Commissioner calls for early implementation of the Veterans Mental Health and Wellbeing Plan in his third and final report on getting transition right in Scotland

A report published today by the Scottish Veterans Commissioner says that the healthcare needs of those transitioning from the armed forces must not be neglected as the NHS struggles to recover from the Pandemic. The report examines provision of healthcare for veterans in Scotland and makes four recommendations to enable a more seamless transition to the civilian world.

Titled ‘Positive Futures: Getting Transition Right in Scotland – Health & Wellbeing’, the report is the third in the Commissioner’s Positive Futures series, which explores the challenges faced by those transitioning from the armed forces now.

The key actions recommended to achieve the best possible health and wellbeing outcomes for veterans in Scotland include ensuring:

  • All those who need it receive timely and equal access to high-quality mental health care and support services whenever they need them, wherever they live
  • Service leavers are well prepared to look after their own health and wellbeing in the civilian world through the provision of accessible and relevant information
  • An efficient and timely handover from Defence Medical Services to NHS Scotland healthcare, including early transfer of medical records
  • Veterans receive a high quality of person-centred care by improving understanding of their needs among medical and health care professionals

Commenting on the report’s findings, Scottish Veterans Commissioner Charlie Wallace said: “It is in the area of mental healthcare that I most commonly hear about unmet need and the frustrations of veterans and their families trying to find the right support. While a number of statutory and third sector services are doing sterling work with the resources they have, demand isn’t always being met or the wait for support or treatment is far too long. That situation has been exacerbated by ongoing problems caused by the Pandemic.”

“The 2021 Veterans Mental Health and Wellbeing Action Plan, co-produced by the Scottish Veterans Care Network, aims to address these issues. The Plan, a recommendation by my predecessor, represents a once in a generation opportunity to get the structure right and address a long-standing need – to ensure our veterans and their families can access consistently high-quality support and services, whenever they need them, wherever they live in Scotland. What I would like to see now is a clear timeline for delivery so that the momentum built and the energy and enthusiasm put into shaping the Plan is not lost. Implementation needs to start now.”

“Too many Service leavers struggle to adapt and find it difficult to access and navigate health care in a less familiar civilian world. Additionally, more needs to be done to address the stigma around mental health issues in the forces and veterans’ community. This can lead to delays in seeking treatment when we know that early intervention significantly improves outcomes. Transition can be a turbulent time, and without appropriate care, mental health issues can be exacerbated and ultimately lead to other problems such as unemployment and homelessness which can affect entire families.”

The report also highlights the importance of early preparation for Service leavers – also identified as a critical step in the areas of employment and housing explored in previous SVC reports.

“We need to ensure Service leavers are well informed and well prepared to look after their own health and wellbeing in the civilian world by providing better preparation for transition,” continues Col. Wallace.

“A key improvement required here is greater acknowledgement of devolved health services across the UK. MOD publications often include information about accessing health care services which is only accurate for England. Service leavers and their families should have ready access to accurate information relevant to whatever part of the UK they intend to settle.”

In addition to better preparation, the report identifies a timely and efficient handover from Defence Medical Services to the NHS in Scotland, including early access to a service leaver’s full health records, as integral to a seamless transition.

Col. Wallace says: “The transfer of patient care and medical records are for DMS and the NHS in Scotland to worry about and should be a smooth and straightforward enough process. Unfortunately, I have heard that in too many instances it’s still not what happens. My predecessor highlighted his concerns about this and recommended that procedures should be kept under review, and while there does seem to have been progress since 2015, it is painfully slow. I am advised that Defence Medical Services is discussing pilots to test improvements and this has to be a priority if Service leavers in Scotland are not to continue being disadvantaged.”

The report also highlights improved awareness of veterans’ needs, common conditions and veteran specific support services among GPs as a positive step forward for veterans’ healthcare.

Col. Wallace says: “As the entry point for NHS services in Scotland, it is vital that veterans are fully aware of the importance of registering with a GP as soon as possible and that they tell their GP they have served. Having ‘veteran friendly’ accredited GP practices can really help GPs to understand veterans, and veterans to better understand the new system of healthcare they are now a part of.”

