Meeting of the Parliament

Meeting date: Thursday, May 17, 2018

Official Report 799KB pdf

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Veterans (Health and Wellbeing)

The next item of business is a statement by Shona Robison on the Scottish veterans commissioner’s report on veterans’ health and wellbeing. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

I thank the Scottish veterans commissioner, Eric Fraser, for the work that he has done in producing his recent report “Veterans’ Health & Wellbeing: A Distinctive Scottish Approach”.

Our armed forces community, veterans and their families are an asset to Scotland, and the Scottish Government remains committed to providing them with the best possible support and opportunities. With the appointment of the veterans commissioner as a dedicated post to promote those interests, we led the way in the United Kingdom.

Last year, I met the commissioner to discuss his forthcoming report. I was pleased that he recognised the strong track record in Scotland of ensuring that veterans are given the best possible treatment, care and support.

We welcome the report, which makes a number of recommendations on how we could refocus and re-energise Scotland’s approach to looking after our ex-servicemen and women. The report was considered in detail at the recent meeting of the armed forces and veterans health joint group, which is chaired by the director-general of health and social care and includes representation from key armed forces and veterans stakeholders in Scotland. I look forward to hearing the outcome of its considerations.

The Scottish Government remains committed to ensuring that all veterans living in Scotland are able to access the best possible care and support, including safe, effective and person-centred healthcare. Our current policy states that all veterans should receive priority treatment for health problems as a result of service to their country, subject to clinical priority for all patients. That means that veterans should receive priority treatment for on-going health problems that are a direct result of their service, unless there is an emergency case or another case that demands higher clinical priority. However, the report highlights that that concept, which was introduced in the 1950s, is outdated. The veterans commissioner recognises that we should move beyond the priority treatment policy and calls for a greater focus on the principles of excellence, accessibility and sustainable treatment for all veterans.

The guiding principles for veterans’ health that are suggested in Eric Fraser’s report are entirely consistent with our ambition for safe, effective and person-centred healthcare as set out in the healthcare quality strategy for NHS Scotland. The integration of health and social care in recent years has changed the delivery landscape for healthcare in Scotland, so we need to ensure that the mechanisms that are in place to support veterans’ healthcare are still fit for purpose.

It is the Scottish Government’s continuing aim to ensure that the healthcare needs of serving personnel and veterans are better understood and supported within the national health service. We are already progressing work that addresses some of the recommendations that are made in the report.

The report makes the point that strong and visible leadership is needed to deliver high standards of healthcare, and that leadership needs to be in place nationally and locally. I have already mentioned the armed forces and veterans health joint group, and I know that the group will be keen to ensure that its membership and remit reflect the new landscape in which healthcare for veterans is delivered. At a local level, we have a network of NHS champions for armed forces and veterans who are there to support armed forces personnel, veterans and their families to get access to high-quality services and treatment when required.

To raise awareness of the policies that are already in place to support the healthcare needs of veterans, we recently issued updated information to NHS veterans champions, NHS chief executives and primary care leads, which included guidance for general practitioners on how veterans can share their full service medical record with their GP. We will look at how we can build effective working links between NHS and local authority armed forces champions to reflect the new integrated landscape.

My officials have worked with Veterans Scotland to update existing information for veterans about how to access healthcare from the NHS inform service, which will be followed by an awareness-raising campaign to coincide with armed forces day in June 2018.

The Scottish Government recognises the importance of supporting veterans’ long-term healthcare needs. It is essential that appropriate support is available to veterans and that funding and services are sustainable. The Scottish Government is at the very earliest stage of considering a managed network approach as a potential longer-term solution to ensuring equitable and sustainable services for veterans across Scotland.

Networks are a well-established way of driving improvement in the quality of care through a co-ordinated approach. A formal NHS National Services Scotland application process exists, and NHS NSS is providing advice on the necessary next steps and timeframe before the proposal is progressed further. We envisage that a range of stakeholders and interests will be involved as the proposal develops.

One example through which we provide additional support for those with the most severe and enduring healthcare needs is the national specialist prosthetics service. In 2013, the Scottish Government made a commitment to invest £4.5 million over three years in the national prosthetics service. The service was developed to provide continuing care to those who would benefit most from the new technologies, based on clinical need. The service continues to work with manufacturers to ensure that the very best services are available to our veterans in Scotland.

I welcome the focus on the mental health of veterans and their families in the commissioner’s report. The report rightly focuses on a number of positives. Collectively, we should be proud of achieving those. The report recognises the significantly improved support for those suffering mental ill health after time spent in the armed forces. It recognises that, in recent years, veterans have been able to access a number of specialist and mainstream services, with Scotland being in the vanguard in many instances. It also recognises that the vast majority of those who leave the military do so without severe mental health problems and cope well with the transition to civilian life.

