The partnership between the NHS and the Ministry of Defence (MoD) has enabled the armed forces to provide modern and advanced clinical care, and give its medical staff the broadest and most up-to-date training and experience.
Structure
Medical services are delivered to servicemen and women by the MoD, the NHS, charities and welfare organisations.
The MoD is responsible for providing:
- primary care: such as general practice, dentistry, occupational medicine and community mental health services within the UK and at defence outposts overseas.
- specialist healthcare: such as secondary care and rehabilitation through the Headley Court Defence Medical Rehabilitation Centre.
Services are staffed by regular uniformed and reserve medical personnel from all 3 services: the British Army, Royal Navy and Royal Air Force.
Military casualties
Armed forces personnel returning from operations for treatment in the UK usually go to Birmingham's Queen Elizabeth Hospital Birmingham (QEHB), which is also the home of the Royal Centre for Defence Medicine (RCDM).
During their treatment at QEHB, most military patients are grouped together in a secure trauma ward staffed by military and NHS medical staff.
The RCDM and UHB have earned an excellent reputation for treating the complex injuries typical of military casualties.
Mental health
All serving personnel receive their mental health care through MoD-commissioned services.
Military mental health professionals are sent on operations overseas, so they can provide assessment and care in the field.
In the UK, mental health services work alongside community-based mental health services, to ensure they follow national best practice guidelines.
Care is offered at 15 military Departments of Community Mental Health (DCMH) across the UK (and smaller centres abroad), which provide outpatient mental health care.
Inpatient mental health care services in the UK are provided under contract by a partnership of 8 NHS trusts.
This is led by the South Staffordshire and Shropshire Healthcare NHS Foundation Trust. Service personnel are assessed, stabilised and treated in hospitals as close to their home or parent unit as possible.
The priority is to return injured servicemen and women to work as quickly as possible.
The trusts providing inpatient healthcare are:
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust
- Cambridge and Peterborough NHS Foundation Trust
- NHS Grampian
- Southern Health NHS Foundation Trust
- Lincolnshire Partnership NHS Foundation Trust
- Somerset Partnership NHS Foundation Trust
- Tees, Esk and Wear Valleys NHS Foundation Trust
- NHS Greater Glasgow and Clyde
Transition and veterans health
Everyone leaving the armed forces is given a summary of their medical records, which they are advised to give to their new NHS doctor when they register with them.
A rigorous handover process – known as the Seriously Injured Leavers Protocol (SILP) – is in place for veterans with healthcare requirements after leaving the forces.
Subject to the clinical needs of others, veterans are also entitled to priority NHS treatment for any condition that may have been caused during service.
Individuals within the non-serving armed forces community can access all NHS services, including those services set up to meet the needs of veterans, like prosthetics and mental health.
The Veterans and Reserves Mental Health Programme (VRMHP) (formerly the Medical Assessment Programme) provides mental health assessments for veterans and reservists who have concerns about their mental health as a result of service.
Serving personnel: NHS hospital care
All hospital care is provided by the NHS. This includes emergency and elective care.
Since 2001, the main treatment centre for military patients seriously injured has been the Royal Centre for Defence Medicine (RCDM).
The RCDM is based at the Queen Elizabeth Hospital Birmingham (QEHB), which is part of University Hospitals Birmingham NHS Foundation Trust, and is the primary receiving hospital for service personnel injured on operations.
The QEHB also offers non-urgent admissions to service personnel based in England through the NHS e-Referral Service.
These elective cases are managed in line with normal NHS procedures and waiting times.
Military casualties
The main arrival points for military casualties are Birmingham International Airport and RAF Brize Norton, with which UHB has good transport links.
QEHB staff are highly experienced in treating the most common types of injuries to service personnel, such as polytrauma (where someone has suffered multiple traumatic injuries).
Casualties arriving for treatment at QEHB are either placed on a trauma ward or taken straight to intensive care, depending on the severity of their injuries.
Medical notes, images, scans and lab results will be sent ahead of the patient, so by the time they arrive, members of the clinical team at QEHB will have already planned their treatment.
The QEHB military ward is in a designated trauma and orthopaedics ward, where up to 32 military patients are cared for in single rooms or four-bed bays.
The ward has additional features for the use of service personnel only. These cater for their specific requirements and boost the military atmosphere.
It has more staff (both military and civilian) than a normal NHS ward, plus a quiet room for relatives, communal space for patients, and a physiotherapy suite.
Patients get regular visits from defence medical welfare services, who deal with their day-to-day needs and maintain links with their units.
Routine hospital care
For service personnel based in England, non-urgent and routine procedures can be accessed at any NHS hospital through the NHS e-Referral Service.
These admissions will adhere to normal NHS procedures and waiting times, and the amount of choice available may be subject to certain operational criteria.
