HC Deb 15 September 2004 vol 424 cc465-71WH

11 am

Mr. Desmond Swayne (New Forest, West) (Con)

May I draw the House's attention to my entry in the Register of Members' Interests, which records that I am a serving officer in the Territorial Army with recent mobilised service?

I begin by quoting a written answer from the Minister given on 19 July, which states that the Ministry of Defence, through the Defence Medical Services, provides comprehensive medical services, to standards at least equal to the NHS". He continues: Overseas, the Ministry of Defence is committed to providing medical services for families accompanying Service personnel which are comparable to those provided by the NHS."—[Official Report, 19 July 2004; Vol. 424, c. 32W.] That is the mission statement and the Minister's objective in respect of what is one of his core duties: to provide medical services to our armed forces, particularly those serving abroad, which is the focus of this debate.

Let me contrast that mission statement and objective with the experience of my constituent, Mrs. Deborah Crowton and her daughter Amelia, from the village of Everton. Until she was medically discharged from the services, my constituent had 17 years of military service, of which 12 were as a nurse. As a nurse, she has a volume of experience in such matters. I shall be brief in covering the details of the case because I want the Minister to have the opportunity to hear those details from my constituent at first hand. He would benefit from that, so my first request is that he meet my constituent. I caution him, however, as I found it difficult to maintain my composure when I was first appraised of the details of the case.

My constituent was posted to Cyprus to join her husband in September 1998. She was 27 weeks pregnant. She expressed reservations about being posted in that state, but the posting went ahead. On 4 October 1998, Mrs. Crowton's waters broke, leaving her without amniotic fluid. Her husband drove her to Dhekelia camp, where she was diagnosed with pre-eclampsia and was in need of an emergency caesarean section. RAF Akrotiri was unable to carry out that procedure and she was taken as an emergency admission to a civilian hospital in Nicosia.

The admission was attended by a certain amount of chaos, due to the language barrier and so on, despite Mrs. Crowton's experience as a nurse. However, after some time, she was assured that she would receive an emergency caesarean section that day. She did not, and she did not for five days. She was kept in enormous pain, and despite her requests for pain relief she did not receive it. On the fifth day, she was strapped up and required to give birth naturally in what I can describe only as horrendous circumstances from which her husband was excluded despite his request to be present.

My constituent, Mrs. Crowton, on giving birth to Amelia, immediately had to be treated for very high blood pressure. After it became possible to appraise her of what had happened, she was told that her daughter was suffering from septicaemic shock, pneumonia and a brain haemorrhage, and that an urgent baptism should be arranged.

In the following weeks, the insensitive and, indeed, callous treatment of my constituent continued, particularly on the issue of access to the child and visiting times. Staff told her to stop blubbing because, after all, she was young enough to have another child and she would only upset the other mothers. Little wonder, therefore, that my constituent, Mrs. Crowton, had to be discharged from her military service suffering from depression and that she has since been unable to accompany her husband on postings.

That was all some time ago. Amelia is now five and a half years old. She cannot walk, she cannot talk and she cannot use her hands. She is blind and she suffers from severe epilepsy. She requires full-time care. Those of us who are parents and who have incurred the expense of having children will find the expenses that my constituents have incurred mind-boggling: £2,000 for a pram, £3,000 for a bed, £8,000 for a bath and £65,000 to adapt and extend the house to cater for Amelia. All that has occurred without apology or acknowledgement of responsibility.

What redress is available to my constituent? I will tell the House: she may sue the medical authorities at the hospital in Cyprus, with all the attendant problems of distance, language and a statutorily set minimum compensation that is much less eligible.

