The Healthcare Commission has published the first- independent review of the Defence Medical Services (DMS), the service that provides healthcare to defence personnel and their families in the UK and overseas. The findings were generally positive, with the BBC describing military trauma care as "exceptional", and rehabilitation services as "excellent".
Who was involved in the review?
The review was conducted by the Healthcare Commission, which checks health services in England to ensure that they meet standards in a range of areas. From next month the Healthcare Commission becomes the Care Quality Commission.
The review assessed the standards of healthcare provided to armed forces personnel by the DMS. It was conducted at the request of Britain’s most senior military medic, the Surgeon General, Lieutenant General Louis Lillywhite.
The DMS is responsible for the healthcare of around 258,000 people including military personnel based in the UK and overseas, their families and other entitled civilians. It is made up of the Defence Medical Services Department, the Defence Medical Services, the Defence Dental Services, the Joint Medical Command and three single-service medical directorates. All are military bodies.
How does the DMS deliver healthcare?
The DMS employs 7,000 medical personnel including GPs, dentists, consultants, nurses and surgions. It commissions domestic inpatient hospital care from the NHS, rather than running its own hospitals. Care is delivered via six NHS trusts – the main one being the the Royal Centre for Defence Medicine (RCDM) based at University Hospital Birmingham Foundation Trust.
In war zones and overseas, the DMS runs its own hospital and care facilities where it looks after service men and women until they can be retured to the UK.
It also runs specialist rehabilitation services at Headley Court Defence Medical Rehabilitation Centre in Surrey and a number of other centres in the UK and Germany.
What was the scope of the review?
The review assessed a range of medical services provided by the DMS in the UK and overseas, including primary medical and dental care, acute care, rehabilitation, occupational medicine and specialist medical services such as aviation medicine and underwater medicine.
How was it carried out?
The review involved self-assessments from DMS units including military hospitals, rehabilitation centres, dental services, community mental health services and general medical services.
This was followed-up by inspections at 53 DMS units in the UK and overseas. The review also incorporated 500 comments from current and ex-service personnel, family members and organisations that work with the DMS.
What areas were praised?
The report said trauma care was exceptional and greatly increased the chance of survival and recovery for injured personnel.
- Rehabilitation services were “excellent”. These services are provided at Headley Court rehabilitation centre and regional units in the UK and Germany.
- The system of regular reviews of best practice in trauma and rehabilitation services meant care was “continuously improving and innovating”.
- Patient diaries, kept for personnel recovering from injury in hospital to aid with short-term memory loss, were described as “innovative”.
Areas for improvement?
- The review found that the DMS needs to ensure that the high levels of healthcare on the frontline are reflected throughout its services.
- The DMS medical centre in Cyprus needs to improve its cleanliness and “urgently” replace its ambulances, which are considered “unsafe”.
- Procedures for safeguarding children need to be overhauled. The review found that some military medical staff did not realise that 16 and 17-year-old recruits were legally still children.
- The DMS should collect information centrally, to allow comparison across all services and to provide a clear overview of quality of services across the whole organisation.
The MoD has appointed an Inspector General, Surgeon Rear Admiral Philip Raffaelli, to ensure that all recommendations made by the Healthcare Commission are implemented in full.
An MoD spokesman said: "We have already remedied a number of the more serious problems identified in our infrastructure. We are working on the rest and will carry out a review of our other facilities to identify and address any similar deficiencies. Action is also under way to replace all our ambulances in Cyprus by July this year."
He added that the Surgeon General has also started discussions with the NHS about sharing best practice procedures.
Want to know more about military medicine?
At the end of this month NHS Choices will publish a special report on British military medicine. We have been given unique access to look at how warfare is pushing the boundaries of medical treatment.
Links to the headlines
BBC News, 2 March 2009
The Daily Telegraph, 2 March 2009
The Independent, 2 March 2009
The Sun, 2 March 2009
The Times, 2 March 2009