Serving personnel: mental health services
Organisations
Combat Stress
Combat Stress is the UK's leading charity for veterans' mental health. The charity provides specialist treatment and support for veterans with complex mental health issues.
Call their helpline:
- 0800 138 1619 for veterans and their families
- 0800 323 4444 for serving personnel and their families
You can also text 07537 404 719 or email combat.stress@rethink.org
Big White Wall
A charity providing safe, anonymous, round-the-clock online support, with trained counsellors available at all times. There's a supportive community and lots of resources that all armed forces personnel, veterans and their families can use at any time. The service is free for UK military personnel, veterans and their families.
Alcoholics Anonymous (AA)
AA is a free self-help network. Its "12-step" programme involves getting sober with the help of regular support groups. AA believes people with drink problems need to give up alcohol permanently.
SMART Recovery
SMART Recovery runs a network of self-help and mutual aid meetings where participants help themselves and fellow members with recovery from any kind of addictive behaviour.
Serving personnel: rehabilitation services
Welfare organisations
Royal British Legion
The charity helps armed forces personnel, reservists, veterans and their families all year round. They also campaign to improve lives and remember the fallen, as well as organising the Poppy Appeal.
The Royal British Legion website
SSAFA
A charity that provides lifelong emotional and practical support for active and veteran armed forces personnel and reservists, and their families.
Help for Heroes
The Help for Heroes charity provides direct practical support to wounded, injured and sick service personnel and veterans, and their families.
The Soldiers' Charity
The charity provides financial assistance to soldiers in need and their families, covering debt relief, mobility assistance, education bursaries, care home fees and respite breaks.
Blesma
The limbless veterans' charity supports all armed forces personnel who have lost limbs, the use of limbs or their eyesight in service.
Defence Medical Welfare Service (DMWS)
A charity providing practical and emotional support to military personnel, their families and other entitled civilians when they are in hospital, rehabilitation or recovery centres.
Combat Stress
Combat Stress is a mental health charity for veterans. It provides specialist treatment and support for veterans with complex mental health issues.
Service families: welfare and support
Everyday family life has its up and downs. Life for members of an armed forces family, whether they're regulars, reservists, or veterans, or their spouses, partners or children, can have additional worries.
These include:
- stress around deployment
- extended and repeated periods of separation from spouses and partners
- social isolation from family and friends
- additional and sudden caring responsibilities
The Armed Forces Covenant says that the whole nation has a moral obligation to the armed forces community and sets out how they should expect to be treated.
The Covenant aims to remove disadvantage, to ensure that the whole armed forces community, including their families, receive the same outcomes as the civilian community. A useful point of contact for covenant issues are the service family federations.
The majority of families of serving personnel, reservists and veterans access and receive their healthcare through the NHS in exactly the same way as the rest of the population.
In specific circumstances (for example, during posting overseas), some families may receive their primary care services from the Ministry of Defence (MoD) through Defence Primary Healthcare (DPHC) medical centres.
The availability of health and other support services for armed forces families serving overseas can vary between locations.
The MoD has a robust process in place for assessing the support available to family members before an overseas move is confirmed.
This ensures that all essential services are available, whether that be health or education, and that the move to the new location is as smooth as possible.
Additional needs
Service personnel are required to inform their chain of command if they have a family member with additional needs or a disability.
Service families are encouraged to register an additional need or a disability with the chain of command through the single service policies. For the Army, this is mandatory.
Service children who have special educational needs (SEN) should be registered with the Children's Education Advisory Service (CEAS), who can provide advice and support to parents when they move.
Prior to a child with SEN moving overseas, an MoD Assessment of Supportability Overseas (MASO) will be carried out to ensure that essential health, education and social care services are available.
Armed forces families accessing services within the UK and frequently moving due to postings are responsible for informing their local GP, health visitor, dentist, school nurses and other services of their individual circumstances.
Proactively informing these services before a move will ensure medical records are transferred and enable the continuity of any care and support that family members may receive.
The Armed Forces Covenant states that family members should retain their relative position on any NHS waiting list if moving location due to the service person postings.
Welfare organisations
There are a number of organisations, in addition to NHS services, armed forces families can go to to get the advice and support they may sometimes need.
The Navy, Army and RAF all have their own welfare support organisation and information services.
There are other organisations and charities that may be able to offer assistance and provide additional welfare services. Some are listed below.
Soldiers, Sailors, Airmen and Families Association (SSAFA)
The SSAFA is the national charity supporting service personnel, veterans and their families. SSAFA offers support to the community, whether at home, overseas or in an operational environment.
Families federations
The 3 Service Families Federations (Army, Navy and RAF) are the independent voices of Service families.
Each offers independent and confidential advice on a range of issues and works to improve the quality of life for Service families.
