Government Support (Veterans)

Sandra Osborne (Ayr, Carrick and Cumnock) (Lab): I am pleased to have secured the debate, following on as it does from veterans' awareness week and last Sunday's world war two national commemoration day. Recently, we held a similar event in Ayrshire, which was organised by the three Ayrshire councils and the lord lieutenant. More than 100 veterans from the second world war took part in a service and recounted memories of their comrades at home and abroad. However, some local women who had taken part in it made it clear to me that they considered that women's contribution to the war effort had never been given the recognition that it deserved. I know that they will be delighted that Her Majesty the Queen has unveiled a memorial to commemorate the 7 million women who worked for victory in the second world war in both the armed forces and on the home front.

I believe that, to date, only one debate on the Floor of the House, in June 2004, was dedicated exclusively to veterans' issues. It is a little disappointing that such a debate has not become an annual event. Although there are opportunities in defence debates to raise veterans' matters, such as the one that was held last week, does the Minister agree that a specific debate held in Government time would help to raise the profile of veterans' awareness week and highlight further some of the excellent work that is undoubtedly going on, as well as providing a platform for hon. Members to raise concerns on behalf of their constituents who are veterans? Moreover, members of our communities are concerned about how society treats our veterans.

I wish to make it clear that I am no expert on defence matters. In common with many hon. Members, I do not have personal experience of the armed forces. That is why I am grateful to have had the opportunity of taking part in the armed forces parliamentary scheme and completing 22 days with the Royal Marines. I pay tribute to Sir Neil Thorne and all who made the scheme possible. It afforded me the chance to learn at first hand about the armed forces in a way that I would never otherwise have had. As I said, such an experience does not make me an expert, but it gave me an opportunity to hear from the real experts on both a formal and informal basis. It opened my eyes to many issues in respect of the armed forces, which are for another debate.

I wish to draw attention to some relevant points that I learned during my time with the Royal Marines. If we do not treat them fairly today, we cannot expect serving members of our armed forces to have confidence that they will be treated well when they become the veterans of tomorrow. Much work has been done, for example, in tackling homelessness among ex-servicemen, and that is important for those who are vulnerable. However, as Ministers have stated on many occasions, most people settle well when they leave the armed forces. There is the possibility for them to leave the armed forces enhanced by skills and experience and to develop their potential in the wider community, but I was informed by some marines that they could not afford to get on the property ladder because they were not paid enough.

I am acting as an unofficial shop steward on behalf of the Royal Marines. Perhaps we should seriously consider introducing a trade union to the armed forces. I saw at first hand the job that members of the armed forces do and the contribution that they make, for which they should be appropriately rewarded. The Ministry of Defence is modernising the service to increase the opportunities for serving personnel to put down roots and extend the time that they can spend with their families. We need to encourage recruitment and retention, but getting on the property ladder is surely part of the preparation for civilian life. I do not suggest that young members of the armed forces are unique in that regard, but I ask the Minister to consider that as a serious issue.

My second point follows on from that. Preparation for civilian life should be part of the process from the beginning and not an afterthought when the end is in sight. I know that efforts are being made to ease the transition from military to civilian life, and I would be grateful if the Minister provided an update on what is being done to assist serving personnel to plan for the future.

I am indebted to the armed forces parliamentary scheme, but also to the Veterans Agency, the Royal British Legion and particularly Combat Stress for the information and advice that they have made available in their work and campaigns. The situation for veterans today is very different from that of the past. However, that does not mean that everything is rosy. I refer, for example, to an article by Dr. Niall Barr in the first issue of the Royal British Legion magazine, "Forward". It provides an historical perspective on how veterans have been neglected by the state in the past and on how the legion was formed in 1921 to form a veterans' movement, which, as we know, continues today.

Although people do not leave the services now as part of a great wave of demobilisations as in 1918 or 1945, a return to civilian life can be difficult for some people today. They may not leave the services destitute, but they leave as individuals and face loneliness, a lack of support and often a lack of public empathy. Thanks to the efforts of its servicemen and women, British society is insulated from the demands and human costs of war and there remains little real understanding of what they have experienced on operations. Unfortunately, last week we saw a measure of how bad that can be. Let us hope that we never see a repeat of it.

