The veteran population
A veteran is someone who has served in the British Armed Forces (Regular or Reserve) for at least one day. Veterans also include any member of the Merchant Marine who has served in a war zone. This includes crew from convoys in World War 2 and more recently in the Falklands conflict and Gulf Wars.
There are around 2.4 million British Armed Forces Veterans in Great Britain, of whom 89% are male and 60% are aged 65 and over. Clinical commissioning groups are responsible for the commissioning of health services for veterans, reservists and service families registered with NHS GPs in their area. However, there is evidence that some GPs are unsure of how many of these individuals are registered with their practice and more guidance is needed on how to meet the health needs of these patient groups.
About 18,000 service people move back into civilian life every year. While most of these individuals have similar levels of health to the general population, around 2,000 leave on medical grounds. The top reasons for medical discharge are for issues relating to back, knees, mental health and hearing.
Our duty to the armed forces community
The NHS has a duty to deliver on a number of health commitments in relation to the Armed Forces community (service personnel (regular and reserves), their families and veterans), which are set out in the Armed Forces Covenant and the NHS Constitution.
The Armed Forces Covenant
- 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 understand the Armed Forces culture.
Visit the Armed Forces Covenant for more information.
This is recognised in 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”.
Dedicated services for veterans
Veterans’ mental health services
Whilst there is often an emphasis on veterans with post-traumatic stress disorder (PTSD), the actual rates are not high (around 6.2%), which is broadly equivalent to the incidence amongst civilians. More common issues include other mental health difficulties, such as anxiety and depression, as well as problems related to alcohol. However, for those veterans who deployed when serving, rates of PTSD are higher at 9% and up to 17% for those who deployed in a front-line, infantry combat role.
There is growing evidence that a range of mental health conditions may appear (or patients may present) some years after individuals have left the armed forces. These conditions may relate to combat, training or other military experiences, transition out of service or indeed pre-service vulnerabilities.
The historical issues of stigma associated with mental health and a traditional culture of reluctance to admitting to a perceived weakness or being in a position of having to ask for help means that a substantial number of unwell veterans are unlikely to access the appropriate support and services. This is further compounded by a lack of awareness amongst veterans of what services are available to them, as well as varying levels of awareness across the NHS on the health needs of this patient group. In addition, the widespread public perception, often fuelled by mainstream media, that all veterans are damaged by their military service and all of them have PTSD is not only wrong but harmful.
Op COURAGE: the Veterans Mental Health and Wellbeing Service
Op COURAGE is the new over-arching name for the three NHS veterans’ mental health services (Veteran’s Mental Health Transition, Intervention and Liaison Service (TILS), Veteran’s Mental Health Complex Treatment Service (CTS) and Veteran’s Mental Health High Intensity Service (HIS). The new name has been developed by veterans and their families and is intended to make the services easier to find and access.
Op RESTORE: the Veterans Physical Health and Wellbeing Service
Op RESTORE is the veterans physical health and wellbeing service for those who have served in the UK Armed Forces and is the new name for the Veterans Trauma Network (VTN). Op RESTORE will continue to accept only GP referrals.Op RESTORE can help you if:
- you have served at least one day in the UK Armed Forces
- you are soon to leave or are in the process of leaving the UK Armed Forces
- you have sustained a physical health injury that was attributable to your time in Service regardless of when that happened
- you have ongoing medical problems related to the physical injury sustained in Service
- we have received a clinical referral from your GP.
GPs can obtain a referral form by emailing imperial.oprestore@nhs.net
Veterans’ Mental Health Transition, Intervention and Liaison Service (TILS)
This is a dedicated out-patient service for serving personnel approaching discharge from the Armed Forces and veterans who are experiencing mental health difficulties. The TILS 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, leaving the armed forces The service works with the Ministry of Defence (MOD) to offer mental health support for Armed Forces personnel approaching discharge.
- 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. Where appropriate, the TILS will aim to see patients two weeks after this. This will be with a clinician who has an expert understanding of Armed Forces life and culture. They may also be supported by a care coordinator who will liaise with other services and organisations to ensure a coordinated approach to their care.
- 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.
If an assessment finds that an individual has significant mental health difficulties that are service related and have not improved with previous treatment, they will be referred to their local CTS.