They regularly engage with the chain of command, local authorities and government to represent the views of armed forces families.
Each of the 3 Services has its own Welfare Support and Information Service Teams and Defence Medical Welfare Service (DMWS).
Defence Medical Welfare Service (DMWS)
The DMWS is a registered charity that works for the MoD and with other charities to provide practical and emotional support to military personnel, their families and other entitled civilians when they're in hospital, rehabilitation or recovery centres.
Veterans: priority NHS treatment
A veteran is someone who has served in the armed forces for at least 1 day. There are around 2.4 million veterans in Great Britain.
When servicemen and women leave the armed forces, their healthcare is the responsibility of the NHS.
It's very important for continuing healthcare that you register with an NHS GP and remember to tell them that you have served. This will help your GP to better understand any service-related health conditions that you may have and ensure that you are referred, where appropriate, to dedicated services for ex-forces.
If you've recently left the armed forces, it's important to give your GP the paperwork that your military medical centre gave you, including any medical records. This will help to ensure your military health record transfers to your NHS health record. It will also give your GP information on your health and ensure that any ongoing care and treatment is continued.
Being flagged as a veteran in your NHS medical notes will help to ensure that you are able to access dedicated services for those who have served in the UK armed forces. These include services for mental health and physical health conditions.
Find out more about the range of dedicated health services for ex-forces (PDF, 278kb).
'No disadvantage'
You should not be disadvantaged from accessing appropriate health services, so it's important that you notify your current GP if you're moving, particularly if you're on a waiting list for medical treatment, so this information can be transferred across.
Details of GP surgeries and other health services within your area can be found by using find GP services.
All veterans are entitled to priority access to NHS care (including hospital, primary or community care) for conditions associated with their time within the armed forces (service-related).
But this is always subject to clinical need and doesn't entitle you to jump the queue ahead of someone with a higher clinical need.
If the NHS service you're dealing with is unaware of priority treatment, you're actively encouraged to tell them about it and ensure you have told them you have served.
Failing that, you can enlist local health care commissioners, your local authority community covenant lead or one of the national service organisations, such as the Royal British Legion, to support you.
For more information on the duty of care owed to service personnel, read the Armed Forces Covenant (PDF, 919kb).
Personalised care programme
If you have served in the UK armed forces and have a complex and lifelong health condition, you may be eligible for the veterans personalised care programme. This is to ensure you have more choice and control over how your care is planned and delivered. It is based on what matters to you, meaning that you can choose how best to live your life and get the right support to do so.
If eligible, you will have a single personalised care plan for all your health and wellbeing needs that is developed with you and a range of organisations, including health and social care and military charities.
As part of this, you may get a personal budget to pay for some of the care and support you need. You should also get more support in the community and be able to access a range of help, such as emotional and practical support from people who have similar health conditions or disabilities.
For more information, read Personalised care for veterans in England (PDF, 685kb)
To apply, you should contact your local clinical commissioning group (CCG).
Veterans: NHS mental health services
Mental illness is common and can affect anyone, including serving and ex-members of the armed forces and their families.
Some people cope with support from family and friends, or by getting help with other issues in their lives. Others need clinical care and treatment, which could be from the NHS, support groups or charities.
Although it's completely normal to experience anxiety or depression after traumatic events, this can be tough to deal with.
Furthermore, the culture of the armed forces can make getting help for a mental health problem appear difficult.
Some people may not experience some of these symptoms until a few years after leaving the armed forces.
They may also delay getting help for a number of reasons, such as thinking they can cope, fear of criticism, or feeling that NHS therapists will not understand.
Read more about the symptoms of depression.
NHS support and treatment
If you think you or your partner may be experiencing mental health difficulties, you can get expert help from the NHS Veterans' Mental Health Transition, Intervention and Liaison Service (TILS) or the NHS Veterans' Mental Health Complex Treatment Service (CTS).
Both these services are available across England and are provided by specialists in mental health who have an expert understanding of the armed forces.
They'll also help to manage your care and support across other organisations.
Families and carers can find it hard to cope when their loved ones are not well, so, where appropriate, help may be provided for them, too.
NHS Veterans' Mental Health Transition, Intervention and Liaison Service (TILS)
TILS is a dedicated local-community-based service for veterans and those transitioning out of the armed forces with a discharge date.
The service provides a range of treatment, from recognising the early signs of mental health problems and providing access to early support, to therapeutic treatment for complex mental health difficulties and psychological trauma.
Where appropriate, help is also provided for other needs that may affect mental health and wellbeing – for example, with housing, finances, employment, social support and reducing alcohol consumption.
NHS Veterans' Mental Health Complex Treatment Service (CTS)
CTS is an enhanced local-community-based service for ex-service personnel who have military-related complex mental health problems that have not improved with earlier care and treatment.
