Hansard

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 However, the report highlights that that concept, which was introduced in the 1950s, is outdated.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.