The clarity in the report around the importance of mental health accords fully with the guiding ambition in our mental health strategy, which is that we must prevent and treat mental health problems with the same commitment, passion and drive as we do physical health problems. In that respect, we all have a responsibility to help realise our vision of a Scotland where people can get the right help at the right time, expect recovery and fully enjoy their rights, free from discrimination and stigma.

However, although there is much to be proud of, I agree with the commissioner that there is no room for complacency and that further improvements can be made. I note the key recommendation that

“The Scottish Government and NHS(S), through the network on veterans health ... should produce a Mental Health Action Plan for the long-term delivery of services and support.”

I look forward to hearing the considerations of the armed forces and veterans health joint group before taking next steps.

I am confident that many of the key themes and 40 actions in the Scottish Government’s 10-year mental health strategy will impact positively on veterans and their families and will lead to improvement in many of the areas that the commissioner and veterans have identified as important. The strategy seeks to ensure equal access to the most effective and safest care and treatment, a reduction in the variation of care that can be experienced, and improvements in the quality of care, measuring health outcomes and tackling stigma and discrimination.

To support improvements, in 2017-18 I expect that NHS investment in mental health will exceed £1 billion for the first time. I also secured additional funding in the Scottish budget for an additional 800 mental health professionals over the next five years in key areas such as accident and emergency and GP practices. That funding, and other investments in mental health, will help to drive improvement across the system, including for veterans and their families.

I acknowledge the commissioner’s call to protect specialist mental health services. He mentions specifically those services that are provided by Combat Stress and veterans first point. The funding available to support veterans’ mental health through veterans first point and Combat Stress will total over £5.8 million over the next three years. I hope that that demonstrates our commitment to improving mental health services for veterans and I look forward to considering what further help and support we can offer.

I thank Eric Fraser again for his important work in highlighting not only the excellent services that are already in place, but how we can continue to ensure equitable and high-quality services for our veterans. We have much to be proud of, but we should not be complacent. We will consider the findings and recommendations carefully, including how we respond to the challenges that have been raised.

The next update to Parliament, which will be in autumn 2018, will provide an opportunity to demonstrate what we have done and our future intentions in responding to this latest report on veterans’ health and wellbeing.

The cabinet secretary will now take questions on the issues raised in her statement. I intend to allow about 20 minutes for questions, after which we must move to the next item of business.

I thank the cabinet secretary for advance sight of her statement. I join her in thanking Eric Fraser, the Scottish veterans commissioner, for his latest report, and I welcome his recommendations.

A YouGov survey for the Soldiers, Sailors, Airmen and Families Association found these startling facts about veterans: 34 per cent felt overwhelmed by negative feelings and 27 per cent admitted that they had had suicidal thoughts after finishing military service. That shows that we need to do more for the mental health of our veterans community.

The cabinet secretary spoke about improving mental health services for veterans, which I strongly welcome. She also spoke about the funding that the Scottish Government provides for veterans first point centres, which play a vital role in the healthcare of veterans—particularly with regard to mental health—in the areas in which they operate. The cabinet secretary will know that the programme is jointly funded, with half of the money coming from the Government and half of it coming from the health boards. However, I have become aware that veterans first point is being considered for cuts by some health boards, which would result in some centres being lost to their areas. We have already lost veterans first point services in Highland and in Grampian. Will the cabinet secretary today commit to ensuring that veterans first point does not decline in size any further? My aspiration is for veterans first point services to cover the entire country and be available to all veterans in Scotland.

I welcome Eric Fraser to the public gallery—I have just been made aware that he is there—and I hope that he finds the proceedings interesting.

Maurice Corry is aware—-I hope—of the background to the funding of veterans first point and the history of LIBOR funding. When that funding came to an end last year, the understanding that local partnerships would ensure that services became self-sustaining did not materialise, and the Government stepped in to offer partnership funding. It is important to understand the background of the LIBOR funding.

Veterans first point is a network of NHS-led services across six areas in Scotland. Those areas are important, and I have heard nothing to suggest that the services will not continue with joint funding. Mr Corry mentioned issues in Grampian and in Highland. He will be aware that NHS Grampian has enhanced its service through a new venture with the Defence Medical Welfare Service to ensure that older veterans and their families in the north-east with particular needs will have access to support when they are faced with challenges. I do not know whether Mr Corry is aware that a further LIBOR grant of more than £1 million has recently been awarded in Highland. Veterans first point is discussing how to move that forward with a national third sector provider, and I hope that good news will emanate in that respect.

Mr Corry will also be aware that some boards have never been part of the LIBOR funding so have always had their own services for veterans. That is okay. As cabinet secretary, I want services to support veterans, whether those are delivered through veterans first point or through other services. What is important is not who provides the services or how they are provided but the fact that they are provided.

