Defence Medical Services Organisation (Hansard, 26 February 1997)

Earl Howe

The Defence Medical Services Organisation (DMSO) is established primarily to provide medical care for service personnel deployed on operations. This is a vital task. To provide this capability, the DMSO must comprise peacetime structures and a recognised training base which can produce uniformed medical personnel with the right skills and in sufficient numbers to meet forecast operational demands. That peacetime structure can also 97WA make a significant contribution to the provision of secondary medical care for all service personnel and, in certain circumstances, for their dependants. To facilitate effective training, it works closely with the NHS.

Since 1984 there has been a series of separate studies into the Defence Medical Services, aimed at rationalising an area which was consuming over 2 per cent. of the defence budget and adapting them to the changing strategic environment. This work culminated in the Defence Costs Study in 1994, which recommended major restructuring of the DMSO to enable it to provide sufficient rapidly deployable units, primarily manned by regular personnel, to support forces deployed on operations, and a more efficient and cost-effective support structure, including establishing a number of Agencies to provide secondary medical care and recognised training for medical personnel.

These necessary changes have meant major upheavals for the Defence Medical Services which, naturally, not all those involved have welcomed. The DMSO was suffering from some shortages of personnel (particularly anaesthetists, orthopaedic surgeons and intensive care nurses—mirroring shortages in the NHS) and we are striving to improve this situation. We have established all of the key elements of the new organisations and we are now focusing on achieving the right balance in their relationships with the NHS and their function as military units in the light of experience with the operation of the new structure.

Three regular field hospitals of 200 beds have now been established with permanent command and administrative staff. The clinical staff to support the field hospitals will be drawn from the Defence Secondary Care Agency (DSCA). There are currently gaps in some specialties which we look to fill, as we did in the Gulf and in Bosnia in other specialisations, by volunteer reservists under the provisions of the Reserve Forces Act 1996. We have provided the proper level of medical support to British troops on operational deployment in the Gulf, Bosnia and elsewhere.

Defence planning to reflect the changing strategic circumstances has already evolved further since 1994. 98WA We have therefore set up a study team to examine whether these new circumstances, together with recent changes in medical practice, require further changes to our detailed assumptions for the provision of medical support to the front line. This should report by the middle of the year.

We continue to improve our holdings of medical equipment and supplies. Two sets of containerised modular operating theatres are now in use in Bosnia. We intend to purchase more of those in the future; the next will be delivered later this year. We also plan to improve medical facilities in RFA Argus for its role as a hospital ship.

At the time of the restructuring of the DMSO—which involved the closure of three service hospitals and the concentration of medical facilities at the Royal Hospital Haslar and in three MDHUs (Ministry of Defence Hospital Units) at Derriford, Frimley Park and Peterborough—waiting lists increased. They have now been substantially reduced through robust management action by the new Defence Secondary Care Agency. There is also a programme of improvements at the Royal Hospital Haslar. Most of the enhancements to the clinical facilities should be complete by June 1997, with the remaining programme of capital works (for health and safety) completed over the next two years.

Work to align terms of service for medical personnel in each of the three Services and so produce a more cohesive DMSO is well in hand. The first measures will be implemented in April. Naval and army medical and dental officers will be allowed to extend their short service commissions in line with current RAF policy to enable them to complete their clinical training in uniform, and there will be a common return of service for that training.

Young officers are being attracted into the Defence Medical Services, on cadet schemes, and there are early and encouraging signs that an increasing number of them are prolonging their service to take advantage of the improved facilities and opportunities offered by the new structure. We are determined to build on this, and to provide the Armed Forces with the medical support appropriate to their needs.