The physical health and wellbeing of veterans

Michael Almond, Professor of Veterans & Families Studies and wing commander, talks about the importance of the Armed Forces Covenant, and why it is essential NHS organisations ensure they are providing the best possible support and services for veterans.

Michael is The Forces in Mind Trust Professor of Veterans and Families Studies in the Faculty of Health, Education, Medicine and Social Care at Anglia Ruskin University.

Quite appropriately attention is drawn to those veterans suffering from physical wounds and with mental health problems directly attributable to service in the Armed Forces. However, a much larger veteran community exists with physical problems no different to the general population.

A recent YouGov report [1] identified that the majority of the general public believes that people serving with the armed forces are associated with positive attributes: bravery and discipline being the two most frequently quoted. After transition to civilian life, however, negative associations are also common: disabled, maladjusted or mentally damaged and particularly post-traumatic distress disorder feature prominently.

Additional factors negatively associated with post military service on personal wellbeing are difficulties in finding a good job, homelessness and alcohol or substance misuse. 

However, with an estimated 2.5 million veterans in the UK, almost 50% of whom are over 75 years of age [3], the physical health needs of veterans are actually very similar to those of the general ageing population: typically including difficulties with mobility, visual and hearing impairment and difficulties with self-care. [4]

Michael Almond, Professor of Veterans & Families Studies and wing commander.

However, with an estimated 2.5 million veterans in the UK, almost 50% of whom are over 75 years of age [3], the physical health needs of veterans are actually very similar to those of the general ageing population: typically including difficulties with mobility, visual and hearing impairment and difficulties with self-care [4].

It’s important to note as little as one day’s service, regular or reserve, is sufficient to qualify as a veteran. Veterans spread across a diverse range of the population, including women and younger people who have served, but are predominately still male and reflect those who served in World War 2 or during National Service, the last those leaving in 1963. 

A recent survey of veterans, shows that despite YouGov opinions, veterans themselves report no higher incidence of ill health than the general population, are just as likely to be in employment (if they are of working age) and enjoy similar rates of home occupation, with 99% either buying or renting even when comparisons were made by age and region.

The Armed Forces Covenant [6] is a simple document that includes the statement, ‘Those who serve in the Armed Forces, whether regular or reserve, those who have served in the past, and their families, should face no disadvantage compared to other citizens in the provision of public and commercial services.’ 

It goes on to state that the Armed Forces community should ‘enjoy the same standard of, and access to, healthcare as that received by any other UK citizen in the area they live and retain NHS waiting list positions should they have to move due to the Service person being posted. Veterans should also receive priority treatment where it relates to a condition which results from their service in the Armed Forces, subject to clinical need.'  So how does the NHS ensure that veterans are catered for in the way the Covenant outlines?

The NHS’s response is to have organisations sign up to The Covenant and for secondary care providers to become Veteran Aware Hospitals [7], and in so doing be accredited as exemplars in delivering the best care for veterans and help drive improvements in NHS care for people who serve or have served in the UK Armed Forces and their families.

Michael Almond, Professor of Veterans & Families Studies and wing commander.

The NHS’s response is to have organisations sign up to The Covenant and for secondary care providers to become Veteran Aware Hospitals [7], and in so doing be accredited as exemplars in delivering the best care for veterans and help drive improvements in NHS care for people who serve or have served in the UK Armed Forces and their families.
 
Unfortunately, the evidence from a recent enquiry into the is that both the spirit and intent of the covenant is not being met either in primary or secondary care [8]. This study demonstrated the variations in performance of NHS Trusts and CCGs in relation to The Armed Forces Covenant. Inconsistencies arose in the response to the Freedom of Information requests, the appointment of a veteran lead, the job roles of the veteran lead and the commissioning of veteran-specific services.

A more positive picture is, however, painted in The Armed Forces Covenant Annual Report 2018/2019 where details of access to health care and specialist services provided in England, Scotland, Wales and Northern Ireland demonstrate as good as or better provision for veterans compared to non-veterans.

The charitable sector has specific support for serving personnel, veterans and their families with physical health needs. One report [10] indicates this sector (121 charities) administered £103M in one year for physical health alone. Twice that of mental health, housing and education combined. Only 17% of the veteran charities responsible for physical health deliver services directly administered by a health-care professional, demonstrating a need for the third sector to work in close collaboration with NHS professionals for an effective delivery of support.

How does this affect the RCP, and its members and fellows?

Firstly look around your workplace. Your clinical junior, nurse, paramedic, receptionist or manager may be a veteran, probably those demonstrating above average teamwork skills, social perceptiveness, flexibility, resilience, critical thinking, and decision making.

The patient you are about to see may be a veteran, including the 30 year old lady requiring advice and support; ask. You may learn of their experiences and their veteran status may open access to bespoke services and a need for or an ability to expedite care and or discharge in line with The Covenant.

Next, ask your NHS organisation if it has signed The Covenant. Is it taking the appropriate steps to become a Veteran Aware organisation or commissioning veteran-specific services? If not, why not?

Correspondence

Prof. Michael Almond QVRM AE DM FRCP VR
Forces in Mind Trust Professor of Veterans and Families Studies
Veterans & Families Institute for Military Social Research
Forces in Mind Trust Research Centre
Anglia Ruskin University
Michael Salmon Building
Chelmsford Campus
Bishop Hall Lane
Chelmsford CM1 1SQ
Email: michael.almond@anglia.ac.uk

References

1. Latter J, Powell T and Ward N. 2018. Public perceptions of veterans and the armed forces. YouGov research report. 

2. British Veterans. 

3. Population Projections: UK Armed Forces Veterans residing in Great Britain, 2016 to 2028. Ministry of Defence published 10 Jan 2019.  

4. A UK Household Survey of The Ex-Service Community. 2014. The Royal British Legion.  

5. Annual Population Survey: UK Armed Forces Veterans residing in Great Britain, 2017.  Published 31 January 2019.  

6. The Armed Forces Covenant

7. NHS Improvement. Updated 9 November 2018

8. McGill G, Wilson G, Hill M, et al. Utilisation of the principles of the Armed Forces Covenant in NHS Trusts and Clinical Commissioning Groups across England: a freedom of information investigation. BMJ Open 2019; 9:bmjopen-2018-022053. doi: 10.1136/bmjopen-2018-022053

9. The Armed Forces Covenant Annual Report 2018. 

10. Doherty, R., Robson, A. and Cole, S., 2018. Focus On: Armed Forces Charities' Physical Health Provision. London: Directory of Social Change. 2018.