So, let me contrast that with what would be available to my civilian constituents were they to be treated abroad in a foreign hospital; it is possible for our constituents to be treated by the NHS in foreign hospitals. I have guidance issued by the Department of Health in November 2002. It is entitled, "Treating more patients and extending choice: overseas treatment for NHS patients—guidance for primary care and acute trusts". I quote briefly from section 6.1, which says should a patient sent abroad for treatment wish to raise an issue of medical negligence, the courts may regard NHS bodies as having a duty of care that cannot be delegated, despite the fact that the treatment was being provided by a non-UK provider. Patients would therefore be able to sue the NHS in the English courts, rather than having to take a case through foreign courts. This is the key passage: This approach is in line with the Government's policy preference, which states that patients travelling abroad for treatment should have the same rights and remedies as patients receiving treatment in the UK. I take the Minister back to his written answer to me, which I quoted at the beginning of the debate, in which he said that Defence Medical Services, provides comprehensive medical services, to standards at least equal to the NHS". I have not come here to find out what the law is. The courts determine what the law is; lawyers will tell us what the law is. I have come here, and brought the Minister here, to do what only a Minister and a politician can do—discuss not what the law is, but what the law ought to be and, if it ought to be different, what he proposes to do to change it.

Ought it be the case that citizens are so much advantaged over our military constituents as a consequence of their being civilians rather than in the military? Given the sacrifices that we expect and require of our military constituents, is it right and proper that the Secretary of State for Health should have an enduring duty of care to patients, irrespective of how he might subcontract that care, whereas once a citizen joins the armed forces, he ceases to have the benefit of that duty of care and in turn takes on a duty discharged by the Secretary of State for Defence, although that Secretary of State has no enduring duty of care corresponding to that which is discharged for civilians by the Secretary of State for Health? Can that be right? I will leap to the assumption that the Minister agrees that there should be a level playing field—military personnel should not be disadvantaged in this way. If he does agree, what is he going to do about it?

Perhaps the Minister has already begun to do something. Can he confirm that payments have been made to military personnel who were taken ill or suffered injuries during the exercise Saif Sareea and were treated in Omani medical facilities where they suffered medical negligence? Have those payments been made? If so, will he acknowledge that that touches on the same principle as cases I have mentioned, particularly those relating to designated provider hospitals in Germany and my constituent's case relating to Cyprus?

I am here today to ask the Minister whether he will review those cases. Will he consider not the positive question, "What is the law?", but the normative issue of what it ought to be, and what the Ministry of Defence might be able to do for citizens who find themselves in the position of my constituent Mrs. Deborah Crowton and her daughter Amelia?

11.12 am
The Parliamentary Under-Secretary of State for Defence (Mr. Ivor Caplin)

I welcome the hon. Member for New Forest, West (Mr. Swayne) to the debate and thank him for raising those points. His interest in medical services for the armed forces reflects his service in the Territorial Army over the years and his call-up last year to Iraq, of which the House is aware. I have to say to him that I am unsighted on the specific case; he did not raise it with me in advance. I undertake to look in Hansard tomorrow morning at the points that he has raised in relation to his constituent, as I do for many other hon. Members. I will review the circumstances and write to let him know my views on the matter by the end of this month.

I think it would be helpful, in the context of this debate on the provision of medical services for service personnel serving overseas, to make some general points about our progress. Day in and day out, our servicemen and women have demonstrated, through their dedication and professionalism, why they are respected throughout the world. British forces are performing diverse, difficult and demanding tasks around the world. It is only right that we should provide them with the health services that they require to deliver what we expect of them. Defence Medical Services comprises doctors, nurses and other health professionals who are well trained and equipped to provide our people with the most appropriate health services for their needs.

As an employer, the Ministry of Defence has a responsibility to take care of all its people—a responsibility that we take very seriously. Wherever our service personnel are serving, we are totally committed to providing them with high-quality medical services that are as close as possible to those provided by the NHS.

