Armed Forces Personnel and Veterans Health Joint Group Implementation Group minutes: 5 March 2025

Attendees and apologies

•    John Harden (Chair), National Clinical Lead for Quality and Safety, Scottish Government
•    Martin Bell, Veterans Scotland, Health Representative
•    Sharon Callaghan, Operations Manager Scotland, Defence Primary Healthcare (Scotland & North)
•    Robert Reid, Director, Scotland NI and the Military, Defence Medical Welfare Service (DMWS)
•    Craig Murney, NHS National Services Scotland (NSS) Armed Forces and Veterans Champion
•    Ian Cumming, Third Sector Representative: Erskine
•    Jo McBain, NHS Highland Armed Forces and Veterans Champion

Official support: 

•    Stephanie Johnstone (Secretariat), Armed Forces and Veterans Healthcare policy team, Scottish Government 
•    John Wilson, Long Term Conditions Policy, Scottish Government

Guests:

•    Kari Magee, NHS Highland Armed Forces and Veteran Project Manager
•    Mark Fergusson, Senior Policy Manager: Survivor Support, Scottish Government

Apologies: 

•    Gary Cocker, Person Centred, Participation and Sponsorship Unit, Scottish Government
•    Andrew Carter, NHS Borders Armed Forces and Veterans Champion 
•    Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion 
•    Mairi McKinley, NHS Fife Armed Forces and Veterans Champion
•    Col Kate Nicholson, Regional Clinical Director for Defence Primary Healthcare
•    Maura Lynch, Trauma, Adverse Childhood Experiences and Resilience Unit, Scottish Government

Items and actions

Welcome and apologies 

John welcomed all to the group particularly Martin Bell in his new role at Veterans Scotland and noted the apologies. 

Brief roundtable catch up 

John invited the group share any issues they were facing. 

Ian Cumming updated on an issue with the national care home contract and care packages for veterans. Shifting demographics had allowed for changes in business activity at the charity, however, the charity had also experienced an increasing call for care provided in the community. 

A new Erskine Veterans Activity Centre (EVAC) had been established in Forres with positive feedback received. Erskine were seeking to provide a similar facility in the East in the future. The Support at Home service which had provided support with mobility had received very positive feedback. Plans to reach out to 100 participants and to scale-up, linked to EVAC location were being developed.

Work was also being taken forward on 24 apartments focussed on veterans transitioning to the community with the possible inclusion of an all-female corridor.

Craig Murney talked on the positive recruitment of a veteran internship with a view to extending the term for this. In addition he mentioned the possibility of further development around an unpaid internship. 

The group discussed the difference veterans can make in employment, particularly in social care. 

Jo McBain informed the group that work was progressing to build-in business-as-usual process to support the community during the winding-down of the Armed Forces Covenant project. Project infrastructure and process would be a focus during this phase and would include General Practice (GP) training, canvassing colleagues views and what work had been taken forward nationally. 

Discussion with Help with Heroes had already taken place. Work with Historic Scotland on employment of veterans was reported on. Staff moves were discussed with a colleague moving post and two interns now employed with governance being looked at through NHS NSS, the Champions Network and this group. 

Martin suggested the governance home for interns would be NHS Education for Scotland (NES) and agreed to share Jo’s update with colleagues at NES regarding the employment work programme. Martin also noted that training modules for GPs needed to be added to, to align more with the Lord Etherton report / rest of the UK (LGBTQIA+ considerations) and two volunteers were available to progress this with NHS Highland. 

Funding for the armed services employment programme was scheduled to end in 2027 and would require consolidation to address issues such as skills recognition and job equivalence to an armed forces role.

Bob Reid highlighted that he would keep the group informed on the any potential withdrawal of services in the Borders. A plan to expand services in Tayside was ongoing with plans for funding also proceeding. 

Craig Cunningham was also progressing work linked to this. A bid for Veterans First Point (V1P) contract had been successful with Transfer of Undertakings Protection of Employment issues to be progressed and an update to be provided for the next meeting. 

Bob also updated on two projects with Vector 24 to provide services in the Borders. One of these, Affirm, was a three year funded project run with the Scottish Ambulance Service (SAS) looking at medical and welfare issues for veterans. It was envisioned that once embedded with the SAS, then Police Scotland and Scottish Fire and Rescue Service engagement would be sought. 

Work with the Scottish Government was also taking place around a test of change in mental health. Bob welcomed suggestions on these projects and updated on training modules for blue-light services. 

John Harden thanked Bob for this and suggested that these modules should also be shared with the emergency departments to strengthen connections with colleagues.

Sharon Callaghan updated that Colonel Kate Nicholson was the new Regional Clinical Director for Defence Primary Healthcare and hoped that she would be able to join the next meeting of the Strategic Overisight Group (SOG). 

