Military medical services are at crisis point
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7082.695a (Published 08 March 1997) Cite this as: BMJ 1997;314:695All rapid responses
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I took my option to leave the RAF Medical Branch ten years ago, as, even then, the committment to maintaining a viable specialist medical service seemed less than wholehearted. Even so, I have watched with incredulity as a Conservative Government systematically dismantled the Defence Medical Services. It is therefore reassuring to see that the present Government are accepting that things have gone too far, but even now their concern seems to be focused on the need to support the armed forces during time of conflict.
In order to have adequate medical support available when conflicts arise, it is necessary to re-establish a viable peacetime service, which allows medical and paramedical staff to train in the Services, and to provide care to troops and their families as part of the military team. Until the mid eighties, medical care in the military was second to none, and it is impossible to overestimate the positive effect this had on the morale of the fighting men and women, not to mention the benefits in operational terms of knowing that key members of staff with medical problems would be treated promptly and efficiently by medical staff who understood the importance of their patients' roles. That service had evolved over many years. Sadly, I doubt if it will ever be restored, and the use of reservists and other part-timers will certainly not be the answer.
Competing interests: No competing interests
Never too late!
After spending most of my career, from 1957, in the Royal Air Force, I retired in 1991. The last five years were in triservice appointments at the Ministry of Defence. After my first retirement I became a Consultant in Public Health Medicine in South Wales from which I recently retired after a further six years.
Before leaving the MOD, the Soviet Empire had collapsed and it was obvious that there would have to be changes in the size, structure and disposition of the Armed Services. As I was to see later in the reorganisation of Health Authorities in Wales, change is an opportunity to get it wrong. However recrimination is not productive. The Armed Services need medical support just as ships, vehicles and aircraft have to be maintained.
Up to the 'Options for Change', the Defence Medical Services were of a high professional standard, but there were no management cost apportionments. Health Authorities collected the capitation payments for the military population within their boundaries and spent it on other patients. Servicemen overseas paid UK income taxes for no NHS benefits. Local residents treated in military facilities only generated marginal payments if the hospital was lucky.
When the internal market was introduced, the Armed Services should have been treated as a Health Authority, receiving money for their population, paying for servicemen in NHS hospitals and earning from civilian patients. The additional costs reflecting occupational services and military needs should rest with the defence budget.
The knock for knock agreement negotiated with the DoH in 1948 has proved a subsidy by Defence for the NHS. Proper accounting would have shown the net cost of the Defence Medical Services. This would have been seen by the Chiefs of Staff as being very good value. Unfortunately it is now going to be very expensive to set the errors right.
Competing interests: No competing interests