Veterans Affairs Committee on June 6th, 2013

[The Chair, Conservative, Greg Kerr]

I call the committee to order.

As everybody knows, we're doing the comparison study on services and benefits offered to veterans by Canada and its allies. We're very pleased this morning to have Dave Rutter, head of armed forces and veterans' health with the Department of Health in Britain. I'm sure things are fine in London and the weather is perfect. We're glad to have you with us today.

Our process is that we'll ask you to give an opening statement, around 10 minutes or so, but it's your time call. Then the committee members will ask you some questions, and we'll all go home happy.

Are you ready for this?

[Dave Rutter, Head, Armed Forces and Veterans' Health, Mental Health, Disability, Equality and Offender Health, Department of Health, Government of the United Kingdom]

Absolutely fine.

[The Chair, Conservative, Greg Kerr]

The committee is prepared, so then we'll ask Mr. Rutter to begin his presentation.

Please go ahead.

[Dave Rutter]

I'll just say I'm Dave Rutter, sir. I head the armed forces and veterans' health team here in the Department of Health. I lead a very small team here, but we work very closely with NHS England with regard to delivering the programs and services that we provide.

It's important to note that this is England and not the U.K. Health is devolved within the U.K., so the Scots, Irish, and Welsh would have their own NHS health provision. I apologize if you're already aware of that, but I thought I'd better make it clear that when I speak of the programs that we run, they're predominantly for veterans' families and armed forces in England. Bearing that in mind, of course, with veterans of the military we work obviously with MOD—the Ministry of Defence—which has a U.K.-wide footprint and beyond. Veterans, when they leave the armed forces, will go back to their homes anywhere within the U.K. So we have to work very closely with our colleagues in the devolved administrations and we do so.

Just by way of context, and again apologies in advance if you are familiar with this, the Ministry of Defence here in the U.K. have health responsibility for the primary health care of those servicing, including dentistry, across the U.K. They do in some instances have primary health care responsibility for some families that are registered with their GPs. This tends to be in the very large bases or where they're in outlying areas. For veterans within NHS England, within U.K. as well more generally, the health care is the responsibility of the NHS administration. So within NHS England, we have responsibility for around about 4.5 million veterans, and our program is also designed to help their families as well where appropriate.

My responsibility here within the Department of Health is to take forward the government policies determined by our ministers, working very closely with NHS England, which was just set up quite recently, the first of April this year, with a responsibility for delivering armed forces health. But we also work very closely with service charities as well. You may be familiar with Help for Heroes, Royal British Legion, and others. We have a program designed to just go beyond the statutory services, if I can put it that way.

There are three key areas of work for us, which I'm very happy to answer questions around. One is around the continuity of health care for those who have been seriously injured or wounded during their time in the armed forces. The second key area is the mental health care of veterans, and the third area is the physical care of veterans, particularly those who have lost a limb as a result of their service.

I should say at the outset, although l know a lot about those programs and the wider areas of veterans and family health care, I'm not an expert in relation to the detailed compensation payments, etc., but certainly familiar with the way in which they are applied across the board within the NHS. I mentioned that we work closely with service charities. This is key in delivery. We have a small budget to deliver against these programs. I'm happy to go into that as well on request.

Actually, I think that probably concludes my opening remarks. I'm very happy to start taking questions from you.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Rutter. You may be setting a bad precedent by being so brief. We're not used to people being brief like that. We appreciate that.

[Dave Rutter]

I was briefed to be brief.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Greg Kerr]

We appreciate that very much.

In our system, as you know, we have multiple parties. We're going to go to the official opposition with Ms. Mathyssen first for five minutes.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much, Mr. Chair, and thank you very much, Mr. Rutter. We appreciate you taking time to tell us about how you look after your service personnel in Great Britain, particularly in England. Of course veterans are our primary concern.

You talked about there being a continuity of care for service personnel and their families. Does this extend to veterans? For example, once someone who's been injured leaves the service, can they expect that they will continue to receive care?

