Specialist Rehabilitation Service Needs of Veterans in Wales

1. Specialist Rehabilitation Service Needs of Veterans in Wales 6th October 2010 Dr Rhianwen Stiff

2. Overview • The Task • Background • Methods • Results • Discussion Points • Recommendations Dr Rhianwen Stiff

3. The Task To undertake a brief needs assessment to support the planning of specialist services for veterans over the next five years Dr Rhianwen Stiff

4. Background The Command Paper (2008) “… to remove the disadvantage imposed by Service life on our personnel, their families and veterans.” Dr Rhianwen Stiff

5. Command Paper Commitments • Develop additional acute care capacity • Service personnel undergoing IVF will not be moved mid treatment cycle • Ensure access to NHS dentists • Improve information on veterans’ health needs Dr Rhianwen Stiff

6. Command Paper Commitments • Prior waiting times will be taken into account when Service personnel, veterans and families re-locate • The standard of prosthetic limb provision by Defence Medical Services (DMS) will as a minimum be matched post-service by the NHS • Develop Community Mental Health services for veterans Dr Rhianwen Stiff

7. Scope Veterans’ needs broadly similar to general population At primary care level - no significant unmet need around physical health • Included • Artificial limb and appliance services • Neuro- and spinal- rehabilitation services • Traumatic brain injury services • Excluded • Mental health and psychiatric services Dr Rhianwen Stiff

8. Aims • Estimate current and future size of the veteran population resident in Wales • Estimate specialist rehabilitation health needs of the veteran population • Estimate future financial requirements necessary to meet specialist rehabilitation needs • Explore views of veterans surrounding their experience of specialist rehabilitation services Dr Rhianwen Stiff

9. Methods Epidemiological Need • Routine data sources • Publically available briefings and research • Expert opinion • Direct information requests Dr Rhianwen Stiff

10. Methods Corporate Need • Stakeholders • Outline current services • WAG workshop and briefings • Project advisory group • Focus group Dr Rhianwen Stiff

11. Methods Comparative Need • Health needs of veterans vs. general population • Care provided to serving personnel by DMS vs. care of veterans within NHS • Examples of good practice from elsewhere Dr Rhianwen Stiff

12. Results: Definitions Veteran Need Health Essential posture and mobility need Dr Rhianwen Stiff

13. Results: Epidemiological Need • 195,718 in UK Armed Forces (2010) • 10% estimated to be from Wales • 2,200 Welsh residents leave the Forces each year • 240,050 Veterans resident in Wales (2005) • 2,000 Reservists resident in Wales Dr Rhianwen Stiff

14. Dr Rhianwen Stiff

15. Results: Epidemiological Need • 2 schemes aid Veterans • War Pension Scheme • Injury/illness acquired pre 2005 • 8,565 recipients resident in Wales • Armed Forces and Reservist Forces Compensation Scheme • Injury/illness acquired post 2005 • 155 recipients resident in Wales Dr Rhianwen Stiff

16. Dr Rhianwen Stiff

17. Limb Amputation in the NHS • 3,570 adult Welsh residents known to ALAC services • Number of veterans is unknown • Cardiff ALAC received 150-180 new referrals each year over past 4 years Dr Rhianwen Stiff

18. Limb Amputations in Service Dr Rhianwen Stiff

19. Results: Corporate Need • ALAS – Artificial Limb and Appliance Service • 3 Artificial Limb and Appliance Centres (ALAC) • Resourced to meet essential posture and mobility needs Dr Rhianwen Stiff

20. Results: Corporate Need Dr Rhianwen Stiff

21. Results: Focus Group • Availability of advice and support at time of injury • Period of transition from Service to Civilian life, and the availability of assistance at this time and beyond • Impact of injury on the individual, spouse, family and wider population • Views on Command Paper commitments • Ideas for improvement Dr Rhianwen Stiff

22. Results: Comparative Need • In-hospital stays • No field to record Veteran status on PEDW • GP treatment • Reed Codes for Veterans do exist • Rarely used • Patients don’t disclose veteran status • GPs don’t record veteran status • Lack of knowledge of impact of disclosing / recording • ALAS centres • Veteran status not routinely requested / recorded Dr Rhianwen Stiff

23. Others’ Good Practice • Veterans’ Community Mental Health Scheme • Royal British Legion – needs assessment conducted 2005 • South-West England Regional Forum • Military Personnel section within some English PCTs’ Joint Strategic Needs Assessments • US Department of Veterans’ Affairs Dr Rhianwen Stiff

24. Results: Comparative Need • NHS Prosthetic Leg • Usual number of limbs issued = 1 • Replaced every  5 years • Average cost for low activity limb component • £500 (below knee) • £800 (above knee) Dr Rhianwen Stiff

25. Results: Comparative Need • DMS Prosthetic Leg • Usual number of limbs issued = 4 or 5 • Warrantee 36 months • Estimated cost for high activity limb (myo-electric) • £8-10,000 Dr Rhianwen Stiff

26. Current Uncertainties • Expectations and interpretations of different stakeholders vary considerably • Estimates derived from imperfect and incomplete data • Unpredictable length of time between injury and discharge from Forces Dr Rhianwen Stiff

27. Future Uncertainties • Strategic Defence and Security Review • Future Armed Forces deployments? • Where? When? Duration? Duties? • Which regiments / units? • Welsh component? • Future warfare strategies? • Likely nature of injuries / injury rates? Dr Rhianwen Stiff

28. Future Uncertainties • WAG Wheelchair Service review in progress • ALAS contracts review in progress • Financial constraints • Demand from and needs of the civilian amputee population in Wales Dr Rhianwen Stiff

29. Recommendations • It is essential to maintain clarity and consistency of terminology and definitions used by all stakeholders • Data capture and information sharing must be improved without infringing patient confidentiality Dr Rhianwen Stiff

30. Recommendations • In aiming “… to remove the disadvantage imposed by Service life on our personnel, their families and veterans”,we must ensure we do not establish inequity within our Specialist Rehabilitation Services disadvantaging the civilian population Dr Rhianwen Stiff

31. Acknowledgements • Dr Hugo van Woerden, Public Health Wales • Advisory Group Members • Cardiff, Wrexham and Swansea ALAS • WHSSC • BLESMA • Cardiff ALAS Data Analysis Team • Veterans’ Community Mental Health Team • WAG • MoD • Headway Dr Rhianwen Stiff

32. ? Any Questions Dr Rhianwen Stiff