We provide £825,000 to support veterans first point services, and that has been match funded by the boards. I will follow the matter up and make sure that the boards that have committed that match funding continue to do so.

On a point of order, Presiding Officer. I declare that I am a veteran.

Thank you very much.

I join the cabinet secretary in recognising the contribution of our armed forces community, our veterans and their families. I welcome Eric Fraser’s report and the cabinet secretary’s statement.

This week is mental health awareness week, so I will focus my remarks on that issue. One of the report’s recommendations is a new national action plan. The report highlights that funding is at times disjointed and ad hoc, particularly for specialist services. It raises concerns about geographic inequalities in services and highlights a recurring theme among veterans that mainstream NHS service providers do not always understand the specific needs and experiences of veterans. The report goes on to stress the importance of the suicide prevention plan and the substance misuse strategy. Will all those issues be considered by the new national action plan? What is the timeframe for its delivery?

As I said in my statement, Scotland’s 10-year mental health strategy, which was launched last year, reinforces our commitment to the armed forces covenant and includes a range of actions to improve care services and support for people with a mental health problem, including veterans and their families. Obviously, some of that work is already under way.

The recommendations on the process going forward are being looked at in detail. The mental health action plan is a key element, and we will take that forward through the network on veterans’ health, which I think is the best forum to use. It is for the network to set out the timeframe, ensuring that it has enough time to make the action plan as good as it can be and that it addresses the recommendations and the issues that have been raised in the report.

It is worth pointing out that specialist services of a very high quality are already provided. Combat Stress provides a 24-hour helpline for veterans or their family members who need to talk about mental health. That is a very good service that is provided by a first-class organisation.

Eleven members wish to ask questions. I ask for succinct questions and answers that reciprocate.

I thank the Scottish veterans commissioner, Eric Fraser, for another valuable report, which this time is on the health and wellbeing of veterans, and I thank the cabinet secretary for her supportive statement.

I welcome the commitment to launching an awareness-raising campaign in June, which is needed in rural areas, in particular. We must make every effort to ensure that veterans in places such as Moray, where there are thousands of veterans, are aware of the services that are out there. Perhaps the cabinet secretary can speak to Veterans Scotland about how to do that in the foreseeable future.

The awareness-raising campaign is an opportunity to make veterans and their families aware of the range of services that I talked about in my statement and that members have mentioned. Armed forces day, which is next month, provides an opportunity for those services to be highlighted. The awareness-raising campaign will be very important in making people aware of services, and we fully support it.

I declare that I am a veteran.

The report identifies that many servicemen have been exposed to

“combat, harsh physical conditions, stressful situations and a lifestyle that has had a detrimental effect on their long-term ... wellbeing.”

The wellbeing and mental health of such servicemen is constantly being challenged by historic allegations being levied against individuals. Does the cabinet secretary agree with me that there should be a statute of limitations in relation to historic allegations, and will she write to the Ministry of Defence supporting moves to enforce such a limitation?

That is a bit outwith the scope of my statement, but I will certainly get the relevant minister to write to Edward Mountain on that subject.

I agree with Edward Mountain that many veterans have specific needs relating to their wellbeing and mental health, although many veterans come out of the forces and adjust very well to civilian life. For those who need support, whether it is with post-traumatic stress disorder or with other issues, it is important that the sharing of records happens quickly so that information on health is transferred quickly. That needs to be improved in order that veterans who need that support get it as quickly as possible.

My question follows on from that answer. Does the cabinet secretary agree that, if veterans are to receive appropriate care and the support that they need, it is absolutely essential that the MOD passes on full and accurate medical records when requested? I understand that that is still not a given.

We have been pressing United Kingdom Government ministers for some time on the need to improve the process of transferring the medical records of personnel who are leaving the services. Officials continue to engage with NHS Digital about programme cortisone, which will deliver an integrated, compatible, data-sharing capability in the NHS. The importance of that programme in assisting the transfer of prior medical history and in ensuring continuity of care after service cannot be overstated.

I also welcome the constructive and positive report from the Scottish veterans commissioner. I welcome him to the gallery.

In my postbag, I have a number of issues from veterans, particularly from those who suffer from complex post-traumatic stress disorders. Is the cabinet secretary willing to ask Healthcare Improvement Scotland to look at doing some detailed work on that issue for those veterans who suffer from that complex and difficult condition?

Yes, and a range of evidence-based treatments are available and can be tailored to the patient’s needs for PTSD that has been determined by clinicians, based on a detailed assessment. Those treatments vary from low to medium-level interventions that are available on the NHS to more specialised care and treatments. As I mentioned earlier, we also continue to fund the provision of specialist and community mental health services by Combat Stress, which has a lot of experience in that area. It has a residential facility for those for whom that would be the most appropriate treatment. We funded that to the tune of £1.4 million this year. I am happy to make sure that we keep those issues under review.