Veterans’ Mental Health Complex Treatment Service (CTS)
This is an enhanced out patient service for ex-forces who have military related complex mental health difficulties that have not improved with previous treatment. The service provides a range of 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.
The NHS Veterans Mental Health High Intensity Service (HIS) for veterans needing urgent help who are in mental health crisis has been trialled in some regions since October 2020. It is now being rolled out across the country as part of a phased approach. Those needing urgent help will receive a same day referral.
Veterans can self-refer or be referred by their GP, a charity or family or friends to access specialist care through this single route of Op Courage.
For further information on Op Courage, including the contact details for the service in your region, visit www.nhs.uk/opcourage.
See the NHS website as well as this leaflet on veterans’ mental health services.
Prosthetics
A veterans’ prosthetics programme was put into place to implement the key findings of A better deal for military amputees report by Dr Andrew Murrison MP.
Dr Murrison recommended that a small number of NHS disablement centres should provide specialist prosthetic and rehabilitation support to veterans to ensure that they continue to have access to high quality care similar to that which was provided to them whilst they were in the Armed Forces. The following nine Disablement Service Centres (DSCs) were selected to provide this support although veterans are free to attend the NHS DSC of their choice:
- Bristol – Bristol Centre for Enablement, North Bristol NHS Trust
- Leicester – Leicester Specialist Mobility Centre, provided by Blatchford Clinical Services on behalf of clinical commissioning groups (CCGs)
- Sheffield – Mobility and Specialised Rehabilitation Centre, Northern General Hospital
- Carlisle – Disablement Services Centre, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust
- Preston – Specialist Mobility & Rehabilitation Centre, Lancashire Teaching Hospitals NHS Foundation Trust
- Stanmore – Stanmore Prosthetic Rehabilitation Unit, Royal National Orthopaedic Hospital Trust
- Portsmouth – Prosthetic Regional Rehabilitation Department, Portsmouth Hospitals NHS Trust
- Birmingham – West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Trust
- Cambridge – Addenbrooke’s Rehabilitation Clinic, Cambridge University Hospitals NHS Foundation Trust
In addition to providing support to nine DSCs, a Veterans’ Prosthetics Panel (VPP) was established in 2012. The VPP was designed to ensure that veterans could access high-quality prosthetics regardless of which DSC they attend. Applications for funding from the VPP are made by a veteran’s prosthetist.
The National Prosthetics Service (NPS) is Scotland’s centre for designing and fitting prosthetic limbs.
Personalised care for veterans with a long term physical, mental or neurological health condition or disability
NHS England, 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 new 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.
Veterans Covenant Health Alliance
The Veterans Covenant Health Alliance is a network of over 30 acute hospitals that have been accredited as exemplars of the best care for veterans, helping to drive improvements in NHS care for people who serve or have served in the UK armed forces and their families.
The ambition is to have 75 NHS providers accredited by the end of 2019, with plans to expand this important initiative to mental health and ambulance trusts. For more information please email e.nickell@nhs.net or visit the NHS 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 British Legion website.
The Armed Forces Healthcare Navigator Service
The Defence Medical Welfare Service (DMWS) provides emotional and practical support to the Armed Forces community when they are on a health care pathway, receiving treatment in hospital, community based health care, or at home.
Assessing, identifying, and addressing welfare and wellbeing issues that are a barrier to recovery or good health and wellbeing, DMWS work with the individual, their family, carers, and health and social care partners, to find solutions and provide onward supported referrals to other organisations for services beyond the scope of DMWS intervention.
DMWS’ professional and expert medical welfare service evidences reduction in delayed transfers of care, reduction in frequent attendance at A&E, enables independent living, reduces social isolation, improves wellbeing, and provides a coordinated, holistic approach to accessing the right support, in the right place, at the right time
Veterans can be referred to DMWS or can contact DMWS directly. For more information, visit Defence Medical Welfare Service website
More information
Further information on NHS services for veterans can be found on the NHS website
Other services available to veterans
Veterans’ Gateway
Veterans’ Gateway is for any ex-service personnel and their families looking for advice or support, 24 hours a day. It is the first point of contact to a network of military and non-military partner organisations to help veterans and their families find exactly what information, advice and support they need, when they need it – across key areas from physical and mental health to employability, housing, finances, personal relationships and more. For more information, visit the Veterans’ Gateway website or call 0808 802 1212.