I shall concentrate most of my remarks on ex-service personnel who suffer from mental health problems, what is being done for them, where gaps need to be filled, the contribution made by Combat Stress—the ex-services mental health society—and especially Hollybush house, newly in my constituency. It was formerly in the constituency of my former colleague, the Member for Carrick, Cumnock and Doon Valley, who has gone to the other place as Lord Foulkes of Cumnock. I am indebted to him; he was very committed to the work of Hollybush house. He invited the former Minister with responsibilities for veterans, Ivor Caplin, to visit the house, and I was delighted to be present at that occasion. The Minister was impressed by the work being done there.

I summarily extend an invitation to the current Minister with responsibilities for veterans to visit Hollybush house to see the work that is being done there. I am sure that he would enjoy his visit to Scotland and I know that the people there would be happy to welcome him.

I should like to recognise the progress that has been made since the appointment of the first Minister with responsibility for veterans. In preparing for this debate, I was struck by the amount of intensive strategic work going on in this area, which appears to differ substantially from the somewhat piecemeal approach adopted by Governments in the past. Previously, problems were addressed as they developed, but the Government are now taking a more structured approach and are basing policy—and, ultimately, resources and action—on evidence of real and measured needs. In the past, services for veterans have been delivered by a variety of Government and voluntary sector organisations, often working in isolation. Increasingly, social services are delivered on a cross-Government basis or through partnership between the Government and private or voluntary sectors. It is that partnership that I want to explore more fully this morning.

I question whether we fully support veterans with mental health illness, but there is no question that at least there is a coherent plan, and mechanisms to measure success or failure, what is or is not working. I am sure that that will be widely welcomed throughout the House, but the difficulty is that it will not necessarily convince our veterans who want practical proposals. They are not overly impressed by phrases such as "coherent strategies" or "partnership working"—I suspect that they would have used other expressions in their serving days—that may appear to be nothing more than bureaucratic window dressing to someone who cannot access the treatment that they need.

I would not dare to speak for ex-service organisations, but I can speak from my experience of working with a voluntary organisation that supported women who had been abused and who suffered from post-traumatic stress disorder as a result of experiences that were somewhat different from those of veterans. It is always pleasing when a Government, who have the power to take on board the concerns that an organisation has campaigned on with little recognition for many years, start to take the issue seriously, but it is always done on the Government's terms. It can be difficult for the organisation to comply with consultations on strategies while it struggles to provide a service at the coalface with scarce resources.

Partnership between the Government and the voluntary sector must therefore recognise the authentic experience and the campaigning roles of the veteran's organisations. It is necessary to ensure that jointly funded work does not detract from the Government's responsibility to provide state support for veterans or impinge on the charities' independence. That is a fine balance. I hope that the Minister will inform us that it is being achieved through the Veterans Forum and its various working groups.

I would also be grateful if the Minister could outline how the Government are putting their money where their mouth is. We all applaud the sterling fundraising efforts of ex-service organisations and the support that they get from the public, but what is the role of public money in supporting veterans? How does our contribution to supporting veterans compare with that of other countries? It is often said that a country can be judged by how it treats its veterans. My right hon. Friend the Secretary of State said that last week's events would give the country an opportunity to thank a generation that made so many sacrifices for freedom. However, that generation was not particularly well treated at the time. What of the generations that have come after it and future generations?

Mr. David Marshall (Glasgow, East) (Lab): I congratulate my hon. Friend the Member for Ayr, Carrick and Cumnock (Sandra Osborne) on securing this important debate. I have recently dealt with several cases of the type to which she refers, and I shall be grateful to the Minister for what I am sure will be a helpful response. Does my hon. Friend agree that stress and mental health problems may not manifest themselves immediately or even early on in a person's service career—they may not become apparent until many years have passed—and that they could result not only from having served in areas of conflict but from having been subjected to stress by superior officers, from having been treated as a guinea pig and given inoculations without proper explanation or from having served in nuclear test areas? It is only when people reach the later stages of their life that such events begin to prey on their mind and cause them the mental health and stress to which my hon. Friend refers.