The service provides intensive care and treatment including, but not limited to, support for drug and alcohol misuse, physical health, employment, housing, relationships and finances, as well as occupational and trauma-focused therapies.
Accessing NHS mental health care for veterans
To access these services, you need to go through TILS. This can be done by contacting the service directly, or by asking a GP or a military charity to refer you.
To contact the service directly:
- in the north of England, call 0303 123 1145 or email vwals@nhs.net
- in the Midlands or east of England, call 0300 323 0137 or email mevs.mhm@nhs.net
- in London or the southeast of England, call 020 3317 6818 or email cim-tr.veteranstilservice-lse@nhs.net
- in the southwest of England, call 0300 365 0300 or email sc.veterans@nhs.net
To access these services, you must:
- be a resident in England
- have served in the UK armed forces for a full day
- be registered with a GP practice in England or be willing to register with a GP
- provide your military service number or another acceptable form of proof of eligibility
When your referral has been received, you'll be offered an initial face-to-face assessment within 2 weeks and, where appropriate, a first clinical appointment 2 weeks after that.
Register with a GP
It's important to register with an NHS GP and tell them you have served in the armed forces so, where appropriate, you can access these and other dedicated services for veterans.
There are also many charities that provide great services, advice and support for veterans, reservists and family members. Similar services exist in Scotland, Northern Ireland and Wales.
Post-traumatic stress disorder (PTSD)
Some people with mental health issues may develop post-traumatic stress disorder (PTSD).
Symptoms can include:
- being constantly anxious
- being unable to relax
- vividly re-experiencing a traumatic event
- avoiding anything that might trigger distressing memories or feelings
- becoming socially isolated
PTSD can lead to problems in relationships and at work, including irritability, anger and substance misuse, particularly alcohol.
While some symptoms, such as nightmares, are normal in the weeks following a traumatic event, symptoms that last longer than this can indicate a problem.
If this happens to you, it's important to get advice from a GP as soon as possible.
If you have not already done so, register with a GP, tell them you served in the armed forces and are a veteran, and bring to their attention any health problems relating to your time in service.
Veterans: NHS services for those with physical injuries
Veterans Trauma Network
The Veterans Trauma Network provides care and treatment to those injured during their time in the armed forces.
The service is available in selected NHS health centres across England close to where people live.
Veterans accessing this service will be cared for by military and civilian clinicians who understand the nature and context of the injuries.
The Veterans Trauma Network works closely with Defence Medical Services, national centres of clinical expertise, the Veterans' Mental Health Transition, Intervention and Liaison Service, the Veterans' Mental Health Complex Treatment Service and key service charities to make sure patients have a personalised care plan in place.
As families and carers can be seriously impacted when their loved ones are injured, they can also be supported to access services that may help them.
The Veterans Trauma Network also works with veterans who've been injured, as well as their families and academic research partners, to better understand the impact of this work.
The service has been designed following feedback and information from injured veterans and their families.
How to get help from the Veterans Trauma Network
The referral process is simple. Make sure you have told your NHS GP you served in the armed forces and they can refer you by emailing england.veteranstraumanetwork@nhs.net.
You can also be referred by Blind Veterans UK and Style for Soldiers.
For more information, email Blesma at bsoprosthetics@blesma.org or call 020 8548 7080.
NHS prosthetic services for veterans
The veterans' prosthetics programme was set up to put into practise the key findings of 'A better deal for military amputees', a report by Dr Andrew Murrison MP.
Dr Murrison recommended that a small number of multidisciplinary centres should provide specialist prosthetic and rehabilitation services to ensure veterans have access to high-quality care similar to that provided by the armed forces.
9 Disablement Service Centres (DSCs) across England have been selected to provide enhanced services to veterans who have lost a limb as a result of their service in the armed forces:
- Sheffield – Mobility and Specialised Rehabilitation Centre, Northern General Hospital
All DSCs in England can apply to the Veterans Prosthetic Panel (VPP) on behalf of veterans.
Veterans Prosthetic Panel
The VPP was established in 2012 so veterans could apply for funding for high-quality prosthetic limbs, regardless of which DSC they attend. Applications are assessed by a specialist panel.
Who qualifies for VPP funding for prosthetics?
This additional funding is only available to veterans who've lost a limb during military service.
A veteran who has left military service, but whose limb loss is attributable to an injury sustained while in service, also qualifies.
Veterans who lose limbs after they leave the military or while in the military, but not as a result of service, such as in a civilian road traffic accident, will still be able to access services as usual through their local DSC.
To find out more about NHS prosthetics services for veterans, speak to your prosthetist.
You can also contact Blesma at bsoprosthetics@blesma.org or call 020 8548 7080.
