What is a veteran?

A veteran is anyone who has served for at least one day in the Armed Forces, whether regular or reserve. It means the same as ‘ex service personnel’ or ‘ex-forces’, although not all veterans know, choose or want to associate with the term ‘veteran’. This is particularly the case amongst younger veterans who often refer to themselves as ‘ex-forces’, due to the common belief that a veteran is someone who fought in the First / Second World War. 

What is the RCGP advice on veteran’s health?

Whilst many aspects of the health needs of veterans are the same as for the general public, there are sometimes significant differences, particularly in relation to conditions attributable to service life and the impact upon families. These differences can be reflected in the way in which healthcare is delivered, the range and types of some specific services provided and the long-term impact upon patients and families. 

Please also see the Armed Forces healthcare pages on the NHS website.

What is the Armed Forces Covenant? 

The NHS has a duty to deliver on a number of health commitments, which are set out in the Armed Forces Covenant as follows:

• The Armed Forces community should enjoy the same standard of, and access to healthcare as that received by any other UK citizen in the area they live
• Family members should retain their place on any NHS waiting list, if moved around the UK due to the service person being posted.
• Veterans should receive priority treatment for a condition which relates to their service, subject to clinical need.
• Those injured in service should be cared for in a way that reflects the nation’s moral obligation to them, by healthcare professionals who have an understanding of the Armed Forces culture.

This is reflected in principle four of the NHS Constitution, which states ‘the NHS will ensure that in line with the Armed Forces Covenant, those in the Armed Forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside’.  

The Covenant is an important aspect of our approach to care, especially as the Armed Forces community can be at a disadvantage due to their mobility and frequent moves.

What dedicated NHS services and support are available to veterans?

Veterans’ Mental Health, Transition, Intervention and Liaison Service (TILS)

The TILS is for both serving personnel approaching discharge from the Armed Forces and veterans with mental health difficulties.  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. Help may also be provided with housing, employment, alcohol misuse and social support.

The service comprises three elements: 

• Transition: service for those in transition from the Armed Forces: For those due to leave the Armed Forces, the TILS will work with the Ministry of Defence (MOD) to offer individuals mental health support through their transition period and beyond.
• Intervention: service for veterans with complex presentation: Service personnel approaching discharge and veterans will have an assessment within two weeks of a receipt of referral.  If their needs are identified as suitable for treatment within the TILS, the service will aim to see them for their first appointment two weeks after this.  They will be supported by a military aware team who will develop a personalised care plan with the individual. 
• Liaison: general service for veterans: Patients who do not have complex presentations, yet would benefit from NHS care, will be referred into local mainstream NHS mental health services where they will receive treatment and support.  This could include talking therapies or treatment for other conditions, such as eating disorders or psychosis.

Veterans’ Mental Health Complex Treatment Service (CTS)

The CTS is for ex-forces who have military related complex mental health difficulties that have not improved with previous treatment.  The service provides intensive care and treatment that may include (but is not limited to) support for drug and alcohol misuse, physical health, employment, housing, relationships and finances, as well as occupational and trauma focused therapies.

Referral to both of these services is via the TILS. Individuals can self-refer or ask their GP or a military charity to refer them.  Contact details are as follow: 

• South West England, call 0300 365 0300 or email sc.veterans@nhs.net.

Veterans Trauma Network (VTN)

The VTN is the first NHS pathway for veterans’ physical health, providing care and treatment to those with a service-attributable healthcare problem. Located in ten major trauma centres (Plymouth, Oxford, London (three centres), Birmingham, Nottingham, Liverpool, Leeds and Middlesbrough) across England, the VTN works closely with Defence Medical Services, national centres of clinical expertise, the TILS and CTS, as well as military charities to provide a complete package of care. It is run largely by healthcare professionals who are either veterans or serving members of the Armed Forces. GPs can use a single national email to refer veterans to the service england where they will benefit from specialist care by military and civilian experts.  

Prosthetics

The Veterans’ Prosthetics Panel (VPP) was established in 2012 as a way of ensuring that veterans can access high quality prosthetics regardless of which Disablement Service Centre (DSC) they attend. This additional funding is available only to veterans who have lost a limb whilst in military service. A veteran who has left the Armed Forces, but whose limb loss is attributable to an injury sustained whilst in service, also qualifies. Veterans who lose limbs after they leave the military or suffer limb loss whilst in the military, but not in a service attributable incident, such as in a civilian road traffic accident, will continue to access services as usual through their local DSC. 

The additional funding for veterans is for treatment that would not typically be provided by the NHS, for example higher specification prostheses than are normally available on the NHS. Funding is approved on a case by case basis, with DSCs making individual funding applications to the VPP, which clearly set out the requirement and the benefit that is expected if the request is supported. More information is available on the NHS webpage on services for veterans with physical injuries. 

Eligible veterans are also able to access the Complex Prosthetics Assessment Clinic (CPAC), which is run by Defence Medical Rehabilitation services. CPAC supports veterans with particularly complex prosthetic socket needs who have previously been seen at the Defence Medical Rehabilitation Centre Headley Court.

Veterans personalised care programme for ex-forces with a long term physical, mental or neurological health condition or disability

NHS England and NHS Improvement, together with the Ministry of Defence, have published the Personalised care for veterans in England, a guide for clinical commissioning groups and local authorities, which sets out a personalised care approach for those veterans who have a long term physical, mental or neurological health condition or disability.