I should also stress that, where our forces are serving on accompanied tours, our commitment extends to their families. I shall give some details about that, but how we achieve it will vary depending on local circumstances. It is neither possible nor desirable to mirror the NHS abroad. What remains consistent, however, as I indicated in the written answer to the hon. Gentleman, is our determination to fulfil our duty to take reasonable care to provide access to health care. We ensure that the standards of health care for all entitled personnel are maintained, whether through in-house providers, utilising local civilian health care, repatriation to the UK or a combination of all those provisions as necessary. I pay tribute to all those in the Defence Medical Services who provide the medical and dental care to our troops around the world.

The British forces Germany health service is responsible for the provision of health care for service personnel—mainly from the Army, but including some from the RAF—based in Germany. The entitled population in British forces Germany totals approximately 55,000, and the annual British forces Germany health service expenditure on overall health care runs at about £60 million.

As in the NHS, various organisations are responsible for different aspects of the service and, just like the NHS, the British forces Germany health service seeks to make the care that it provides seamless from the patient's perspective. It does so under a military director—currently a brigadier—by bringing together military personnel, Guy's and St. Thomas' NHS Trust and the Soldiers', Sailors' and Airmen's Families Association, known as SSAFA, in an innovative and co-operative partnership, effectively bringing together military-civilian and public-private health care provision. The relationships between those elements are complex, but firmly backed by open-book financial arrangements and close collaboration at every management level.

Primary care is provided by medical centres located in each of our five Army garrisons and run by military and civilian medical staff. Clinical staffs in each centre are a combination of uniformed members of the Defence Medical Services, UK-based civilian doctors, locally recruited civilians or locum staff recruited from the UK. SSAFA provides professional and managerial support services for medical centres, as well as care services under contract, including community midwifery, health visitors and social workers. Together, the organisations provide a fully comprehensive primary and community care service to our service personnel based in Germany.

Since 1996, secondary hospital-based care has been delivered by Guy's and St. Thomas' NHS Trust as the prime contractor to British forces Germany health service, via subcontracts let with designated German provider hospitals located in the five garrison areas.

Mr. Swayne

In one of the Minister's written answers to me in July, he said that regular attempts were made to scrutinise the standards in designated provider hospitals. Can he give me, either in correspondence or now, some guidance on what that involves? Can he tell me whether a register of complaints is kept? Can he also shed some light on the arrangements regarding subcontracted hospitals in Cyprus? I have correspondence showing that the obstetrics unit at the hospital that treated my constituent, Mrs. Crowton, has no knowledge of inspection or scrutiny.

Mr. Caplin

The hon. Gentleman has raised an interesting point, to which I will not respond immediately. I will get back to him, specifically on complaints, procedures and inspections, in the time scale I have set out.

In the German hospitals, Guy's and St. Thomas' liaison staff provide on-site support to patients. To overcome the inevitable language and cultural issues that present themselves, Guy's and St. Thomas' has developed a successful system of hospital liaison officers, who are bilingual personnel located in each German provider hospital. They are there to solve any problems and misunderstandings that may arise. That service has greatly assisted the delivery of the best possible care to our servicemen and women and their families. For example, British-style menus are available, as well as English language television and newspapers.

The British forces Germany health service also conducts annual satisfaction surveys, although I accept that that is not the same as inspection. The results consistently show satisfaction rates of above 87 per cent. The aim is to deliver a service that takes advantage of the benefits of the German clinical approach to care while giving our people the enhanced privacy and access to services to which they are often accustomed in the UK.

We also have large entitled populations in Cyprus, as the hon. Gentleman mentioned, and in Gibraltar, the largest of our permanent joint operating bases overseas. There we provide, and will continue to provide for as long as is needed, a comprehensive primary health care service, managed as a joint service activity, that includes community services such as ante and post-natal care and mental health services. Cyprus and Gibraltar have accredited general practitioner training practices.

To ensure NHS-comparable standards of secondary care, we also maintain, and will continue to do so for as long as is needed, military hospitals in Cyprus, namely Princess Mary's hospital at Akrotiri, and in Gibraltar, the Royal Naval hospital. I am sure the hon. Gentleman agrees that, in general, both facilities provide excellent secondary health care, covering core clinical disciplines such as general surgery, paediatrics, obstetrics and gynaecology, as well as medical cover for operational activities.

