Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: November 2020

Attendees and apologies

Name	Organisation	Attending / Deputy / Apologies
Jason Leitch	Scottish Government Clinical Director of Healthcare Quality and Improvement (Chair)	Attended
Neil Morrison	Veterans Scotland – Health representative	Attended
Ian Cumming	Third sector representative: Erskine	Apologies given
Mairi McKinley	NHS Fife Armed Forces and Veterans Champion	Attended
Claire Wood	NHS Highland Armed Forces and Veterans Champion	Attended
Craig Cunningham	NHS Lanarkshire Armed Forces and Veterans Champion	Apologies given
Sharon Callaghan	Regional Clinical Directors Operations Manager, MOD	Attended
Martin Bell	NHS Champion, NHS National Services Scotland	Attended
Kate Burley	Scottish Veterans Care Network	Attended
Lucy Abraham	Scottish Veterans Care Network	Attended
Katie Hislop	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Michael Ross	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Ruth Jays	Unit Head, Person Centred Healthcare and Participation Unit, Scottish Government	Attended
Annalena Winslow	Team Leader, Armed Forces and Veterans Healthcare policy team, Scottish Government	Attended
Shaun Cauvin	Veterans Scotland	Attended
Amanda Cronin	Improvement Advisor, Scottish Government	Attended

Items and actions

1. Welcome, Introductions and Apologies

Jason Leitch, Chair, welcomed members to the meeting. As some attendees were new to the Group, members introduced themselves.

2. Minutes of the last meeting, 1 September 2020

The minutes of the September meeting were approved.

3. Priority Areas for 2020-21

Jason Leitch referred to the Strategic Oversight Group (SOG) of 1 October which he felt had gone well, and reflected that he was particularly pleased with the progress of the Scottish Veterans Care Network (SVCN). He reminded the Group of the priority areas for 2020-21 identified at the SOG meeting, which will be taken forward by the Implementation Group (IG), to report back to the SOG in May 2021. These are:

• Priority Treatment – constituting 3 streams: messaging, identifying veterans and access to services for veterans post-COVID-19
• Employability of veterans within the NHS
• Mental Health

Jason informed the Group that he had recently discussed these priorities with the Scottish Veterans Commissioner (SVC), who indicated that these aligned with his own priorities. During this conversation, the SVC reflected very positively on the SOG and IG, offering that he would be pleased to engage at any time. The SVC also indicated to Jason his intention to produce three reports in 2021 – in order of publication, these will be on employability, housing and health.

Jason invited views from the group about how to approach these new priorities.

Employability of veterans within the NHS

Neil Morrison suggested that Shaun Cauvin might offer views, as his responsibilities in Veterans Scotland include employability. Shaun provided insight on methods to increase the visibility of NHS jobs for service leavers. It was recognised that the process of advertising vacancies on NHS Board websites may require review and that this may be taken forward with the NHS Scotland (NES) and Career Transition Partnership (CTP).

It was recognised that the employability work stream also includes greater complexities and supplementary work on explaining the applicability of transferrable skill sets to veterans and service leavers, and presenting jobs for young service leavers as a second career path is also of importance.

Claire Wood advised that forms of apprenticeships have been successful and suggested that it may be worth exploring increasing such opportunities.

There was agreement that a “task and finish” group would be set up to progress the employability work and report back to the Implementation Group (IG) with recommendations. In taking forward this work, Jason suggested that the IG can offer support where any escalation is required.

Shaun, Claire and Sharon offered to input into the project group. Katie Hislop suggested that cross-Scottish Government links would be drawn in, to ensure the appropriate policy expertise.

Mental Health

Jason reflected on the positive direction of the SVCN and referred to a discussion at the 1 September IG meeting and the 1 October SOG meeting, where the continued funding of Veteran First Point (V1P) had been raised. Jason informed the Group that positive progress was being made on this issue and that more information would be available soon.

Priority Treatment

Ruth Jays reflected on whether work on Priority Treatment may have to wait until the UK Government legislation on the Armed Forces Covenant, which will impact public services in Scotland, has been passed – possibly the end of 2021. Concerns were raised about the possibility of the legislative timetable being further delayed and the impact this may have on progressing the work stream, if the IG were to wait until the legislation is in place. In terms of messaging, Katie Hislop added that there will be a Scottish policy document and guidance to accompany the legislation, so it would be important for our messaging on Priority Treatment to align and complement these documents. Jason said that, this aside, it is important not to lose momentum.

Neil suggested revisiting previously agreed work on reviewing and updating the 2018 guidance on the role of Champions and the Covenant. Neil noted this may also be impacted by the Covenant legislation but, in general, priority treatment is a clearly defined area that is unlikely to change after the legislation. Neil also referred to the Pan-UK working group on Priority Treatment which concluded earlier this year. The intention is for this working group to continue on a bi-annual basis, so that best practice can be shared across the UK.

Martin Bell suggested that veterans’ access to services and waiting lists, in relation to remobilisation of the NHS, could be drawn into discussions at NHS Chief Executive level. Jason is involved in these discussions.

On all of these priorities, Jason suggested that an update should be provided to the NHS Champions Network, which is due to reconvene on Monday 23 November.

The Group agreed to keep this priority work stream under review due to the uncertainty around the impact of the legislation.

Action: Secretariat to establish an employability project group from those who offered to participate, alongside expertise from across the Scottish Government.