Veterans First Point – Scotland
Veterans First Point drop-in services are available across Scotland and were developed by veterans for veterans. This offers a “One Stop Shop” for help and assistance to veterans, and their families, no matter what that need might be, including physical or mental health issues, housing, socialising, education, employment and other issues. For further information visit the Veterans First Point 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, MOD, 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 helps veterans, service personnel and their families live well after service. The charity provides direct, practical support for wounded, injured and sick service personnel, veterans and their loved ones. No matter when or where someone served, the charity offers support with physical and mental health needs, a range of welfare issues and regional and community-based sporting and social activities across the UK and online. Help for Heroes can assist with the provision of financial grants for things such as home adaptations and medical equipment to help people overcome challenges from illness or injury.
The Hidden Wounds Service at Help for Heroes is accredited by the Royal College of Psychiatrists and offers a confidential, evidence-based range of Step 2 and Step 3 psychotherapeutic interventions, tailored to individual needs. Psychotherapeutic interventions are psychological talking therapies to support individuals in addressing and improving their mental health symptoms. Support is delivered remotely via phone or video calls from psychologists, counsellors and low and high intensity cognitive behavioural therapists.
Help for Heroes’ Recovery College offers free online courses and self-help guides designed by veterans and their families on a wide range of topics including pain management and sleep, to help make lasting and positive changes in key areas in their lives.
The Veterans Clinical Liaison (VCL) service focuses on holistic clinical support to improve an individual’s quality of life and is a point of contact for those with serious complex injuries and long-term health issues. The VCL nurses can contact GPs, attend appointments with veterans, signpost and are aware of the veteran-specific provision within the NHS.
Occupational Therapists within the team provide functional assessment and intervention for the veterans as well as home visits, and liaison with statutory and other services. Common needs are fatigue management, pain management, sensory interventions and sleep support. OT’s can assist with the provision of equipment such as profiling beds, wheelchairs and small aids.
Combat Stress
Combat Stress is the UK’s leading mental health charity for veterans. They provide 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 them to work directly 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.
Supporting Wounded Veterans
Supporting Wounded Veterans (SWV) understands the impact pain can have on a veteran and their family. They offer an online “review” with a Consultant in Pain Medicine who is also a veteran. This discussion considers the options that may be available for the management of pain. Following their discussion, they are sent a letter which, with their permission, will be copied to their family doctor; at no point do they become SWV “patient”.
One option available is attending the SWV online Veterans’ Pain Resilience Programme; designed by veterans, for veterans. They also have links to a NHS Veterans’ Opioid Weaning Service.
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 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. For further information, visit the Blesma website.
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’ Medical Funds webpage.
ATS & WRAC Association Benevolent Fund
The ATS & WRAC Association Benevolent Fund awards one-off and recurring financial grants to purchase specific goods, services or facilities for eligible former servicewomen, or their dependents, in need. The charity also provides annual maintenance grants to former servicewomen who are either elderly, alone, living on low incomes or in ill health, and makes contributions to top-up care-home fees. Any former ATS or WRAC servicewoman, including TA, with one day’s paid service or more prior to 1992, is eligible for assistance. All cases must be referred through the local branch of SSAFA or regional Royal British Legion (RBL) office. SSAFA or the RBL who will arrange for a trained caseworker to interview the applicant in their home to establish the full range of assistance needed. Please see ATS & WRAC Association Benevolent Fund website or contact 0300 400 1992 for more information.
The Poppy Factory’s employment service
The Poppy Factory provides a dedicated employment service for ex-Forces patients across England and Wales, to which GPs and other health professionals can refer directly using a simple web-based form. The role of meaningful employment or training in a patient’s recovery can be significant and in 2021-22, nearly 200 ex-Forces patients were referred through the NHS, representing 35% of all referrals. Regular assessments showed that 64% reported increased health and wellbeing. The Poppy Factory’s consultants have expertise working with ex-Forces personnel with mild, moderate and complex mental and physical health conditions and will support veterans with challenges relating to mental or physical health and stability issues such as housing, finances or relationships. They can connect patients to other specialist services and work at whatever pace is right for the individual.
The Poppy Factory welcomes referrals from GPs and other health professionals. A simple referral form can be found online at The Poppy Factory Referral Registration.