[Dave Rutter]

Absolutely. You'll be familiar with the way in which health care is provided here in the UK, which is obviously free at points of need. One of the things we identified some years ago—four or five years ago when I came into this work—was the difficulty of those who had been seriously injured being discharged from the armed forces and then facing what's been described as a cliff edge in relation to care. That level of care would dip until such time as the NHS and other services of course help with the needs of that individual.

We approach this challenge through welcoming the Ministry of Defence to create a seriously injured leaders protocol. So this puts an onus on the Ministry of Defence working within their own system—their own clinicians, welfare staff, social care staff, etc.—to engage at a much earlier time with the NHS. Rather than leaving it to almost the very end of that person's time within the armed forces, we would expect them to be in contact up to six months in advance of departure, making contact with the statutory services in the area where this person will live, ensuring that the clinical handover is fully understood and any challenges that go with that particular individual—health care challenges with that individual—are seen in advance so that they can be addressed before departure, along with the welfare and living requirements of that individual. They may need adaptations to their home, for example, depending on their injuries.

So we aim for that to be as seamless as possible. The measure of success of that is hard to gauge. With some of these things, you gauge it on the basis of not receiving complaints, difficulties, or issues being raised by individuals. We receive some—and we're talking single figures where there have been difficulties—but the protocol has been designed in such a way that where these do arise, there are contact mechanisms in place to ensure that those are dealt with as soon as possible.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you.

If a veteran leaves the forces and there are situations in regard to that individual's health that crop up 10 or 15 years later, does that veteran have a standard of proof that he or she does indeed have injuries or health problems related to their time in the forces? Do you have a protocol whereby the veterans have to demonstrate that they need specialized help from your department?

[Dave Rutter]

There's no protocol in answer to that part of the question. The requirement for those who will be in receipt of armed forces compensation or war pension...then they can certainly make reference to that in accessing the health services. That will particularly help them access some of the services we put in place specifically for veterans. But we're very trusting over here, and if somebody presents to—particularly one of our veteran's mental health teams—and says that they're a veteran, then they will be dealt with as a veteran.

Clearly if there is a problem and that continues, the professionals who are dealing with that individual will learn whether indeed that person is a veteran. But for those with very specialized needs, it's safe to say that more than likely, they'll be receiving armed forces compensation or a war pension scheme. That's the reference point, if you like.

[The Chair, Conservative, Greg Kerr]

Thank you very much, Mr. Rutter.

We now go to the government for five minutes, to Mr. Lobb, who has been up all night practising for his questions. He's just ready to go.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you, Mr. Chair, and thank you for that endorsement.

The first question I have this morning for Mr. Rutter is on the topic of mental health services.

I know that's under your mandate, and I wondered if you could give us an idea of how that has evolved in the last number of years and what the situation is today. Is it deemed to be a success or a work-in-progress at this point?

[Dave Rutter]

We have taken the work in relation to veterans' mental health quite some way over the last two years, or over the last four years, actually. But it's only over the last two that there has been real progress made. Any veteran will of course have access to the National Health Service mental health services in any event. They will have immediate access to that.

As for what we've done, Dr. Murrison, MP, produced a report in October 2010 called “Fighting Fit”. It's publicly available. It can just be googled.

The report made a number of recommendations around veterans' mental health, including such things as an online mental health provision, which we do in partnership with Big White Wall, and the creation of veterans' mental health teams around England. We've put in place 10 veterans' mental health teams around England. We've also put in an e-learning package for GPs, so that when somebody presents in front of them, they have that to refer to. We have a 24-hour helpline that we've put in place in partnership with Combat Stress, one of the leading veterans' mental health charities here.

We're in the process of producing something called the veterans information service. This will be a process whereby folk who have discharged from the armed forces will be contacted a year or so after discharge by e-mail, and by letter if needs be. Basically, they will just be asked how they are and whether they need help with certain mental health problems, but also with other issues, such as housing, welfare, benefits, etc.

We're working in collaboration with the Royal British Legion here to provide a one-stop shop to help with those problems. Obviously, depending on their problem, they may go on to statutory services or charity services.