Director Defence Healthcare, Air-Vice Marshall David McLaughlin hoped to visit Scotland in May with dates on hold in calendars. 

Martin Bell confirmed he had been in post at Veterans Scotland for three months. The charity focussed on three themes to support veterans; housing and employment, health and wellbeing and comradeship and remembrance. 

Martin reported on a positive recent cross party group meeting focussed on employment issues. The charity’s Health and Wellbeing Committee was scheduled to meet next on 19 March and would move to an action point based approach. 

Martin spoke on a lack of ‘Yellow pages’ support for veteran services.  Discussion on social prescribing with GPs had elicited a similar response and request to link veterans to a single point source for support. 

Going forward, the charity had also been awarded a grant to support engagement with statutory bodies regarding the covenant over the next 24 months. An aim would be to develop a one-stop shop to sign-post support. Ian Cumming informed the group that the Star and Garter charity in England had been in touch to discuss a veteran friendly framework and the potential for linkage to the Veterans Scotland work and formal support in Scotland. 

Jo McBain added that regarding social prescribing and one-stop shops, a refresh of the ALISS (A Local Information System for Scotland) platform was currently taking place and may offer the possibility of support for the work described. The use of Google interactive maps was also discussed. 

Stephanie provided an update on behalf of Craig Cunningham. Craig had asked for confirmation of funding for V1P psychologists. He also provided an updated that DMWS were now going to provide peer support for V1P in Lanarkshire taking over from Lanarkshire Association for Mental Health. 

An issue on a lack of national agreement for prosthesis for veterans was raised and the potential route to a national solution. There was discussion on the status of current provision which was on a case by case basis with costs met by individual Boards. 

Update on IG Priorities 

Stephanie introduced herself to the group as the new policy contact within Scottish Government for Armed Forces and Veterans Healthcare and gave the progress update on current priorities. 

General Practice Armed Forces and Veterans Recognition Scheme

Stephanie explained that she is looking to promote training into secondary care and working on promoting further within Primary Care. 

A meeting with Veterans Covenant Healthcare Alliance (VCHA) is planned to understand how they achieved the roll out of secondary care training for the Veteran Aware scheme. She also explained that Mr Dey would be writing to MSP’s to promote the scheme to highlight its importance to their local GP practices.  

It was highlighted that there was some issues with collecting information on what GP Practice the trainer is from. Stephanie is actively looking into a solution with NHS Highland. 

She explained that she is also working on logo design for the GP scheme and hopefully be able to roll out a poster and vinyl stickers for practices who have already completed the training. 

Veterans In Service Injury Network (VISIN)

Stephanie gave a brief update on VISIN as Kari Magee, project co-ordinator for VISIN was due to give a presentation later in the meeting.  She thanked Kari and Jo for the work they had already undertaken. 

The launch of the scheme was discussed and reported that a soft launch would take place in early April. A further launch will take place during Armed Forces Week (22nd – 28th June). Minister will be updated with this information. 

Covenant Standards Framework

Stephanie explained that she will be working on this document at pace. 

From the initial working group meeting, that took place in October 2024 with NHS Highland, VCHA and DMWS, it is envisioned to have four standards which include strategic oversight, level of training, identification of military personnel and links to third sector orgs etc. This may spread out to 5 standards but Stephanie will keep the group informed with any further development.         

MOD Interfaces

Stephanie provided an update on behalf of Dr Ian Thompson who is GP Clinical Lead in Digital Health and Care Directorate, on the work his team is doing to tackle the problems with Ministry of Defence (MOD) / NHS Interfaces which the group heard about in September. 

The group learned that several meetings with MOD personnel had taken place over the last 2 years to look at how to improve the interfaces between MOD and NHS Scotland. What has held things back is frequent changes in personnel and long periods of low activity. 

In 2024, Dr Thompson’s team came up with various ideas around a number of activities that could be undertaken as part of a small project. They will be speaking with the MOD soon where they will ask what progress they have made on their side, that will further inform what we may want to focus on. 

It was noted that the caveat to the project is funding and how much of a priority Health Boards (where there is an MOD base) would place on the necessary digital work that would have to happen.

Update on the Progress of Veterans Mental Health and Wellbeing Pathway

Mark Fergusson, Senior Policy Manager: Survivor Support, Scottish Government reported on progress. 

It was noted that in December, the Ministers approved the Veterans Mental Health and Wellbeing Pathway Advisory Group’s recommended model of delivery for the pathway. This model is a national framework to be applied locally, overseen by a centralised hub. Under this model, a nationally agreed framework would be implemented, with national standards set out that local authorities, third sector partners, and Health Boards / Health and Social Care Partnerships (HSCPs) would then be assessed against. In addition, a national hub would also be introduced to co-ordinate the referrals to local pathways and services.

