Armed Forces, their families and Veterans

Armed Forces, their families and Veterans

Introduction

This chapter considers the health and social care needs of Armed Forces personnel, their families and Veterans. Veterans include anyone who has served for at least one day in the Armed Forces (Regular or Reserve), as well as Merchant Navy seafarers and fishermen who have served in a vessel that was operated to facilitate military operations by the Armed Forces.


The CCGs is responsible for commissioning hospital and community health services required by Armed Forces’ Families (where registered with NHS GP practices) and services for Veterans and Reservists when not mobilised.  


NHS England’s is responsible for commissioning hospital and community health services for members of the Armed Forces, mobilised Reservists and their families (if registered with military medical centres).  NHS England also commissions specialised services, including specialist limb prosthesis and rehabilitation services for Veterans.


The Ministry of Defence is responsible for primary medical care for the serving Armed Forces personnel.


The Borough Council has the responsibility for safeguarding and promoting the welfare of the children, including those in service families. The Council also has the responsibility to monitor the wellbeing of care leavers, including those joining the Armed Forces.  The Armed Forces provide professional welfare support to augment those provided by local authorities.


The Borough Council considers the social care needs of anyone over 18, including includes Veterans, Reservists and adult members of Armed Forces families.


Support to the Armed Forces community has received political impetus over recent years.   The Armed Forces Covenant sets out the relationship between the nation, the government and the Armed Forces. The Covenant’s two principles are that:

  • the Armed Forces community should not face disadvantage compared to other citizens in the provision of services in the area where they live
  • special consideration is appropriate in some cases, especially for those who have given most such as the injured and the bereaved.  

The Borough Council and its partners signed a local Community Covenant with the Armed Forces Community in Wokingham Borough in 2013. 

 

Arborfield Garrison is the only Ministry of Defence establishment within Wokingham Borough, although this is soon to close.  In surrounding areas there is the Territorial Army Brock Barracks, Oxford Road, Reading (Seven Rifles) and the Hermitage Denison Barracks, near Chieveley in West Berkshire. 

     

Accurately identifying the number of Armed Forces community that reside in an area can be difficult, given the range and quality of data that is available.  We have drawn on Census, pension and primary care data.
 

2011 Census

 

The 2011 census identified 508 people in Wokingham Borough as “usual residents aged 16 and over who are members of the Armed Forces.”

Figure 1 - all usual residents aged 16 and over who are members of the Armed Forces (2011) 

Residents in armed forces

Source: Census, 2011

 

The Census also identified 497 “'associated persons” who are not a member of the Armed Forces, but are a spouse, same-sex civil partner, partner, child or step child of a member of the Armed Forces.

 

Figure 2 - Associated persons in households, 2011     

Associated persons in households

 Source: Census, 2011

 

War Pension Scheme and Armed Forces Compensation Scheme 

Pension and compensation scheme data can be used as a proxy for the number of veterans in an area (however, not all veterans are in receipt of pension or compensation payments).  For Wokingham Borough in 2014, this amounted to 880 Veterans.   

 

Figure 3 - In receipt of war pension or compensation, 2014

War pension

Primary Care

 

GP Practices can identify the Armed Forces community through the use of Read codes. In Wokingham CCG Practices, 21 Veterans have been coded.  No Reservists or Family members have been coded.   Use of Primary Care data is currently limited by:

  • Awareness or willingness of the Armed Forces community to identify themselves as such when first registering with a GP; and 
  • Awareness of the existence of relevant Read codes by GPs and other primary care staff.

 

A number of changes over the next few years which will have some impact on the local Armed Forces population:

  • The closure of Arborfield Garrison, although some Armed Forces housing will remain on the site;
  • A reduction in the size of the UK army
  • An increase in the size of the UK reservist force

Although the number of people within the Armed Forces Family in Wokingham Borough is relatively small, and numbers may be projected to decrease, it is still an important part of the wider community. 

 

There is no robust source of data relating specifically to the needs and inequalities of the Armed Forces community within Wokingham Borough. Instead, national data is relied upon to highlight key issues.


Armed Forces Families 

The majority of armed forces families are relatively young women of child bearing age. Spouses often have to cope with being alone by themselves or with the children for quite long periods due to deployment or training. Also, many families live away from family support.  

 

Reservists 

For some groups of conditions, Reservists report higher rates of mental health issues than Regulars.  Compared with Regular Armed Forces Families, there can be even greater isolation for Reservist’s Families.


Veteran population 

Veterans will be predominantly male.  The majority of the ex-service population successfully make the transition to civilian life.  Some may have difficulties finding suitable housing, obtaining adaptations to accommodate injuries or other physical health needs, or obtaining financial aid to which they are entitled. Health data for service leavers demonstrates that the overwhelming majority (92%) of them depart in good health.   


They are generally fit and with a relatively low prevalence of long-term conditions. They have a broadly similar prevalence of mental health-related conditions to the general population.  But some will present with complex health and welfare issues including muscular-skeletal, mental health, alcohol related health complications and substance misuse.  


Probable Post-Traumatic Stress Disorder (PTSD) affects about 4% of veterans The overall rate of suicide is no higher than for the general UK population, with the exception of male veterans aged 24 or younger (early leavers from service) who are at increased risk compared to their general population counterparts.   For veterans over 65 years old, mobility, independent living and social isolation are main concerns. 


Armed Forces Families 

 

Access to services is a key issue for Armed Forces Families , including:

  • Time accrued on NHS waiting lists being honoured when moving to a new area;
  • Family members receiving care in one area often find that they don’t meet the criteria of the new area
  • Spouses who have been waiting for mental health treatment often get the treatment required just before they move and have to start again
  • Some families who are carers for a family member with additional needs/disability find it difficult to access short breaks or support when their spouse is deployed or away training.

Reservists

Provision of health care being regularly switched between military and NHS services can be a problem for Reservists, particularly with respect to the transfer of medical records and continuity of care.

    

Veterans

Many veterans find the way health issues are managed in the transition from military to civilian life unsatisfactory:   

  • Problems about the transfer of medical records
  • Difficulties in the continuity of care
  • Medical personnel do not always know or understand the patient’s military background.
  • Many veterans know little about how the civilian health service works.
        

The CCG has implemented some of the changes suggested in the previous JSNA, including the identification of a GP lead.  All practices have been briefed on Armed Forces commissioning.  An audit of the recording of the Armed Forces Community in General Practice has highlighted short-falls in coding. Therefore the following recommendations are made:

 

1.Encourage all GP surgeries to add Read codes relating to the Armed Forces when registering new patients 

2.Encourage the Armed Forces Community to register with an NHS GP and identify their Armed Forces status
 

Registration should act as a flag for GPs to consider the potential for specific health and wellbeing needs in such individuals and target assessments and treatments most appropriately.