Sandra Osborne : I entirely agree with everything that my hon. Friend said. A well-known feature of post-traumatic stress disorder is that it can affect people many years after the event, even though they were not necessarily aware of a problem at the time. There are a number of contentious issues about how people end up with mental health illnesses following their service. They have been ongoing for many years.

I turn to my main concern, which is to raise specific issues relating to mental health problems associated with combat. Thousands of British veterans still struggle with the horrific psychological effects of combat. Many of those brave veterans face a daily struggle against nightmares, flashbacks, depression and anxiety. That is the brutal legacy of combat experience. As the organisation solely dedicated to helping the veterans recover from their injuries, the society—Combat Stress—provides intensive therapy at three treatment centres. One is in Surrey, one is in Shropshire and the other is Hollybush house in Ayrshire, which is in my constituency.

Hollybush House is vital to Scottish and Irish veterans. It is the only specialist service providing for the psychologically wounded in Scotland. It provides a unique safe environment where experienced staff can use the veteran peer group to help break down the mental barriers associated with post-traumatic stress disorder and other conditions. They can engage the veterans in therapy much more quickly and much more effectively than outpatient national health service appointments can do.

Research by Professor Simon Wesley and the current review of the society by the health and social care advisory service show that the NHS is not well equipped to understand the experiences of those veterans who have the mental health problems of combat-related psychological injury. Interim suggestions for policy have come out of Professor Wesley's King's college scoping study, which was commissioned by the MOD to examine key areas of need not already being met. They included the idea that for people who have left the services, joint work with the Department of Health for enhanced provision of service-related mental health problems was required. Such provision should be in a setting sensitive to veterans' unique needs. I would suggest that Combat Stress and its various treatment centres provide such a setting.

Ex-services people feel disfranchised and have often been fobbed off or pushed from pillar to post when trying to access health services. The reality is that most clients referred to Combat Stress have already done the rounds and have not been helped in the existing NHS system. Their condition is often chronic. They are often unemployed, may have housing problems related to the breakdown of relationships, are dependent on the state benefits system and have not uncommonly left a partner and children in similar circumstances.

It appears that many other countries recognise the fact that to achieve positive outcomes with that client group, a dedicated service is required for them, hence their Governments also fund them. For example, Australia, New Zealand, Canada and the United States have a different system, where veterans' organisations and hospitals are funded by the Government. In this country, some time ago, money was transferred to the NHS when service hospitals closed, in the belief that it would provide services to veterans. It has been left to the ex-services organisations to pick up the pieces.

I do not say that we should lose the partnership approach that we have, nor the valuable experience of our longstanding ex-services organisations, but if they are spending most of their time worrying about funding, that affects their ability to provide the service and they cannot expand it, either to accept higher numbers of referrals or to respond to real and measured needs, to use the MOD phraseology.

Many people seem to think that an ex-services mental welfare society will be dealing only with veterans of the two world wars. They tend to see images of shell shock, images from the past. Those are important images but they do not necessarily relate to today's younger veterans.

The society is picking up an unprecedented number of new cases: it had 900 last year, and put 500 on its books. The damage caused to veterans frequently requires long-term treatment and is getting more and more complex because of societal changes and the different active engagements of troops. However, many clients are now referred earlier to Hollybush house. Those are the clients most likely to achieve positive outcomes, but they are also the very people for whom funding is not available.

The aims of treatment for these clients should be to provide curative treatment that will enable them to deal with the effects of their symptoms to a degree that allows them to live a more normal life, form relationships and join the work force. However, that cannot be offered, because although Combat Stress has the expertise, it does not have the funding to allow it to provide the level of input necessary to achieve those outcomes. There is a big vacuum at the moment, as it cannot do the outreach work that would complement the work of community mental health teams in the national health service.

