Armed Forces Personnel and Veterans Health Joint Group Implementation Group minutes: March 2023

Attendees and apologies

Attendees

• Jason Leitch (Chair), National Clinical Director, Scottish Government
• Neil Morrison, Veterans Scotland, Health Representative
• Mairi McKinley, NHS Fife Armed Forces and Veterans Champion
• Sharon Callaghan, Operations Manager Scotland, Defence Primary Healthcare (Scotland and North)
• Robert Reid, Regional Manager Scotland and Overseas, Defence Medical Welfare Service (DMWS)
• Andrew Carter, NHS Borders Armed Forces and Veterans Champion
• Jo McBain, NHS Highland Armed Forces and Veterans Champion 
• Martin Bell, Director Primary Care and Counter Fraud Services, NHS National Services Scotland (NSS)
• Craig Cunningham, NHS Lanarkshire Armed Forces and Veterans Champion
• Ian Cumming, Third Sector Representative, Erskine
• Professor Murray Leith, Division of Social Sciences, University of the West of Scotland   
• Mark Fergusson, Senior Policy Manager, Survivor Support and Veterans’ Mental Health, Scottish Government 
• Aleksandra Brokman, Policy Adviser, Trauma, Adverse Childhood Experiences and Resilience Unit, Scottish Government
• Laura-Isabella Muresanu, Armed Forces and Veterans Healthcare policy team, Scottish Government
• Lindsey Restrick, Armed Forces and Veterans Healthcare policy team, Scottish Government
• Gary Cocker, Armed Forces and Veterans Healthcare policy team, Scottish Government 

Apologies

• Lesley McDowall, Head of Survivor Support, Survivor Support and Veterans’ Mental Health, Scottish Government 

Items and actions

Welcome, introductions and apologies

Jason welcomed all to the group and noted the apologies as above.

Brief roundtable catch up 

No update given.

Update on Implementation Group (IG) priorities

Gary gave a progress update on current priorities. Jason invited the group to comment on each priority as the update is given.

Scottish Veterans’ Treatment Pathway (SVTP)

The working group established for supporting the development of this priority has agreed a vision, set of principles, outline pathway process, and governance structure. 

The group has now been paused until August 2023, to allow the time for carrying out actions, and working in tandem with colleagues from Scottish Government Mental Health. As this priority is now tied to the implementation of the Mental Health and Wellbeing Action Plan (MHWAP), the structures that we will be put in place will very much depend on those that will be established by the MHWAP Implementation Board and Implementation Team. 

In the meantime, the team will be engaging with clinicians and working on establishing the membership of the multidisciplinary team (MDT), as well as its operational pattern. 

Jason invited Neil to comment on the pathway. Neil expressed his admiration for the work that Lindsey Restrick has done on developing this priority. Neil noted his concern regarding the current engagement between the Armed Forces and Veterans Healthcare policy team and the MHWAP Implementation Team, as more could be done through collaborative working to ensure that both the physical and mental health pathways are integrated.

Martin agreed that more overlap is needed between the two pathways.

Craig queried whether there is a paper that describes the pathway, and highlighted that in the last three weeks his health board dealt with three difficult cases, where all other options had been exhausted.

Lindsey noted that the pathway is also supposed to help the veteran live well with their condition.

Action point: Scottish Government officials to circulate the documents prepared for the Scottish Veterans’ Treatment Pathway.

The General Practice Armed Forces and Veterans' Recognition Scheme

Gary noted that after concluding an initial development stage, the pilot version of the scheme was launched in December 2022. The pilot is being trialled in 18 practices across nine health boards until April 2023. As part of the pilot, a Turas training website has been developed, containing resources aimed at clinical and non-clinical staff working in a primary care context. Additionally, a registration form is currently in place, providing some insight into present levels of awareness, local procedures, and any areas where practices might benefit from further support. 

Out of the 18 pilot practices, 13 practices from seven health boards have completed the registration form. Scottish Government evaluated the responses, and it seems that while approximately two thirds of practices are aware of how the Armed Forces Covenant applies to veterans, and are actively trying to support their veteran patients, not the same can be said about Armed Forces Families. Except for one practice, none of the others are aware of the rights of service families and the need to code these patients. 

From the responses submitted, practices rely heavily on NHS Inform as a source of information on veterans’ matters, highlighting the importance of keeping this platform updated.

Scottish Government will collect feedback from the pilot practices at the beginning of April 2023. This will be done through a combination of one-to-one meetings and a brief survey. 

Approval has been secured to brand this scheme as an NHS Scotland and Healthier Scotland initiative, and the NHS Scotland and Healthier Scotland logos will be used on all subsequent communications and promotional materials. This will be reviewed in January 2024, in case there will be any further changes. As it currently stands, the Scottish Government will continue to be the administrator of the scheme. The scheme will be launched nationally in the second half of 2023.

There is also an opportunity to extend the learning programme prepared for this scheme into secondary care. Colleagues from NHS Greater Glasgow and Clyde and Defence Medical Welfare Services (DMWS) have proposed to collaborate with Scottish Government on this matter.

Laura mentioned that another future consideration for this scheme will be its extension to healthcare providers in the criminal justice system.

Fife Coding Project 

Gary mentioned that the feedback from the Fife practice has indicated that the process to re-code is very straightforward, and this has been confirmed by other practices. 

To ensure that all General Practices across Scotland are coding veterans and service families consistently and correctly, the group proposes issuing a letter from the National Clinical Director with a set of recommendations. These recommendations would represent the minimum that practices would be advised to do. The General Practice Armed Forces and Veterans’ Recognition Scheme would be available for all those that would be interested in knowing more.