This guide is for those individuals and organisations who are leading or involved in supporting this patient group through the delivery of NHS Continuing Health Care or a jointly agreed care plan.  A supporting patient leaflet is also available.  

Eligible individuals will have a single personalised care plan for all their health and wellbeing needs that is developed with them and a range of organisations, including health and social care and military charities.  This approach will give the individual more choice and control over how their care is planned and delivered, meaning they can choose how best to live their life and get the right care and support to make this happen.  It will also take into account personal preferences that relate specifically to the individual’s military service. As part of this, they may get a personal budget to pay for some of the care and support they need, as well as more support in the community, such as emotional and practical support from people who have similar health conditions or disabilities.  To apply, individuals should contact their local clinical commissioning group.  

The Veterans Covenant Health Alliance (VCHA) 

The VCHA aims to improve NHS care for the Armed Forces community by supporting trusts, health boards and other providers to identify, develop and showcase the best standards of care. 33 hospital trusts have already been accredited as ‘Veteran Aware’, having demonstrated their commitment to eight core manifesto standards, including signing the Armed Forces Covenant, raising awareness of veterans’ healthcare needs among staff, and establishing links with local support providers. The VCHA is working with many more trusts to achieve accreditation.  For further information, visit the webpage for Veteran Aware hospitals. 

More information on NHS services for veterans can be found on the NHS website here.

What other services are available to veterans? 

Hearing loss and tinnitus services 

If a patient has acquired hearing loss and / or tinnitus relating to their time in service, additional support can be funded through The Royal British Legion Veterans’ Hearing Fund. To access the service, patients can be referred by their GP to their local NHS audiology department or an application form can be downloaded from the Veterans Hearing Fund section on The Royal British Legion website. 

Mobility equipment support

The Royal British Legion has a Veterans’ Mobility Fund, which provides specialist wheelchairs, orthotic equipment and other mobility related items for veterans who have a service related serious physical injury and whose needs cannot be met through statutory services. Eligibility for the fund requires the condition to be attributable to service and typically applicants will be in receipt of a War Pension or relevant award under the Armed Forces Compensation Scheme. To find out more, visit the Veterans Mobility Fund section on The Royal British Legion website.  

Veterans’ Gateway

The Veterans’ Gateway is made up of a consortium of organisations and Armed Forces charities, including The Royal British Legion, SSAFA, Combat Stress and Connect Assist.  It is a main point of contact for veterans seeking support, putting them and their families in touch with the organisations best placed to help with the information, advice and support they need – from healthcare and housing to employability, finances, personal relationships and more. For more information, visit the Veterans’ Gateway website.

Contact 

Contact is a group of charitable, support and state organisations that have joined forces to enhance mental health support available to the Armed Forces community. The partnership consists of Big White Wall, Cobseo, Combat Stress, Help for Heroes, The Royal British Legion, Walking With The Wounded, the NHS, the MOD, the UK Psychological Trauma Society and King’s College London. Contact aims to improve collaborative care management, increase instances of help-seeking behaviour, improve service provision, encourage best practice across the sector and improve public knowledge of what support is available and how best to access it.  For more information, visit the Contact website.

Cobseo 

Cobseo, as the Confederation of Service Charities, offers membership to charities who promote and further the welfare and general interests of the Armed Forces community, subject to fulfilling the membership criteria. Comprising 255 members, Cobseo provides a single point of contact for interaction with the Armed Forces community.  For more information, visit the Cobseo website. 

Help for Heroes

Help for Heroes provides direct, practical support for wounded, injured and sick service personnel, veterans and their loved ones from any conflict. They have four recovery centres in the UK offering medical care, guidance, support and advice. Patients can self-refer or be referred by a professional. Once referred, an initial assessment will take place within one to two weeks and there is no waiting list for treatment. For further information, visit the Help for Heroes website. 

Combat Stress

Combat Stress is the UK’s leading mental health charity for veterans. It provides free specialised clinical treatment and support to ex-servicemen and women across the UK with mental health conditions. Combat Stress has a strategic partnership with the MOD and the Department of Health and Social Care. This enables the charity to work with NHS mental health trusts and Armed Forces Health Networks to develop services suitable for military veterans. For further information, visit the Combat Stress website.

Blesma

Blesma supports limbless veterans to lead independent and fulfilling lives. Blesma is dedicated to assisting serving and ex-service men and women who have suffered life-changing limb loss or the use of a limb, an eye or loss of sight. They support these men and women in their communities throughout the UK and provide centralised assistance to those living overseas.

Blesma works closely with the NHS to ensure the latest advances in the relevant medical fields are converted into practical solutions that can benefit all of their members. They do not provide members prosthetics, but they do help prosthetists develop their skills at undergraduate and PhD level.  

Anyone fitted for a prosthesis will know that the socket fit is paramount and it is often the cause of most issues. Blesma keeps up to date with developments in this area and encourages research and development, maintaining close links with NHS national teams, Defence Medical Services (particularly the Defence Medical Rehabilitation Centre at Headley Court) and industry. For further information, visit the Blesma website.  

Please do contact Maywood Surgery using our secure online form if we can be of any further help.

Mark Anderson is the Clinical Lead for Veteran care.