As I said, referral rates are rising, and it is logical to expect further increases as a result of the conflict in Iraq. As the Minister knows, the Territorial Army, and reserves in general, were used quite extensively in Iraq, and more TA soldiers are asking Combat Stress for help than has been the case in any other conflict. I have been informed that the issue is causing concern to not only clinicians in Combat Stress, but the Army Families Federation and community psychiatric nurses working for the Army. There seems to be a shortfall in help for TA service personnel with psychological problems on return home. As the Minister knows, regular soldiers must attend a compulsory decompression process on return from active duty. They also return to the support of barracks and continued help, if necessary, from the defence psychiatric services.

The TA soldier has the option of the decompression process, but quite naturally most opt to get home as soon as possible, where they immediately become the responsibility of the NHS and the victim of long waiting lists, and are dealt with by staff with little or no experience of combat-related psychological problems. It is feared that the current increased referral rate from the TA may be only the tip of the iceberg, and that there may be a substantial increase in demand for support from reserve veterans in future. I would be grateful for the Minister's comments on that.

In April 2004, Combat Stress organised an appeal under the direction of Sir Clive Fairweather to upgrade Hollybush house to meet the statutory requirements laid out in the Regulation of Care (Scotland) Act 2001, which comes into effect in 2007. Fundraising for the new wing now stands at an incredible £730,000, and the appeal has been supported by almost 2,000 donors and organisations. I know that there is a great deal of local support for the appeal because I have attended several local fundraising events.

In Ayrshire we are much aware of the fine work done by Hollybush house, but the appeal has had the added advantage of placing the needs of Scottish veterans with combat-related mental health injuries firmly on the map. There is no doubt, however, that without that appeal the closure of Hollybush house was a distinct possibility. We hope that the Scottish Executive will make a contribution to the final budget of £1.7 million that is needed to secure the upgrade. We wait for a decision to be made. The upgrade is welcome, but it has been hastened by the Scottish Executive's care requirements. I believe that it is incumbent on the Scottish Executive to make a contribution.

There is the vital issue of funding for Combat Stress in the light of the new compensation scheme introduced in April. Even before April, Government support came only in the form of possible funding of treatment for any client who has a war pension of more than 20 per cent for a mental health problem. More than 40 per cent. of the clients did not have that pension, so the society was reliant on using its general fund, which consists of donations from regimental associations, the Royal British Legion branches and other charitable trusts.

Many of the referrals now come from mental health professionals or primary care providers, but such referrals do not come with any funding attached. The new scheme introduced in April does not have that element to it. The single payment compensation with a lump sum will not necessarily be used to pay for treatment at Combat Stress. When funding disappears with current veterans who receive pensions it will not be replaced by the new system. Slowly but surely clients under the new scheme will not be able to be accommodated.

As I have said, 40 per cent. of treatment is already unfunded. The Ministry of Defence appears to be saying that funding for veterans with combat-related mental health issues is a national health service issue, not an MOD one. There is no scheme in place to ensure that that NHS fills the gap. Combat Stress is doing all that it can to raise funds from the public. The Minister knows that it is notoriously difficult to raise funds to respond to mental illness in any circumstance.

The balance of responsibility for funding has been shifted to the NHS. I hope that I have illustrated that it is well established that it is not realistic for appropriate services to be provided by the NHS. It could be done through partnership with Combat Stress, but that would require public funding. If Combat Stress is doing a job that should be done by the NHS and social services, the Government should allocate funds to the organisation that can deliver the service through a contract for specialist commissioned services or some other mechanism. It is worrying that such a system is not in place.

I realise that there are complications due to devolved government, but there must be a national agreement, otherwise a postcode lottery will develop, with veterans accessing services only if their local health authority happens to take the situation on board. I have already stated that much has been done by the Government. Successive Ministers with responsibility for veterans should develop a proper strategy for dealing with veterans' concerns. The Minister responsible for encouraging cross-Government co-operation on veterans' issues must solve the funding problem.

It does not make economic sense not to spend money in the short term that would reduce the long-term drains both on the NHS and the nation's benefit system that will almost certainly result should an increasing number of veterans continue to develop chronic, debilitating conditions that go untreated. Hollybush house does a fantastic job with scarce resources. Is it right that it achieves all that while it is heavily dependent on charitable income? More importantly, does the situation show that we value the sacrifice that our veterans have made for their country? I look forward to the Minister's reply.

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