Martin offered to help with the distribution of the letter.

Female and LGBTQ+ veterans

There are several, UK-wide, ongoing pieces of work in this sphere, such as the upcoming recommendations from the LGBTQ+ review and the Office for Veterans' Affairs (OVA) announcement of a Women Veterans Strategy to be published later this year.

The Armed Forces and Veterans Healthcare policy team is following the work of colleagues, as well as any other emergent research, to determine what could be taken forward. So far, the training for the General Practice Armed Forces and Veterans’ Recognition Scheme includes a section on female and LGBTQ+ veterans, which will serve to highlight some of the specific issues associated with these groups.

Given that this priority is still subject to understanding what the data says and identifying a clear need that could be addressed, the team proposes reorganising this priority with a focus on data gathering and stakeholder engagement.

Martin observed that it is important to prioritise, as there is a limit to how much more work General Practices and health boards can take on in the future. The third sector could potentially help with this priority.

Jason agreed that there needs to first be an understanding of what the work is.

Jo recommended taking the approach that this is part of a different scheme of work, and is delivered on the Armed Forces Covenant.

Neil highlighted that from his knowledge there is no female veteran organisation in Scotland, but there is Salute Her in UK, which could potentially support some of this work. Neil offered to put group members in contact with relevant third sector organisations.

Mairi noted that there is an Edinburgh and district branch of the Association of Wrens, a group of female veterans.  

Future priorities

Going forward, to understand whether there are any other needs that remain unaddressed, Gary proposed that the team extends its engagement with the Armed Forces Community, and focuses on gathering and analysing data to inform any future approaches.

Update on the implementation of the Mental Health and Wellbeing Action Plan (MHWAP)

Jason invited Mark and Aleksandra to give a progress update on the implementation of the Mental Health and Wellbeing Action Plan (MHWAP) and the development of the Veterans’ Health and Wellbeing Hub.

Mark gave a summary of what the service would provide and the importance of navigators in the system, highlighting that the navigators would be veterans themselves.

Navigators will be coordinated by the Implementation Team, but they would be employed by third sector partner charities. A navigator training package and governance structure are currently being prepared.

Mark mentioned that the last meeting of the Implementation Board took place on the 15th of March 2023 in Glasgow. The Implementation Board’s Chair is reviewing the Implementation Plan, and an updated draft is underway. This is expected to be signed off by the minister.

Mark added that for the next twelve months most work will be provisional. In between May and December 2023, the training for the Navigators will be launched. A website is also currently being prepared. The expectation is that the hub will be launched in April 2024.

Aleksandra noted that there was a delay in the recruitment to the Implementation Team due to market circumstances, but the team is now complete.

Craig mentioned that his health board has a contract with the Lanarkshire Association for Mental Health (LAMH), who provide the peer support workers to support Veterans First Point (V1P). The group went through a tender process and a specification, which resulted in the contract being awarded to LAMH. From the feedback so far, the veterans are content with the services provided. Craig emphasised that there is a need to understand what the implications are, once the MHWAP is implemented.

Mark highlighted that there is no plan for this new and additional system to replace current contractual arrangements.

Craig further noted that the difference between a peer support worker and a navigator is currently unclear, which might leave some staff confused about their current roles and responsibilities.

Craig emphasised the need for the Implementation Plan to be shared with health boards before it receives ministerial approval. Jo seconded this position and the fact that the health boards will be responsible for delivering these services.

Jason acknowledged Craig and Jo’s concerns, and agreed on the need to involve the NHS champions in the decision-making. Jason highlighted that every member of the group is keen to help deliver this work, and for this purpose, transparency and collaboration is necessary.

Mark noted that the Implementation Plan will be shared with health boards before being submitted to the minister.

Health Innovation Fund (HIF) Award

Craig, Robert, and Prof Murray Leith presented the NHS Lanarkshire and DMWS project looking at how welfare support and technology can benefit isolated veterans in Lanarkshire.

Craig highlighted that they are currently just scratching the surface of what is available in terms of technology, and this project is an opportunity to learn how to better use technology to aid with some of the resourcing challenges currently faced by healthcare providers, while also seeing the veterans as a catalyst in this process.

Robert provided a brief introduction to the work of DMWS, and independent charity delivering non-clinical welfare and wellbeing service to the individual and the family.

DMWS will be working in collaboration with NHS Lanarkshire in Blantyre to explore the outcomes achieved when using assistive technologies (remote appointments, remote health monitoring, NHS Near Me etc.). These technologies are options for those bed-ridden, lacking means of transportations, or suffering from a variety of medical conditions.

Prof Murray Leith noted University of the West of Scotland’s (UWS) enthusiasm for this project, and mentioned that their role within this three-way partnership is to collect and evaluate data, talking to veterans and colleagues about the efficacy of the project.

The real key is to learn and disseminate knowledge from this project, and UWS will produce two formal annual reports and case studies with the veterans engaged with the service, sharing these more widely with stakeholders' groups.

Robert Reid added that the project has a two-year timeline, and they will spend some time to learn the technologies.

Robert agreed to send quarterly progress reports to the Armed Forces and Veterans Healthcare policy team.

Martin noted that this is a great initiative, and the knowledge and resources should be spread to other organisations to ensure that everyone is involved.

Any other business 

No other business was raised by members of the group.

Date of next meeting 

Jason thanked all for their attendance and closed the meeting.

Scottish Government officials will send out a placeholder for the next meeting in due course.