Action: Secretariat to ascertain whether the UK Priority Treatment working group will meet again before the next IG meeting.  If so, an update can be provided.

Action: Secretariat to provide an update to the NHS Champions Network on 23 November on the achievements and priorities of the SOG and IG.

Action: Secretariat to review and re-issue the 2018 Champions guidance.

4. Identifying Veterans

This issue is part of the Priority Treatment 2020/21 priority and has been discussed within the IG on a number of occasions. Members had been provided an advance copy of a scoping paper, seeking approval to proceed with a project in NHS Fife using Quality Improvement methodology. Amanda Cronin provided a summary of the paper, and Mairi McKinley referred to initial data gathered from a small group of GP practices in Fife.

Proposals include working with NHS Scotland, MOD and Scottish Government e-health colleagues to gather data and work up a specific ask that could be put to a small group of practices within NHS Fife on three strands:

• Identifying veterans within the practice and coding them as such on patient records within the SCI Gateway system
• Educating practice managers and GPs on the importance of recording this status when a veteran registers
• Looking at how this information may transfer to the Trakcare system when an individual is accessing secondary care

It was proposed that support would be sought from NHS Fife Improvement Service and Healthcare Improvement Scotland.

Amanda referred to a potential global aim for this to be spread within NHS Fife and then nationally, at which point the Implementation Group may want to engage the Scottish Veterans Care Network. Katie has begun linking the SVCN in to this work.

Mairi explained that a mix of practices had voluntarily provided data, supporting the sense that there appears to be a local desire for this work. Taking forward this project will require practices to be proactive, so it is encouraging that there is such an appetite.

Neil referred to the MOD sending veterans records electronically to GP surgeries, and anecdotal evidence that this is more effective in NHS England than in Scotland.  He suggested that including work on this issue would be a positive move. Mairi clarified that the project would initially look at veterans who have been out of the services and in the Scottish primary care system for some years, therefore identifying veterans in the community, rather than focussing on electronic records for service leavers. Amanda said a two-pronged approach may be possible, covering the introduction of electronic records to identify recent service leavers in addition to the primary aim of seeking to clarify the status of veterans already within the system, which will achieve referral pathways and enable a gateway for conversations on veteran status.

The group agreed the work should proceed as described, noting that the issue of identifying veterans has been consistently raised as a stumbling block to veterans accessing the services that they are entitled to.

Action: Secretariat, Amanda and Mairi to work on next steps, reporting progress back to the IG.

5. Outstanding work from 2019-20

A paper had been provided to members in advance, setting out work that had been taken forward by the IG in 2019/20 but could not be concluded earlier in the year. Katie spoke to this paper, seeking to establish a route forward for each work area. The agreed approach is as follows:

• Wheelchairs – The letter to Territorial Boards was not sent. This should be quick to complete. SG colleagues with responsibility for wheelchair policy are poised to initiate the wider work.
• Hearing Aids – Evaluation and information-gathering work to measure the impact of the IG’s direction will be progressed. Anecdotal evidence suggests that there may be more work needed to this issue.
• Champions Network – Reconvening on the 23 November 2020.
• Veterans Aware Hospital accreditation – There is still the desire to progress this, but agreed that it will be picked up at a later date.
• Orthopaedic pathway pilot for Serving Personnel – NHS Lothian have indicated they may be able to resume the pilot that was previously paused due to COVID-19, therefore the IG can expect to receive a report once the pilot has been evaluated. The Armed Forces and Veterans policy team are involved, to support as needed.

Action: Secretariat to progress each of these as set out above.  In relation to Veterans Aware Hospital accreditation, Secretariat to ensure this subject remains within IG discussions, so that work can resume when there is capacity to do so.

6. Scottish Veterans Care Network – Update

Lucy provide an update on the Scottish Veterans Care Network (SCVN):

• In order to support our virtual launch, filming for a short video about the SVCN has been completed.  Lucy thanked those AFV Implementation Group members who participated in the video.
• The SVCN team have been busy organising the virtual launch event scheduled for 19 November and encouraged all attendees to participate in the event and to share it with all interested parties. Over 100 delegates from a range of organisations; third sector, NHS, MoD as well as veterans themselves have registered. The event will be an opportunity to hear about the plans for the Network as well as for our partners to shape and inform the Network’s work programme.
• Work has been progressing on the first stage of the service mapping, which is to develop a pro-forma to collect the data. The pro-forma is being refined and will be tested by partners shortly and ratified by facet working group members in due course.
• The website is in development and it is hoped that this will be a comprehensive resource for partners to use on services available in Scotland and plan to launch this as part of our event next week.  
• The Network’s governance structure has been established, with the first meeting of the Oversight Board will take place on 26 November. This meeting will be chaired by Pauline Howie, Chief Executive of the Scottish Ambulance Service on behalf of the NHS Board Chief Executives Group. Members of the Oversight Board include Health and Social Care Partnerships, MoD, Veterans Scotland, COSLA.

Members welcomed news from Kate Burley that the Vice-Chair of the network is Eddie Fraser, Chief Operating Officer of East Ayrshire Integration Joint Board.

7. Next meeting

It was agreed that the group would meet at the end of January and the end of April, which provides two meetings before the next SOG in May.

Action: Secretariat to identify future dates and distribute invites.