Cyprus, in its role as a forward military base, has the ability to expand capacity at short notice in the event of operations. Princess Mary's serves some 8,500 entitled personnel, and has about 185 service and civilian staff. The Royal Naval hospital in Gibraltar, which serves about 1,800 entitled personnel, also has the capacity to provide medical cover for our naval base, and has about 90 service and civilian staff.

I visited the Royal Naval hospital in Gibraltar only yesterday, and was at Princess Mary's hospital in Akrotiri in March. At both facilities, I met some of the first-rate staff and was able to see for myself how we are upholding our long tradition of providing first-class health care for our service personnel and their dependants.

The hon. Gentleman mentioned maternity, and asked whether, at Princess Mary's in Akrotiri, we could provide the facilities he mentioned. He may be familiar with the facility. The hospital does not have the specialist baby-care facilities that we recognise in the United Kingdom. There are circumstances in Cyprus and Gibraltar in which we are unable to provide the appropriate treatment in-house, and we have arrangements in place either to bring in specialists from the United Kingdom or to use local civilian hospitals as appropriate. If clinically appropriate, we can also medically evacuate personnel to the UK.

The hon. Gentleman also asked whether there were any payments—compensation was the term he used—in relation to Saif Sareea, the operation in Oman. I do not have an answer, but I will include one in our correspondence.

Mr. Swayne

Am I to presume that the Minister will address the two other questions I asked in correspondence? They were, first, whether he is prepared to meet my constituent, and, secondly, the normative question whether the treatment available to civilians ought to be so much better than what is available to servicemen, in terms of their recourse when things go wrong. What ought to be the case?

Mr. Caplin

On the first question, I would like to examine the case and write to the hon. Gentleman. Perhaps we could then agree a way forward. That is how I have handled the quite considerable casework in my portfolio, and I hope he accepts that, as other Members of the House have. I cannot give him a specific response on the second question. I think it would be far better for me to include all that matter in a proper letter to him detailing the issues. I have given him some indication of the time scale—a couple of weeks—in which I propose to get that response to him.

I would like to take the opportunity to congratulate the RAF on its skill and professionalism in organising medical evacuations from permanent bases and operational theatres. I know hon. Members will agree on that. It is on immediate notice—24 hours a day, 365 days a year—at RAF Lyneham to provide an emergency medical evacuation service for those who need it.

We also have smaller, permanent joint operating bases on the Falkland Islands and Ascension Island, for which we provide our own primary care; a local civilian hospital provides secondary care. If there is a requirement for more specialist services, we have arrangements in place to use facilities in neighbouring countries or to carry out a medical evacuation back to the UK.

Although we do not have a permanent military base in the United States, at any one time we have about 400 service personnel and dependants living and working there. To fulfil our duty of care to them, we have a reciprocal health care agreement with the United States that covers service personnel and their dependants. Under that agreement, health care is provided to our personnel by US medical services or through an insurance-based system. The NHS provides free medical care to US service personnel serving in the UK and their dependants.

Where our personnel are serving on operational deployments in areas of the world where the medical infrastructure is poor, damaged or overstretched, we can deploy a full range of medical support services. In a major operation such as Operation Telic, with which the hon. Gentleman is familiar, those services would include front-line medical assets integral to the units deployed, dressing stations, field hospitals and RFA Argus, our hospital ship, as well as our medical evacuation capabilities.

Notwithstanding the important individual case that the hon. Gentleman raised and the commitments that I have given this morning to get back to him on the issues that he highlighted, I hope he will agree with me: I am indeed satisfied that our servicemen and women are well served by the skills and professionalism of the Defence Medical Services.

11.28 am

Sitting suspended until Two o'clock.