“The Scottish Government recognises this and I was heartened to see that one of the 2021-22 priorities of the Armed Forces Personnel and Veterans Health Joint Group is to work together with the Royal College of GPs and Veterans Scotland to develop a veteran aware GP Accreditation scheme in Scotland. I am keen to see this developed and rolled out across Scotland as soon as possible.”

“When it comes to the health and wellbeing of the veterans’ community, most individuals leave the forces fit and healthy, with minimal issues. Of course, it is also important to acknowledge that life in the armed forces can be dangerous and result in severe and enduring conditions, both physical and mental. For the individuals experiencing this, lifelong treatment and care should be based on the best possible mainstream and specialist services available. However, these represent two ends of a broad spectrum of the healthcare needs of Service leavers, and we need to look at how we can provide the best possible care for those spanning its entire length.”

“We have around 250,000 veterans in Scotland who have served their country; we owe it to each of them and their families to do our best by them. Setting the right conditions for those leaving the military early in their transition journey and throughout can have a significant impact on their future life chances. If we can get it right, then it is not only the individual Service leaver and their family who benefit, but the Scottish labour market and economy, our communities and society in general.”

Positive Futures: Getting Transition Right in Scotland – Health and Wellbeing can be viewed here. 

Recommendations in full

Recommendation 1

Those transitioning from the military and planning to settle in Scotland should be informed and well prepared to look after their own health and wellbeing, make informed choices and live in good health in the civilian community. That means:

  • Enabling Service leavers to start preparation and planning for their future healthcare needs as early as possible with information provided in briefings and on websites and Apps accessible from early in a Service person’s career
  • Ensuring information provided is relevant to a Service leaver’s intended place of settlement and that it is also accessible to families
  • Ensuring Service leavers have immediate access to high quality NHS health care and support wherever they choose to settle
  • Service leavers and their families using health and social care services have positive experiences of those services, and have their dignity respected

Recommendation 2

Those transitioning from the military and planning to settle in Scotland experience an efficient and timely handover from Defence Medical Services to NHS Scotland healthcare, with primary healthcare systems afforded early access to their full health records. That means:

  • Agreed protocols support efficient, early transfer of electronic medical records and the positive experience of health care we want all veterans and their families to have
  • The transfer of medical records (from Defence Medical Services to the NHS) as part of Programme Cortisone, should be accelerated to test and complete the work to align IT systems supporting electronic transfer of medical records upon transition. The programme should be properly linked into NHS Scotland IT systems

Recommendation 3

Service leavers should experience high quality, person-centred healthcare as part of a smooth transition back to civilian life. To support ease of access they should be identified as they transition and first engage with the NHS in Scotland. That means:

  • All veterans should organise their own healthcare responsibly by registering with a local GP practice as soon as possible and telling their GP that they have served
  • Developing and testing a ‘veteran-aware’ GP accreditation scheme for Scotland that would support GP practices through awareness raising of veterans’ needs, common conditions and veteran specific support services, as well as staff training. It would be sensible to align this with the scheme currently being rolled out in England
  • Building on a GP Accreditation scheme to then develop a ‘veteran-aware’ hospital accreditation scheme for Scotland.

Recommendation 4

All Service leavers should be enabled to look after their own wellbeing, and supported to stay well within their communities. Where it is needed, they should have timely and equal access to consistently high-quality mental health care and support services that are delivered as close to their home as possible. That means:

  • Early implementation of the Veterans Mental Health and Wellbeing Action Plan to secure the long-term delivery of dedicated mental healthcare services to veterans and their families to end the struggle they can have to get the support and services they need
  • Working to tackle and reduce stigma surrounding mental ill health amongst Service leavers and veterans to ensure that it no longer stands in the way of veterans and their families seeking and accessing help
  • Ensuring new care pathways support choice of digital or community-based access and for those with complex needs, there is a clear escalation pathway to more intensive treatments which are made available timeously to those in need
  • Assisting veterans and their families to sustain good health by providing support to address the wider detriments of mental health (housing issues, unemployment etc.) and raising awareness of the various means open to them of keeping well and sustaining good mental health and wellbeing