Rehabilitation Units (RRUs) across the UK, including Headley Court.
Recently, physiotherapists and mental health nurses have been deployed in Iraq and Afghanistan to provide care close to the frontline.
Mental health
Military mental health professionals are sent on operations overseas so they can provide assessment and care in the field.
In the UK mental health services work alongside community-based mental health services so they follow national best practice guidelines.
Care is offered at 15 military Departments of Community Mental Health (DCMH) across the UK (and smaller centres abroad), which provide outpatient mental health care.
Inpatient mental health care services in the UK are provided under contract by a partnership of eight NHS trusts. This is led by the South Staffordshire and Shropshire Healthcare NHS Foundation Trust. Service personnel are assessed, stabilised and treated in hospitals as close as possible to their home or parent unit.
The priority is to return injured servicemen and women to work as quickly as possible.
Trusts providing inpatient healthcare:
Veterans
Everyone leaving the armed forces is given a summary of their medical records, which they are advised to give to their new NHS doctor when they register with them.
A rigorous handover process, known as the Seriously Injured Leavers Protocol (SILP), is in place for veterans with healthcare requirements after leaving the forces.
War pensioners and veterans are also entitled to priority NHS treatment for conditions resulting from their service.
A medical assessment programme based at St Thomas' Hospital in London is available to veterans who are worried they might have a mental health problem.