Scottish Government (SG) officials have now drafted an implementation plan for the pathway. Advisory Group members have until 12 March to provide written feedback and will be the main focus of discussion at the group’s next meeting on 21 March. In April, an updated plan will be presented to the two sub-groups, the Veterans Mental Health and Wellbeing Pathway Operational Working Group and Stakeholder Network, for further comment. A final version of the plan is expected to be submitted to the Ministers in summer.

In addition, Mark explained that Veterans Link Scotland, the veterans lived experience group hosted by SG, continue to meet every two months. The group put together a paper that was presented to the Advisory Group and Operational Working Group for their consideration in January. The paper outlined feedback from the group which included:

• their identified key elements of the pathway
• their identified barriers to accessing mental health services for veterans
• the development of a veterans peer support specification

The feedback will be carefully considered as the implementation plan develops. Veterans Link Scotland are now focusing on developing a peer support specification and model for the pathway to feedback to the Advisory Group. 

Mark also updated the group on A Test of Change Pilot Pathway.  Funding for a three-tiered tests of change pilot veterans mental health pathway has been approved in principle and agreements with service providers are at an advanced stage. 
It was noted that the planned three tiers for the pilot will include a basic level of support (e.g. practical support and befriending); a middle tier of more intensive clinically-informed peer support which is likely to be the standard point of entry); and an upper tier of complex clinical support would be in place. 
The plan is for this pilot to run in three NHS Health Board areas: NHS Dumfries and Galloway; NHS Grampian; and NHS Greater Glasgow & Clyde. The data captured from this pilot will help inform decisions taken by the Advisory. The test of change was awaiting final sign-off from legal colleagues. 

Update to the Strategic Oversight Group (SOG)

Stephanie talked on the scheduled update to the SOG which will take place on 13 May. 

Priority One

To continue to promote the GP recognition scheme and the training for Secondary care with support from;

John Harden noted progress made and the need to continue. Discussion noted the importance of Local Medical Commitees and GP cluster components.

Priority Two

Consider what more can be done to improve the identification of veterans throughout healthcare, particularly on referrals from Primary to Secondary Care.

It was agreed to continue as a priority as work was still ongoing through Dr Thompsons team. 

Priority Three

Once finance approved, oversee the implementation of the VISIN. 

John Harden requested this should be retained, noting the shift from launch into a monitoring phase.

Priority Four

Develop a Covenant Standards Framework. 

It was agreed to retain as a priority.

Priority Five

Explore how forces families are considered in policy delivery and decision making.

It was agreed to retain as a priority, with the scale of the work noted, work taken forward and items to continue.

There was further discussion on prosthetics and evidence on sustainability. Martin Bell offered to engage with Health Boards to establish the status of prosthetic services for veterans. John Harden noted the need to flag to SOG the group’s concerns and need to scope out further. Jo McBain confirmed there were a number of levers to support scoping the current prosthetics service model and that this was also on Allied Health Professionals Director’s radar.

Veterans In Service Injury Network 

Kari Magee presented slides to the group on the VISIN scheme which was due to launch in Spring 2025 and set out the background, purpose, scope of the scheme, the comms policy and steps to the launch. 

It was explained that the Scottish Government had commissioned the project, which is designed to provide independent expert clinical reviews of military service-related injuries, which remain a concern despite treatment and was a new service not done before in Scotland. Support for patient facing Boards had also been discussed when dealing with inquiries.

Jo McBain reported on some feedback regarding the name of the scheme in terms of the use of ‘injury’ in the title and potential connotations. Jo confirmed letters to Board Medical Directors were planned for the launch with the Chair briefed. Discussion on monitoring follow-up for veterans accessing services were ongoing. 

John Harden agreed that the name of the scheme didn’t want to suggest a focus on one aspect of care over another if that was a risk and the group agreed to send suggestions to Kari on potential alternatives.

Any other business and date of next meeting

No other items of business had been raised with Stephanie. 

John Harden confirmed he would be happy to field any queries that today’s meeting had not had time to discuss.

The date of the next meeting would be scoped for August / September. 

Actions 

• John Harden confirmed secretariat would liaise with social care colleagues to explore potential relating to veteran internship
• Stephanie to provide an update to Craig Cunningham on funding confirmation for V1P
• Bob Reid will Share update following V1P bid win for the next meeting of the group
• The Group agreed to maintain the items discussed as priorities and update SOG to reflect this - All
• John Harden and Stephanie Johnstone to highlight to SOG concerns around prosthetic services for veterans and the need to scope out further.