The commissioner’s report highlights early service leavers who leave the military voluntarily before completing the minimum four-year term as being at particular risk. What steps is the Government taking to ensure that this vulnerable group of people has access to the best quality care during their lifetimes?

It is important to note that early leavers, as Mark Ruskell describes them, are a particularly vulnerable group, and the right services have to be provided for them quickly. Part of that comes back to the sharing of information so that services can kick in quickly. The services that are provided by Veterans First Point or Combat Stress have a particular focus and a lot of them involve peer support so that people who understand can offer help. A lot of third sector support is also available. The short answer is yes, but the commissioner’s report points us to where we can do better for that particularly vulnerable group.

It is a source of collective shame that veterans are more likely than most to join the ranks of our homeless population. Given the causal link between mental ill health and homelessness, what action is the Scottish Government taking to help homeless veterans, particularly those who are struggling with mental ill health?

Alex Cole-Hamilton has pointed to a particularly vulnerable group of veterans. What I have laid out here today is our response on health and social care support issues. The member will be aware that there is much more support for veterans in Scotland. We have a strong track record of supporting the veterans’ community. Since its creation in 2008, the Scottish veterans fund has committed more than £1.3 million to more than 150 projects and organisations that support veterans across Scotland. Some of that will be in the area of housing and homelessness prevention that Alex Cole-Hamilton asked about. I would be happy to provide further detail on homelessness to Alex Cole-Hamilton.

Does the cabinet secretary accept that, although employment is not specifically about health, it impacts on and affects people’s health? I accept that it is not under the cabinet secretary’s specific remit.

Keith Brown is the Cabinet Secretary for Economy, Jobs and Fair Work, and he has overall responsibility in Government for veterans. He gave a full update to Parliament last November on the recommendations in the commissioner’s report on transition, the provision of housing information, and employability, skills and learning. He will provide a further update this autumn. A lot of work is being done in the sphere of helping veterans to move on and create new opportunities in civilian life, and employability, skills and learning opportunities are an important part of that.

Does the cabinet secretary agree that, in delivering the best treatment, care and support for our veterans, we should be cognisant of the Scottish Association for Mental Health’s assertion that inclusivity and physical activity are key elements of ensuring good mental health? We have witnessed the incredible impact of things such as the Invictus games on this community and on raising awareness of it. With that in mind, will the cabinet secretary join my colleagues and me in our enthusiasm in calling for the Invictus games to be hosted in Scotland?

The Scottish Government acknowledges the power of sport and its impact on our lives and on the lives of injured servicemen and women. Over the coming weeks, we will be speaking to partners to scope out what a potential bid for Scotland to host a future games would entail, and I would be happy to keep Brian Whittle informed as those discussions go forward.

Can the cabinet secretary provide details on what is being done to ensure that physically injured veterans benefit from the latest technology in order to allow them to regain and maintain their mobility?

In my statement, I talked about the investments that have been made in prosthetics services to ensure that cases are turned around quickly and that high-quality provision is made. A lot of investment has been made there to support veterans with specific needs who have disabilities because of their service. The commissioner’s report lays out a number of recommendations that will improve not just the physical health but also the mental health of veterans, and we are determined to take forward those recommendations.

Members will note my interest in and personal experience of attention deficit hyperactivity disorder. Other members have rightly raised questions about mental health for veterans. Those mental health issues are often impacted by, or have underlying causes in, neurodevelopmental disorders such as ADHD and autism spectrum disorders, and the case study in the report is useful in highlighting those issues. What help and support will be extended by the Scottish Government to veterans with neurodevelopmental disorders such as ADHD in the improved mental health services for veterans?

That is an issue that we would expect the new mental health action plan to consider, but I will certainly ensure that that message is passed on, so that that point is captured in the work on the action plan.

I draw members’ attention to my entry in the register of members’ interests, in that I hold an honorary contract with NHS Greater Glasgow and Clyde.

Recommendation 4 of the report would establish a national managed clinical network on veterans’ health, based on evidence from the existing managed clinical network on perinatal mental health. Can the cabinet secretary provide an early comment on her consideration of that recommendation?

We absolutely recognise the importance of supporting veterans’ long-term healthcare needs. As I said in my statement, we are in the initial stages of exploring with NHS National Services Scotland the option of developing a managed network approach as a longer-term solution to equitable and sustainable health services for veterans. There is a process involved, which I laid out in my statement, but NHS National Services Scotland will shortly provide advice on the necessary set-up requirements and the next steps before we progress further. I would be happy to keep Clare Haughey informed of that work as it goes forward.

That concludes questions on the statement. I am pleased to say that all members had the opportunity to ask their questions.