We've also created the National Veterans' Mental Health Network, which brings together the devolved administrations of Wales, Scotland, and Northern Ireland, and also brings in the service charities and the statutory services. The idea there is to bring together the learning as we're presenting these programs, and to bring the best of those programs together. We're now at the stage where we're looking beyond 2014 and 2015, if you like, to see how we actually embed these services into the NHS.

So have they been successful or a work in progress? Both. I think it's an 80:20 situation. We still have more to go.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Could you elaborate on the 10 mental health teams you have? I guess that was throughout England, or was it throughout the entire U.K.?

[Dave Rutter]

This is throughout England. I have a small amount of funding, which works out to £1.5 million per year to fund these 10 teams. It doesn't go too far once you split it down to 10 teams, but we gain the critical mass, if you like, within those teams by working very closely with Combat Stress, the charity. You have NHS clinicians and professionals working in partnership with Combat Stress, who are also routing veterans directly to them.

There are 10 teams around the country. They've applied their programming in slightly different ways in each area to reflect their own populations. The northwest, for example, and the northeast have very high veteran populations, so they design their service in a slightly different way to some of the teams down in the southeast, in the Kent and Surrey areas.

So they're different, but the teams together create local links with veterans' organizations and make themselves known. People can refer themselves to each of those services, or they can be referred through GPs or other sources.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

From the time a veteran comes forward to discuss an issue to the time he or she would see a specialist or see a doctor and start to receive care, what kind of timeframe is that? I know it's pretty vague because there can be a multitude of different issues, but is that something you measure? Where are you with that right now?

[Dave Rutter]

We're in very early stages. The last of the teams came into being at the back end of last year and early this year, so it's a bit of a rolling program getting those up to speed. Early indications are that veterans are able to access care faster than they would through other National Health Service avenues. They will see a clinician within the first week or two of being referred, depending on the need, and certainly within six weeks.

[The Chair, Conservative, Greg Kerr]

Thank you very much.

[Dave Rutter]

It is very vague because it's still quite early days for that part of the program.

[The Chair, Conservative, Greg Kerr]

Thank you, Mr. Rutter.

We'll now go to the Liberal Party and Mr. Casey, for five minutes please.

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Rutter, I want to start with a bit of a broader question. I noticed that your department's Service Personnel & Veterans Agency is actually part of the Ministry of Defence, which is unique among the countries we're studying because Australia, United States, and Canada each have a stand-alone department. I am also aware there was a bit of a merger done back in 2007 that gave rise to the structure that you have.

Can you offer any comment on the benefits or the challenges to being a part of the Ministry of Defence as opposed to being a stand-alone department?

[Dave Rutter]

I would suggest that's probably more for the Ministry of Defence than the Service Personnel & Veterans Agency to answer, as the Service Personnel & Veterans Agency, or SPVA, is part of the MOD rather than the department I work for, the Department of Health. Certainly, as a government department that has to have a close working relationship with the Ministry of Defence, I also have a close working relationship with the SPVA.

It does provide challenges because you're like an essential government arm of the organization, which is the Ministry of Defence, then you have a service delivery arm, the SPVA, who are providing advice to individual veterans on welfare and other issues. I know that others have commented on this within the U.K. and have suggested, for example, there might be a veterans' champion elsewhere within government, perhaps a cabinet office or elsewhere. It's not for me to comment on that, but I would say that the SPVA are well regarded and I know work very well with the service charities and others in delivering their services.

I suppose in some ways you might argue, perhaps, there's some similarity in the way in which we have the Department of Health, here in Whitehall, working through ministers, then you have a separate organization, which is NHS England, actually providing the health services for the population.

[Sean Casey, Liberal, Charlottetown, PE]

In this country one of the biggest issues we hear about from veterans' groups is this whole idea of a lump-sum payment versus an ongoing pension allowance. I notice that in your country the lump-sum payment was doubled from £285,000 to £570,000—about $900,000 Canadian—back in 2008. Can you tell us the reason for the original lump sum? What was the rationale for it, and what was the discussion and debate around the increase?

Why was it at the level it was and why was it increased?